AJPM focus最新文献

{"title":"Disparities in COVID-19 Vaccine Uptake Among Pregnant People in a Diverse Urban Population With High Vaccine Acceptance","authors":"Christine A. Blauvelt MD ,&nbsp;Maura Jones Pullins MD ,&nbsp;Stephanie L. Gaw MD, PhD","doi":"10.1016/j.focus.2024.100303","DOIUrl":"10.1016/j.focus.2024.100303","url":null,"abstract":"<div><h3>Introduction</h3><div>This study's objective was to compare COVID-19 vaccination rates between pregnant individuals in San Francisco and the city's similarly aged population and to identify the factors associated with vaccine uptake in the pregnant population.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of all patients delivering at 2 hospitals in San Francisco from March 15, 2021, to October 15, 2021. Reference COVID-19 vaccination rates for San Francisco were obtained from the California Immunization Registry. The primary outcome was completion of a COVID-19 vaccine series among pregnant individuals compared with that in the San Francisco general population aged 18–45 years. Secondary outcomes included factors associated with COVID-19 vaccination among pregnant people.</div></div><div><h3>Results</h3><div>Of 2,294 pregnant individuals, 1,181 (51.5%) completed a COVID-19 vaccine series by delivery. Pregnant individuals were less likely to be vaccinated than the San Francisco population throughout the study period. Factors associated with lower vaccination rates in pregnant individuals included public insurance (AOR=0.21, 95% CI=0.16, 0.27), younger age (AOR=0.74, 95% CI=0.64, 0.86), English language preference (AOR=0.58, 95% CI=0.42, 0.80), and self-identified Black (AOR=0.26, 95% CI=0.17, 0.40) (ref: White), Hispanic (AOR=0.61, 95% CI=0.46, 0.81), or other (AOR=0.50, 95% CI=0.36, 0.68) race or ethnicity.</div></div><div><h3>Conclusions</h3><div>COVID-19 vaccination coverage among pregnant people in San Francisco lagged behind that of the city's similarly aged population, particularly among those with public insurance and of non-White race. Despite locally high vaccine acceptance, additional efforts are needed to address barriers and reduce disparities in COVID-19 vaccination within the pregnant population.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 3","pages":"Article 100303"},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Association Between Respiratory Symptoms and Nicotine and Cannabis Use Through Traditional and E-Product Devices in the U.S.","authors":"Phil Veliz PhD ,&nbsp;John Jardine MA ,&nbsp;Luisa Kcomt PhD ,&nbsp;Carol Boyd PhD ,&nbsp;Sean Esteban McCabe PhD ,&nbsp;Rebecca Evans-Polce PhD","doi":"10.1016/j.focus.2024.100291","DOIUrl":"10.1016/j.focus.2024.100291","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this study was to assess the association between past 30-day cigarette smoking, nicotine use with an e-product device (e.g., vape), cannabis smoking, cannabis use with an e-product device, and other forms of cannabis use and past-year respiratory symptoms in a nationally representative sample of people aged ≥12 years in the U.S. during 2021.</div></div><div><h3>Methods</h3><div>Data from Wave 6 (2021) of the Population Assessment of Tobacco and Health Study, a national probability sample of adolescents (aged 12–17 years; <em>n</em>=5,652) and adults (aged ≥18 years; <em>n</em>=30,516), were used. Logistic regression was used to assess the association of past 30-day cigarette smoking, nicotine use with an e-product, cannabis smoking, cannabis use with an e-product, and other forms of cannabis use with past-year respiratory symptoms (a past-year respiratory symptom index was constructed and ranged from 0 to 9; an index of 2+ was flagged as having functionally important respiratory impairment).</div></div><div><h3>Results</h3><div>The odds of a past-year respiratory index score of 2+ was greater among respondents who indicated either past 30-day cigarette or cannabis smoking than among respondents who did not use any nicotine or cannabis during the past 30 days. Past 30-day nicotine and cannabis use with an e-product device was not associated with a respiratory symptom index of 2+. The combination of past 30-day cigarette smoking and cannabis smoking had one of the strongest associations with experiencing a respiratory index score of 2+ among dual users of nicotine and cannabis.</div></div><div><h3>Conclusions</h3><div>Past 30-day cigarette smoking and cannabis smoking were associated with higher odds of functionally important respiratory impairment. In addition, this study provides robust evidence regarding the potential respiratory harms of single or dual nicotine and cannabis smoking as it relates to respiratory health.