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2022 ◽  
Vol 29 (1) ◽  
pp. 383-391
Author(s):  
Marie-France Savard ◽  
Elizabeth N. Kornaga ◽  
Adriana Matutino Kahn ◽  
Sasha Lupichuk

Metastatic breast cancer (MBC) patient outcomes may vary according to distinct health care payers and different countries. We compared 291 Alberta (AB), Canada and 9429 US patients < 65 with de novo MBC diagnosed from 2010 through 2014. Data were extracted from the provincial Breast Data Mart and from the National Cancer Institute’s SEER program. US patients were divided by insurance status (US privately insured, US Medicaid or US uninsured). Kaplan-Meier and log-rank analyses were used to assess differences in OS and hazard ratios (HR) were estimated using Cox models. Multivariate models were adjusted for age, surgical status, and biomarker profile. No difference in OS was noted between AB and US patients (HR = 0.92 (0.77–1.10), p = 0.365). Median OS was not reached for the US privately insured and AB groups, and was 11 months and 8 months for the US Medicaid and US uninsured groups, respectively. The 3-year OS rates were comparable between US privately insured and AB groups (53.28% (51.95–54.59) and 55.54% (49.49–61.16), respectively). Both groups had improved survival (p < 0.001) relative to the US Medicaid and US uninsured groups [39.32% (37.25–41.37) and 40.53% (36.20–44.81)]. Our study suggests that a universal health care system is not inferior to a private insurance-based model for de novo MBC.


Author(s):  
Loreen Straub ◽  
Brian T. Bateman ◽  
Sonia Hernandez-Diaz ◽  
Cassandra York ◽  
Barry Lester ◽  
...  

2022 ◽  
Vol 77 (1) ◽  
pp. 11-13
Author(s):  
Kao-Ping Chua ◽  
A. Mark Fendrick ◽  
Rena M. Conti ◽  
Michelle H. Moniz
Keyword(s):  

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 548-548
Author(s):  
Elham Mahmoudi ◽  
Lauren Groskaufmanis ◽  
Neil Kamdar ◽  
Anam Khan ◽  
Mark Peterson

Abstract Introduction Cerebral palsy (CP) and spina bifida (SB) are congenital disabilities. Due to life-long disability, adults with CP/SB are with greater needs for preventative care. Little is known about racial/ethnic disparities in use of preventative services in this population. Our objective was to examine racial/ethnic disparities in use of preventative care. Methods Using 2007-2017 private claims data, we identified White, Black, and Hispanic adults (18+) with CP/SB [n=11,635; White=8,935; Black=1,457; Hispanic=1,243)]. We quantified the National Institute of Medicine (NAM) definition of disparity by matching health related variables (age, sex, comorbid conditions, and Elixhauser index) between Whites and each minority subpopulation. Generalized estimating equations were used and all models were adjusted for age, sex, comorbidities, income, education, and U.S. Census divisions. Outcomes of interest were: (1) any office visit; (2) any physical therapy/ occupational therapy (PT/OT); (3) annual wellness visit; (4) bone density screening; (5) cholesterol screening; (6) diabetes screening. Results Rate of recommended services for all adults with CP/SB were low and no significant results were found for most preventative services across race/ethnicity. Compared with Whites, Hispanics had lower odds of annual wellness visit (OR: 0.71; 95% CI: 0.53, 0.96) but higher odds of diabetes screening (OR: 1.48; 95% CI: 1.13, 1.93). Blacks had lower odds of bone density screening (OR: 0.54; 95% CI: 0.31-0.95), and annual wellness visit (OR: 0.50; 95% CI: 0.24-1.00). Conclusions There were no substantial racial/ethnic disparities in use of preventive services among privately insured adults with CP/SB who had a higher-than-average income and education level.


