scholarly journals Disparity in Access to Care Impacts Liver Transplant Mortality

2021 ◽  
Author(s):  
Danielle Lentobarros ◽  
Sarah Karp ◽  
Gyorgy J Simon ◽  
Timothy Pruett ◽  
Jesse Schold ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Access To Care ◽  
Insurance Coverage ◽  
Geographical Location ◽  
Geographic Location ◽  
The United States ◽  
Mortality Rates ◽  
Income Level ◽  
Liver Transplants ◽  
Post Transplantation

This study aims to analyze how access to care influences patient mortality rates after liver transplants in adults by analyzing the relationships between insurance coverage, income, geographic location, and mortality rates post-transplantation. It was hypothesized that a sociodemographic variable, such as insurance type, geographical location, and income level would impact mortality rates post-liver transplant. Results showed that unknown insurance coverage increased the likelihood of mortality post-transplant, income level was not found to be a significant indicator, and patients living in the Northeast region of the United States were more likely to die post-liver transplant.

Impact of the affordable care act and early Medicaid expansion on head and neck cancer mortality in the United States.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7035-7035
Author(s):  
Nosayaba Osazuwa-Peters ◽  
Justin M Barnes ◽  
Jaibir S Pannu ◽  
Matthew C Simpson ◽  
Sai D Challapalli ◽  
...  
Keyword(s):  
United States ◽  
Head And Neck Cancer ◽  
Access To Care ◽  
Head And Neck ◽  
Neck Cancer ◽  
The United States ◽  
Mortality Rates ◽  
Medicaid Expansion ◽  
Quasi Experimental

7035 Background: Medicaid expansion has been associated with increased access to care and earlier stage at diagnosis among patients with head and neck cancer (HNC). However, it is unclear whether Medicaid expansion has impacted HNC mortality rates. We examined the associations between early Medicaid expansions (2010-2011) with mortality rates for HNC in the United States. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program. SEER*Stat was utilized to obtain mortality rates for early expansion (CA, CT, DC, MN, NJ, and WA) and non-early expansion states (all others) in the year ranges as available in SEER: 2005-2007 (pre-expansion) and 2012-2016 (post-expansion). Deaths in 2008-2011 were excluded as a phase-in/washout period. Difference-in-differences analyses were utilized to compare mortality rates pre- and post-early expansion in early expansion vs. non-early expansion states. The parallel trends assumption was tested comparing changes in HNC mortality rates between early expansion and non-early expansion states from 2002-2004 to 2005-2007 and from 2005-2007 to 2008-2011. Results: There were 6882 and 35459 deaths due to HNC in early expansion and non-early expansion states, respectively. HNC mortality rates (deaths per 100,000) decreased from 2005-2007 to 2012-2016 in both early expansion (2.17 to 1.85, difference = -0.32, 95% CI = -0.42 to -0.22) and non-expansion states (2.59 to 2.43, difference = -0.16, 95% CI = -0.22 to -0.11). Relative to non-expansion states, there was a reduction of 0.16 deaths per 100,000 (95% CI = 0.05 to 0.27, p = 0.007) after early Medicaid expansion in expansion states. However, in parallel trends testing, there was no difference in the change in mortality rates between early expansion and non-expansion states from 2002-2011 (p > 0.37). Conclusions: In this quasi-experimental analysis, there was an association between early Medicaid expansion with decreased HNC mortality. Thus, Medicaid expansion might help decrease disparities associated with access to care among HNC survivors. As longer-term data emerges, additional follow-up will be necessary to understand the mechanisms that underlie the HNC mortality benefits seen in early Medicaid expansion.

Health Insurance Coverage Disruptions and Access to Care and Affordability among Cancer Survivors in the United States

2020 ◽  
Vol 29 (11) ◽  
pp. 2134-2140
Author(s):  
Jingxuan Zhao ◽  
Xuesong Han ◽  
Leticia Nogueira ◽  
Zhiyuan Zheng ◽  
Ahmedin Jemal ◽  
...  
Keyword(s):  
United States ◽  
Health Insurance ◽  
Cancer Survivors ◽  
Access To Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States

The association between health insurance coverage disruptions and access to care and affordability among cancer survivors in the United States.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 121-121
Author(s):  
Jingxuan Zhao ◽  
Xuesong Han ◽  
Leticia Maciel Nogueira ◽  
Ahmedin Jemal ◽  
K Robin Yabroff
Keyword(s):  
Health Insurance ◽  
Cancer Survivors ◽  
Access To Care ◽  
Insurance Coverage ◽  
Preventive Services ◽  
Health Insurance Coverage ◽  
The United States ◽  
Current Health ◽  
The Past ◽  
Services Use