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 1","pages":"Article 100291"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Influenza Vaccination in a National Veteran Cohort","authors":"Alissa S. Chen MD ,&nbsp;Melissa M. Farmer PhD ,&nbsp;Ling Han MD, PhD, MS ,&nbsp;Tessa Runels MPH ,&nbsp;Brett Bade MD ,&nbsp;Kristina Crothers MD ,&nbsp;Lori A. Bastian MD, MPH ,&nbsp;Isabel S. Bazan MD ,&nbsp;Bevanne A. Bean-Mayberry MD, MHS ,&nbsp;Cynthia A. Brandt MD, MPH ,&nbsp;Kathleen M. Akgün MD, MS","doi":"10.1016/j.focus.2024.100290","DOIUrl":"10.1016/j.focus.2024.100290","url":null,"abstract":"<div><h3>Introduction</h3><div>Only 53% of American adults receive influenza vaccination, and disparities in vaccination exist among particular racial and ethnic groups. This study determines how race, ethnicity, sex, and rurality are associated with influenza vaccination adherence in a national Veteran Health Affairs Administration cohort.</div></div><div><h3>Methods</h3><div>The authors examined differences in documented influenza vaccinations for the 2019–2020 influenza season among Veteran Health Affairs Administration patients in a retrospective cohort study using Veteran Health Affairs Administration administrative electronic health record data. The author used logistic regression to model receipt of influenza vaccination in association with race, ethnicity, sex, and rurality while controlling for clinical diagnoses, demographics, and ambulatory care utilization. The authors also stratified the models by sex and rurality.</div></div><div><h3>Results</h3><div>Among 5,943,918 veterans, 48.6% received influenza vaccination. Unadjusted comparisons showed that those who were vaccinated were more likely to be White, to be of male sex, and to be older. Similar proportions of unvaccinated and unvaccinated veterans were from rural settings. In adjusted models, Black race was most strongly associated with decreased vaccination (AOR=0.69; 95% CI=0.69, 0.70), and American Indian/Alaskan Native race also had reduced odds of vaccination (AOR=0.94; 95% CI=0.92, 0.95) compared with White race. Female veterans had increased odds of vaccination (AOR=1.20; 95% CI=1.19, 1.20) compared with men. Rurality (AOR=0.97; 95% CI=0.96, 0.97) was associated with a small decreased odds of vaccination compared with urban. In stratified models, Black veterans were less likely to receive influenza vaccination regardless of sex and rurality than White veterans. American Indian/Alaska Native female veterans had equal odds of vaccination as White female veterans, whereas American Indian/Alaska Native male veterans had reduced odds of vaccination compared with White male veterans.</div></div><div><h3>Conclusions</h3><div>During the 2019–2020 influenza season, Black and American Indian/Alaskan Native veterans had lower odds of vaccination. Despite the Veteran Health Affairs Administration's universal approach to healthcare, racial disparities still exist in preventive care.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 1","pages":"Article 100290"},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventive Care Needs of the North Carolina Medicaid Expansion Population","authors":"Jennifer C. Spencer PhD ,&nbsp;Rebecca G. Whitaker PhD ,&nbsp;Michael P. Pignone MD, MPH","doi":"10.1016/j.focus.2024.100289","DOIUrl":"10.1016/j.focus.2024.100289","url":null,"abstract":"<div><h3>Introduction</h3><div>Effective December 2023, North Carolina expanded Medicaid eligibility to cover individuals up to 138% of the Federal Poverty Level. The authors sought to understand the preventive care needs of the newly Medicaid-eligible population.</div></div><div><h3>Methods</h3><div>The authors conducted a repeat cross-sectional analysis using the 2016, 2018, 2020, and 2022 North Carolina Behavioral Risk Factor Surveillance Survey. The authors defined the Medicaid expansion population as those aged 18–64 years with household incomes below 138% Federal Poverty Level and reporting no current source of insurance. The authors compared with those enrolled in traditional Medicaid and all nonelderly adult North Carolinians, evaluating up-to-date use of preventive care services. Survey weights were used to estimate total unmet need.