2021 ◽  
Vol 5 (1) ◽  
pp. e001321
Author(s):  
Lucas Oliveira J e Silva ◽  
Jana L Anderson ◽  
Fernanda Bellolio ◽  
Ronna L Campbell ◽  
Molly M Jeffery

In this retrospective study using claims data from the OptumLabs Data Warehouse including 24 658 769 eligible person-years of coverage in the USA, there was substantial decline in codeine dispensing between 2010 and 2019. However, we also observed a persistence of codeine prescribing despite the FDA contraindication in 2018. In 2019, codeine was still being prescribed to children aged 12–17 years at 934 prescriptions per 100 000 person-years of coverage and 106 per 100 000 person-years of coverage in children aged<12 years.


Author(s):  
Rajesh Reddy ◽  
Kaitlyn E. James ◽  
Logan C. Mauney ◽  
Anjali J. Kaimal ◽  
Jamie R. Daw ◽  
...  
Keyword(s):  

Author(s):  
Kathy C. Matthews ◽  
Andrew S. Quinn ◽  
Stephen T. Chasen

Background Prior cesarean delivery is a well-known risk factor for placenta accreta spectrum disorders. While primary cesarean section is unavoidable in some patients, in others it may not be clearly indicated. Objective The aim of the study is to determine the proportion of patients with placenta accreta spectrum who had a potentially preventable primary cesarean section and to identify factors associated with preventable placenta accreta spectrum. Study Design This was a single-center retrospective cohort study of women with pathology-confirmed placenta accreta spectrum from 2007 to 2019. Primary cesarean sections were categorized as potentially preventable or unpreventable based on practice consistent with the American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine “Safe Prevention of the Primary Cesarean Delivery” recommendations. Fisher's exact test and Mann-Whitney U-test were used for comparison with p <0.05 considered statistically significant. Results Seventy-two patients had pathology-confirmed placenta accreta spectrum over the course of the study period, 15 (20.8%) of whom required a cesarean hysterectomy at the time of primary cesarean section. Fifty-seven patients had placenta accreta spectrum in a pregnancy following their primary cesarean section. Of these, 29 (50.9%) were considered potentially preventable. Most were performed without clear medical indication (37.9%) or for fetal malpresentation without attempted external cephalic version (37.9%). The remainder were due to arrest of labor not meeting criteria (17.2%) and abnormal or indeterminate fetal heart patterns with documented recovery (6.9%). Of the 11 patients without clear medical indication for primary cesarean section, eight (72.7%) were patient-choice cesarean sections and three (27.3%) were for suspected fetal macrosomia with estimated fetal weights not meeting criteria for cesarean delivery. There was no difference in the incidence of potentially preventable primary cesarean sections before and after the ACOG-SMFM “Safe Prevention of the Primary Cesarean Delivery” publication (48.8 vs. 57.1%, p = 0.59). Privately insured patients were more likely to have a potentially preventable primary cesarean section than those with Medicaid (62.5 vs. 23.5%, p = 0.008) and were more likely to have a primary cesarean section without clear medical indication (81.8 vs. 18.2%, p = 0.004). Conclusion Many patients with placenta accreta spectrum had a potentially preventable primary cesarean section. Most were performed without clear medical indication or for malpresentation without attempted external cephalic version, suggesting that at least a subset of placenta accreta spectrum cases may be preventable. This was particularly true for privately insured patients. These findings call for continued investigation of potentially preventable primary cesarean sections with initiatives to address concerns at the patient, provider, and hospital level. Key Points


Author(s):  
Benjamin B. Albright ◽  
Ling Chen ◽  
Laura J. Havrilesky ◽  
Haley A. Moss ◽  
Jason D. Wright

Medicine ◽  
2021 ◽  
Vol 100 (41) ◽  
pp. e27457
Author(s):  
Djibril M. Ba ◽  
Jennifer S. McCall-Hosenfeld ◽  
Paddy Ssentongo ◽  
Vernon M. Chinchilli ◽  
Edeanya Agbese ◽  
...  

2021 ◽  
Vol 4 (10) ◽  
pp. e2127784
Author(s):  
Nicholas G. Zaorsky ◽  
Chachrit Khunsriraksakul ◽  
Samantha L. Acri ◽  
Dajiang J. Liu ◽  
Djibril M. Ba ◽  
...  

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