121 Background: Having health insurance is a strong predictor of access to care and affordability. To date, most studies evaluating the effects of insurance coverage measured it only at a single time point. Little is known about the effects of coverage disruptions. This study aims to assess associations of a health insurance coverage disruption with access and affordability among cancer survivors in the United States. Methods: We identified 6476 cancer survivors aged 18-64 years with current health insurance coverage from the 2011-2017 National Health Interview Survey. Coverage disruption was measured by the question “In the past 12 months, was there any time when you did not have any health insurance or coverage?”. Access to care and affordability was measured by: 1) preventive services use (e.g. blood pressure check); and 2) forgoing care because of cost, respectively, in the past 12 months. We used separate multivariable logistic models to evaluate the associations between a coverage disruption and healthcare access and affordability, by current health insurance coverage. Results: Among survivors with current health insurance coverage, 3.7% of those with private and 8.1% with public insurance reported a coverage disruption in the past 12 months. Among survivors with current private coverage, those with a recent coverage disruption reported lower likelihood of any preventive services use (OR = 0.1, 95% CI: 0.1-0.3) and higher likelihood of forgoing any care because of cost (OR = 6.0, 95% CI: 3.9-9.5) compared to those with continuous private coverage. Among survivors with current public coverage, those with a recent coverage disruption reported lower likelihood of any preventive services use (OR = 0.4, 95% CI: 0.2-0.9) and higher likelihood of forgoing any care because of cost (OR = 4.3, 95% CI: 2.5-7.3) compared to those with continuous public coverage. Conclusions: Currently insured cancer survivors with a recent health insurance coverage disruption were more likely to report problems in access to care and affordability compared to the continuously insured. Improving private and public insurance coverage continuity may be effective in addressing these problems.

scholarly journals Recurrent Hepatitis C Post-Transplantation: Where Are We Now and Where Do We Go From Here? A Report from the Canadian Transplant Hepatology Workshop

2006 ◽  
Vol 20 (11) ◽  
pp. 725-734 ◽  
Author(s):  
Kymberly DS Watt ◽  
Kelly Burak ◽  
Marc Deschênes ◽  
Les Lilly ◽  
Denis Marleau ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Hepatitis C ◽  
Natural History ◽  
Present Report ◽  
The United States ◽  
Liver Transplants ◽  
Post Transplantation ◽  
Ongoing Research ◽  
Recurrent Hepatitis

Approximately 400 liver transplants are performed in Canada every year and close to 6000 per year in the United States. Forty per cent to 45% of all liver transplants are performed for patients with underlying hepatitis C virus (HCV)-related liver disease. These patients have a different natural history, new complication risks and different treatment efficacy than nontransplant HCV patients. Every effort must be made to identify those patients at highest risk for progressive liver disease post-transplant. Recurrent HCV is an Achilles’ heel to transplant hepatology. The true natural history of this disease is only starting to unravel and many questions remain unanswered on the optimal management of these patients after liver transplantation. The present report summarizes the literature and ongoing research needs that are specific to HCV-related liver transplantation.

scholarly journals Geographical Location Determines the Population Structure in Phyllosphere Microbial Communities of a Salt-Excreting Desert Tree

2011 ◽  
Vol 77 (21) ◽  
pp. 7647-7655 ◽  
Author(s):  
Omri M. Finkel ◽  
Adrien Y. Burch ◽  
Steven E. Lindow ◽  
Anton F. Post ◽  
Shimshon Belkin
Keyword(s):  
Microbial Community ◽  
Microbial Communities ◽  
Geographical Location ◽  
Geographic Location ◽  
The United States ◽  
Dead Sea ◽  
Content Type ◽  
Extreme Stress ◽  
Diverse Community ◽  
The Mediterranean

ABSTRACTThe leaf surfaces ofTamarix, a salt-secreting desert tree, harbor a diverse community of microbial epiphytes. This ecosystem presents a unique combination of ecological characteristics and imposes a set of extreme stress conditions. The composition of the microbial community along ecological gradients was studied from analyses of microbial richness and diversity in the phyllosphere of threeTamarixspecies in the Mediterranean and Dead Sea regions in Israel and in two locations in the United States. Over 200,000 sequences of the 16S V6 and 18S V9 hypervariable regions revealed a diverse community, with 788 bacterial and 64 eukaryotic genera but only one archaeal genus. Both geographic location and tree species were determinants of microbial community structures, with the former being more dominant. Tree leaves of all three species in the Mediterranean region were dominated byHalomonasandHalobacteria, whereas trees from the Dead Sea area were dominated byActinomycetalesandBacillales. Our findings demonstrate that microbial phyllosphere communities on differentTamarixspecies are highly similar in the same locale, whereas trees of the same species that grow in different climatic regions host distinct microbial communities.