</div></div><div><h3>Results</h3><div>The authors estimated 294,000 individuals in the Medicaid expansion population in 2022. Preventive care use was low for the expansion population in all years. In 2022, 36.7% (27.7%–46.8%) reported having a regular source of care, 40.2% (31.1%–50%) reported a past-year wellness visit, and 45.7% (36.6%–55.2%) reported delaying needed care owing to cost. Among eligible respondents, 28.6% (13.8%–50.2%) were up to date with colorectal cancer screening (vs 49.4% [30.5%–68.4%] for traditional Medicaid and 71% [67.3%–74.4%] for all North Carolina population). It was estimated that 176,000 in the expansion population needed a wellness visit; 186,000 needed a regular care provider; and 66,000 needed 1 or more cancer screening.</div></div><div><h3>Conclusions</h3><div>The North Carolina Medicaid expansion population has a high number of unmet preventive care needs. North Carolina should consider approaches to improve provider capacity for those in Medicaid and promote preventive care and risk reduction for the newly enrolled expansion population.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 1","pages":"Article 100289"},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Filling the Treatment Gap: Geographic Expansion of Buprenorphine Providers Across the U.S.","authors":"Suparna Das PhD ,&nbsp;Kasimu Muhetaer MPH ,&nbsp;Neeraj Gandotra MD ,&nbsp;Naomi Tomoyasu PhD","doi":"10.1016/j.focus.2024.100284","DOIUrl":"10.1016/j.focus.2024.100284","url":null,"abstract":"<div><h3>Introduction</h3><div>With opioid-related deaths reaching epidemic levels, gaining a better understanding of access to treatment for opioid use disorder is critical. Buprenorphine is an effective medication for the treatment of opioid addiction. The analysis is critical post–X-waiver elimination, which extended the ability to prescribe buprenorphine for the treatment of opioid use disorder to all practitioners with Drug Enforcement Agency Schedules II–V on their Drug Enforcement Agency registration. The primary purpose of the analysis was to explore the geographic patterns of substance use treatment and establish a geographic baseline to assess the removal of the X-waiver in the future.</div></div><div><h3>Methods</h3><div>The authors assessed the expansion of buprenorphine providers across the data from all U.S. counties up to December 31, 2022. The authors used all certified buprenorphine providers' data from the database of the buprenorphine waiver notification system. The authors used county-level population data from the U.S. Census of American Community Survey of 2021 and the Centers for Disease Prevention and Control's drug-related mortality data. The authors implemented spatial scan statistics to identify the spatial clusters using SaTScan.</div></div><div><h3>Results</h3><div>The results from this analysis show that Doctor of Medicine/Doctor of Osteopathic Medicine have the highest numbers of certified providers at 8,134 (65.08%) in 2018 and 14,525 (57.87%) in 2022. This analysis shows that the distribution of buprenorphine providers across the counties of the U.S. was significantly clustered. Higher clusters with RR &gt;1 (<em>p</em>&lt;0.001) were found in the states of Washington, Oregon, and Northern California and the Western borders of Montana. Similar clusters of counties with RR &gt;1 (<em>p</em>&lt;0.001) were found in the northeastern states of Maine, Vermont, and New Hampshire.</div></div><div><h3>Conclusions</h3><div>From this analysis, it is evident that buprenorphine-certified providers are clustered in areas of higher drug-related mortality filling a treatment gap. The elimination of the X-waiver will be a significant step toward increasing access to medication for opioid use disorder, and this analysis may be used as a geographic baseline to assess in the future.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 1","pages":"Article 100284"},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concordance Between DASH Diet and Coronary Artery Calcification: Results From the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Prospective Cohort Study","authors":"Bridget Murphy Hussain PhD, MS ,&nbsp;Andrea L. Deierlein PhD, MPH, MS ,&nbsp;Sameera A. Talegawkar PhD ,&nbsp;Alka M. Kanaya MD ,&nbsp;Joyce A. O'Connor DrPH, MA ,&nbsp;Meghana D. Gadgil MD ,&nbsp;Yong Lin PhD ,&nbsp;Niyati Parekh PhD, MS","doi":"10.1016/j.focus.2024.100288","DOIUrl":"10.1016/j.focus.2024.100288","url":null,"abstract":"<div><h3>Introduction</h3><div>South Asian adults are at high risk for atherosclerotic cardiovascular disease, for which coronary artery calcification is an early predictor. Adherence to the Dietary Approaches to Stop Hypertension diet is a modifiable risk factor that may mitigate the progression of coronary artery calcification and atherosclerotic cardiovascular disease.