Secular trends in cryoglobulinemia mortality in the United States in the era of direct-acting antivirals

Background Hepatitis C virus (HCV) is the main etiology of cryoglobulinemia with mortality around 25%. Little is known on the changes in cryoglobulinemia mortality after the introduction of direct-acting antivirals (DAA) for treatment of HCV in 2014 in the US. Methods We calculated cryoglobulinemia mortality from 1999 to 2018. The proportionate mortality ratio (PMR) of cryoglobulinemia cases with HCV and those with autoimmune diseases were computed to assess the impact of introduction of DAA. Results We identified 1299 people aged ≥ 20 years who died with cryoglobulinemia between 1999 and 2018. The cryoglobulinemia mortality (deaths per million) declined from 1999 (0.4) to 2010 (0.22) and mildly increased from 2010 to 2014 (0.26), and then decreased abruptly from 2014 to 2018 (0.19). The proportion of cryoglobulinemia patients with HCV was 39% (118/302) in 2009–2013 and 26% (81/310) in 2014–2018, with a PMR of 0.67 (95% CI 0.50–0.89). By contrast, the proportion of cryoglobulinemia patients with systemic autoimmune diseases was 2.6% (8/302) in 2009–2013 and 4.2% (13/310) in 2014–2018, with a PMR of 1.58 (95% CI 0.66–3.82). Conclusion The changes in cryoglobulinemia mortality during the past two decades are mainly related to the aging and dying of the “baby boomer” cohort who had a high HCV prevalence and to the introduction of a DAA in 2014.

“The Good, The Bad, and the Minimum Tolerable”: Exploring Expectations of Institutional Food

There is a tendency towards greater expectations of consumer goods and services in society—what was once judged as ideal may now be a bare minimum. This presents a challenge for food providers in the upcoming decades. As the more demanding baby boomer cohort ages, health institutions of the future will face challenges meeting their food expectations. The purpose of this study was to explore expectation type dynamics and function with updated empirical material on aging consumers expectations of institutional food and advance our current understanding of how consumers evaluate their expectations. This qualitative study employed in-depth semi structured interviews with 14 informants between the age of 58–79. Content analysis was performed to capture the informants’ food expectations based on the expectation hierarchy proposed by Santos and Boote. Analyzing the content and relationship between different expectation types led to three main findings: expectation functions and content, interconnectedness, and the role of affect. Based on the findings, this study contributes by making several propositions for future research and proposes an updated expectancy–disconfirmation model. Importantly, this study provides novel knowledge that can help health institutions understand and meet aging consumers expectations of institutional food.

Prevalence of Hepatitis C Testing Among Non-Institutionalized Individuals in the US, NHIS 2013-2017

ObjectiveUsing a large nationally representative dataset, we estimated the prevalence of self-reported hepatitis C testing among individuals who were recommended to be tested (i.e., baby boomer cohort born between 1945 and 1965) by the CDC and United States Preventive Services Task Force.IntroductionHepatitis C virus (HCV) infection is the most common blood-borne disease in the US and the leading cause of liver-related morbidity and mortality. Approximately 3.5 million individuals in the US were estimated to have been living with hepatitis C in 2010 and approximately half of them were unaware that they were infected. Among HCV infected individuals, those born between 1945 and 1965 (usually referred to as the baby boomer cohort) represents approximately 75% of current cases. Because of the substantial burden of disease among this age group, CDC expanded its existing hepatitis C risk-based testing recommendations to include a one-time HCV antibody test for all persons born between 1945 and 1965. The United States Preventive Services Task Force (USPSTF) subsequently made the same recommendation in June 2013.DescriptionMethodsThe following question "Have you ever had a blood test for hepatitis C?" has been administered annually from 2013 through 2017 on the National Health Interview Survey (NHIS). The NHIS is a nationally representative cross-sectional face-to-face household interview of civilian noninstitutionalized individuals in the U.S. The NHIS survey uses a complex multistage probability design that includes stratification, clustering, and oversampling. We estimated the prevalence of hepatitis C testing for adults in the US during the study period from 2013 to 2017. In addition, we carried out stratified analyses comparing those with private insurance to those who did not have private insurance. We reported weighted estimates taking into account the NHIS survey design. The R statistical software (R Core Team, 2018) was used to estimate weighted prevalence estimates for hepatitis C testing.ResultsDuring the study period from 2013-2017, there were 148,674 adults who responded to the ever tested for hepatitis C question. In addition, 33.56% of these individuals were born between 1945 and 1965; among all adults, the weighted percentage of individuals that responded yes they had received a hepatitis C screening test was 12.82% (95% CI: 12.54-13.10%) while for baby boomers the estimate was 13.93% (95% CI: 13.51-14.35%).Figure 1 presents the annual trend in the hepatitis C test prevalence over the study period by birth cohorts. For both cohorts, there were significant increases over time in hepatitis C testing prevalence. The two trend lines began to diverge in 2015 with the baby boomer cohort reporting higher rates of hepatitis C testing. For the baby boomer cohort, there was also a substantial increase in reported hepatitis C testing in 2017 relative to 2016. Similar trends were found for the samples when we restricted the sample to only those with private insurance. Compared to the people with private insurance, the baby boomers with 'Non-private’ insurance, including Medicaid, Medicare, or military- government sponsored insurances, reported higher rates of testing.ConclusionAcross the five-year period from 2013 through 2017, we found increasing rates of self-reported hepatitis C testing among non-institutionalized U.S. adults. For the baby boomer cohort, we saw a substantial increase in testing in 2017, which was likely due in part, to increased awareness among both physicians and patients of the CDC and USPSTF recommendation to have all baby boomers tested. Efforts to increase the awareness of these recommendations should continue. Additional targeted promotions among hard to reach populations should also be considered.How the Moderator Intends to Engage the Audience in Discussions on the TopicThis panel will discuss strengths and weaknesses for monitoring hepatitis C testing using alternative data sources including self-reported data, insurance claims data, and laboratory testing data.