Inequalities and Deteriorations in Cardiovascular Health in Premenopausal US Women, 1990–2016

2020 ◽  
Vol 110 (8) ◽  
pp. 1175-1181
Author(s):  
Adrienne O’Neil ◽  
Kelly Thompson ◽  
Josephine D. Russell ◽  
Robyn Norton
Keyword(s):  
United States ◽  
Coronary Heart Disease ◽  
Cardiovascular Health ◽  
Geographical Location ◽  
Premenopausal Women ◽  
The United States ◽  
Mortality Rates ◽  
Mortality And Morbidity ◽  
The Social ◽  
Shed Light

Coronary heart disease (CHD) mortality rates in the United States have declined by up to two thirds in recent decades. Closer examination of these trends reveals substantial inequities in the distribution of mortality benefits. It is worrying that the uneven distribution of CHD that exists from lowest to highest social class—the social gradient—has become more pronounced in the United States since 1990 and is most pronounced for women. Here we consider ways in which this trend disproportionately affects premenopausal women aged 35 to 54 years. We apply a social determinants of health framework focusing on intersecting axes of inequalities—notably gender, class, ethnicity, geographical location, access to wealth, and class—among other power relations to which young and middle-aged women are especially vulnerable, and we argue that increasing inequalities may be driving these unprecedented deteriorations. We conclude by discussing interventions and policies to target and alleviate inequality axes that have potential to promote greater equity in the distribution of CHD mortality and morbidity gains. The application of this framework in the context of women’s cardiovascular health can help shed light regarding why we are seeing persistently poorer outcomes for premenopausal US women.

scholarly journals An Overview of Paediatric Liver Transplant in Hospital Selayang: 2002 to 2015

2021 ◽  
Vol 27 (2) ◽  
pp. 28-34
Author(s):  
Choy-Chen Kam ◽  
Chooi-Bee Lim
Keyword(s):  
Liver Transplant ◽  
Vascular Complications ◽  
Good Survival ◽  
Liver Transplants ◽  
Post Transplantation ◽  
Transplant Program ◽  
Common Causes ◽  
Liver Transplantations ◽  
Causes Of Mortality ◽  
Living Related

Introduction: Hospital Selayang started the liver transplant program in 2002. We report a total of 81 liver transplant cases until year 2015. Among these, paediatric cases constitute almost half. This report aims to review the demography and outcome of paediatric liver transplant cases. Methodology: Case notes of all paediatric patients underwent liver transplant from year 2002 to 2015 were retrospectively reviewed. Results: A total of 38 paediatric cases received liver transplantations from year 2002 to 2015. Age at transplantation ranged from 11 months to 16 years old (mean age 6 years) and weight ranged from 6.47 to 63 kilogram (mean 18kg). There were 20 males and 18 females, 20 of them were Malay, whereas Chinese and Indian were 13 and 4 respectively. Eighteen cases were living-related and 20 cases were cadaveric liver transplants. For recipient blood group, O+ is the commonest. Biliary atresia was the most common indication for liver transplant (22 cases; 58%), followed by intrahepatic cholestasis disorders (5 cases; 13%) and metabolic disease (4 cases; 10%).  Post transplantation, there were 6 (16%) biliary complications, 12 (32%) vascular complications, 26 (68%) developed early onset infection, 13% had acute rejection and 2 graft failure. Out of the 38 transplants, 79% of them survive after 1 year, and 69.7% survive after 5 years. The common causes of mortality were sepsis and vascular complications. Conclusion: Despite limited resources, a successful paediatric liver transplant programme has been established in Hospital Selayang with good survival rate.

Aiming High for the U.S. Health System: A Context for Health Reform

2008 ◽  
Vol 36 (4) ◽  
pp. 629-643
Author(s):  
Karen Davis ◽  
Cathy Schoen ◽  
Katherine Shea ◽  
Christine Haran
Keyword(s):  
United States ◽  
Health Care ◽  
Health System ◽  
High Performance ◽  
Insurance Coverage ◽  
Geographic Location ◽  
The United States ◽  
High Performing ◽  
Equity And Efficiency ◽  
The U.S

On the eve of the presidential inauguration, the U.S. health system faces rising costs of care, growing numbers of uninsured, wide variations in quality of care, and mounting public dissatisfaction. Despite spending more on health care than any other country, a recent Commonwealth Fund Commission on a High Performance Health Care System National Scorecard reports that the United States is lagging far behind other major industrialized countries — all of which provide universal health insurance — in five key domains: healthy lives, access, quality, equity, and efficiency. U.S. national performance is well below benchmarks of top performance set by other countries or high performing states, hospitals, or health plans within the United States, with broad disparities in experience depending on geographic location, income, race/ethnicity, and insurance coverage. National leadership is required to manage the growing health care crisis in the United States and improve care for all Americans.

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