Trend analysis in hepatitis C testing, OptumLabs® Data Warehouse, 2011–2017

ObjectiveUsing administrative claims for privately insured and Medicare Advantage enrollees from a large, private, U.S. health plan, we estimated the prevalence of hepatitis C testing among individuals who were recommended to be tested (i.e., baby boomer cohort born between 1945 and 1965) by the CDC and United States Preventive Services Task Force. This panel will discuss strengths and weaknesses for monitoring hepatitis C testing using alternative data sources including self-reported data, insurance claims data, and laboratory testing data.IntroductionHepatitis C virus (HCV) infection is the most common blood-borne disease in the US and the leading cause of liver-related morbidity and mortality. Approximately 3.5 million individuals in the US were estimated to be living with HCV in 2010 and approximately half of them were unaware that they were currently infected. Among HCV infected individuals, those born between 1945 and 1965 (usually referred to as the baby boomer cohort) represents approximately 75% of current cases. Because of the substantial burden of disease among this age group, CDC expanded its existing HCV risk-based testing recommendations to include a one-time HCV antibody test for all persons born between 1945-1965. The United States Preventive Services Task Force (USPSTF) subsequently made the same recommendation in June 2013.MethodsWe obtained health plan enrollment information and claims data from the 2011 - 2017 OptumLabs® Data Warehouse, and utilized data from patients enrolled in either commercially insured programs or Medicare Advantage. We examined trends in HCV testing for the birth cohort born between 1945 and 1965 and compared their trend in testing to individuals who were not in the birth cohort. We developed two different estimates for HCV testing incidence in order to make comparisons to other commercial claims datasets. The denominator for both estimates was the number of adults continuously enrolled in one or more health plan(s) in a given calendar year (allowing up to a 45-day gap in coverage). The numerator for the first estimate was the number of people receiving any HCV related test in the current calendar year who had not received any HCV related test including HCV antibody test, HCV RNA test or HCV genotype test in the previous calendar years. The numerator for the second estimate was the number of people who were given an HCV antibody test (CPT: 86803 and 80074) in a given calendar year, irrespective of previous testing history.ResultsDuring the study period 2011 - 2017, there were 20,332,848 unique adults who met the inclusion criteria in the OptumLabs® data. Approximately 7.1 million (35.0%) of these individuals were born between 1945 and 1965. On average, there were approximately 2.8 million birth cohort enrollees for any given calendar year. For the birth cohort, the annual incidence of HCV testing was about 2% per year during the time period between 2008 and 2011 (data not shown). In general, between 2011 and 2017, the trends in testing rates were consistent across both estimation methods. Specifically for the birth cohort, the HCV testing rate increased substantially between 2012 and 2017, peaking in 2017 at 8.56% [95% CI: 8.53-8.59%] and 10.24% [95% CI: 10.21-10.27%]. The greatest increase occurred between 2016 and 2017 when the testing rate almost doubled. In contrast, for the non-birth cohort, the HCV testing rate started in 2012 at a rate similar to the birth cohort but did not increase in a similar fashion and did not see a substantial increase in HCV testing in 2016 or 2017.ConclusionsSince CDC and USPSTF recommended universal testing for the birth cohort in 2012 and 2013, respectively, hepatitis C testing rates have been increasing across all age groups. The rate of increase for the birth cohort was substantially greater than that for the non-birth cohort. CDC and USPSTF recommendations are likely a strong contributing factor impacting hepatitis C testing rates in the US. Efforts to promote hepatitis C testing should continue.

Approval of Euthanasia: Differences Between Cohorts and Religion

Studying the role of social change, I investigated trends in approval for euthanasia between cohorts in the United States and how those trends are influenced by cohort replacement and religious attitudes. Using 16 waves from the General Social Survey (1985 to 2014; n = 6,638), I estimated differences in approval ratings between cohorts using logistic regression models. Models accounted for religious preference, religiosity, age, sex, race/ethnicity, socioeconomic status, marital status, and political ideology. Members of the baby boomer cohort are significantly more likely to approve of euthanasia than either their predecessors or successors, suggesting a cohort effect. Individuals who belong to more conservative religious groups and display higher levels of religiosity are less likely to approve. Cohort has a meaningful effect on approval of euthanasia, successors to the baby boomer cohort might increase their approval as their religiosity decreases and their parents and grandparents increasingly face end-of-life decisions.

Do Millennials care about NPOs? Intergenerational differences in attitudes towards nonprofit organizations

In this study, we analyze whether there are differences in attitudes towards nonprofit organizations (NPOs) between the generational cohorts of Baby Boomers, Generation X, and Millennials. We do so by analyzing survey data from Switzerland in two steps, a Bayesian estimation as well as a cluster analysis. The overall results suggest that there are, at best, only few and small intergenerational differences: The only consistent effect we find are the more negative attitudes of the Baby Boomer cohort towards professional associations and towards sports NPOs, but those differences could be due to life cycle rather than intergenerational effects. Overall, our results suggest that the Millennial generational cohort is at least as interested in and willing to engage with NPOs as previous generational cohorts.