</div></div><div><h3>Methods</h3><div>Using data from the Mediators of Atherosclerosis in South Asians Living in America cohort, the authors calculated a Dietary Approaches to Stop Hypertension dietary score (categorized as low, moderate, and high) to examine the associations of Dietary Approaches to Stop Hypertension diet adherence with coronary artery calcification after a 5-year follow up.</div></div><div><h3>Results</h3><div>The authors found that participants in the high Dietary Approaches to Stop Hypertension category were 41% less likely to have coronary artery calcification score &gt;100 (age-adjusted incidence rate ratio=0.59; 95% CI=0.36, 0.95) than those in the low category; this association was attenuated in multivariable models. Differences were observed by sex. Men in the high Dietary Approaches to Stop Hypertension category were 51% less likely to have coronary artery calcification score &gt;100 (adjusted incidence rate ratio=0.49; 95% CI=0.26, 0.95) and experienced 0.46-fold coronary artery calcification change (fold change=0.46; 95% CI=0.18, 0.90) in multivariable models.</div></div><div><h3>Conclusions</h3><div>The findings indicate a relationship between Dietary Approaches to Stop Hypertension diet and early predictors of atherosclerotic cardiovascular disease risk among South Asians living in the U.S., particularly men.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 1","pages":"Article 100288"},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a Diabetes Screening Clinical Decision Support Tool","authors":"Eva Tseng MD, MPH ,&nbsp;Ariella Stein MPH ,&nbsp;Nae-Yuh Wang PhD ,&nbsp;Nestoras N. Mathioudakis MD, MHS ,&nbsp;Hsin-Chieh Yeh PhD ,&nbsp;Nisa M. Maruthur MD, MHS","doi":"10.1016/j.focus.2024.100287","DOIUrl":"10.1016/j.focus.2024.100287","url":null,"abstract":"<div><h3>Introduction</h3><div>The authors evaluated whether an electronic health record clinical decision support system improves diabetes screening across a health system.</div></div><div><h3>Methods</h3><div>Study population included adults without diabetes attending a visit at 27 primary care clinics. Outcomes included the monthly screening laboratory order rate and completion rate among eligible patient visits. The authors performed logistic regression using a generalized estimating equations model and interrupted time series analysis to evaluate the change in the outcome from baseline to implementation and postimplementation periods.</div></div><div><h3>Results</h3><div>From the baseline to postimplementation period, screening laboratory order rates increased from 53% to 66%, and completion rates increased from 46% to 54%, respectively. The odds of laboratory order and completion increased significantly from the baseline to postimplementation period (test order: OR=3.7; 95% CI=3.4, 4.1, <em>p</em>&lt;0.001; test completion: OR=2.1; 95% CI=2.0, 2.3, <em>p</em>&lt;0.001). In the interrupted time series analysis, laboratory order and completion rates increased significantly from the baseline period (<em>p</em>&lt;0.001 for both).</div></div><div><h3>Conclusions</h3><div>The authors developed and implemented a clinical decision support system alert that automatically identifies eligible patients and facilitates single-click ordering of a diabetes screening test. An easily implementable and scalable clinical decision support system alert can improve diabetes screening.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"3 6","pages":"Article 100287"},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142661991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersectional Analysis of Social Risk and Need Among a Large Representative Sample of Adults From an Integrated Health System in the U.S.","authors":"Meagan C. Brown PhD, MPH ,&nbsp;Kara Cushing-Haugen MS ,&nbsp;Robert Wellman MS ,&nbsp;Caitlin N. Dorsey BA ,&nbsp;Consuelo MS Norris MA ,&nbsp;John L. Adams PhD ,&nbsp;John F. Steiner MD, MPH ,&nbsp;Anand R. Shah MD, MS ,&nbsp;Cara C. Lewis PhD","doi":"10.1016/j.focus.2024.100283","DOIUrl":"10.1016/j.focus.2024.100283","url":null,"abstract":"<div><h3>Introduction</h3><div>Social health is increasingly a focus of healthcare systems. Representative and intersectional analyses of individuals’ social risks such as food, housing, transportation, and financial insecurity and their interest in receiving assistance from the healthcare system (social needs) can provide healthcare organizations with more nuanced estimates that can lead to more effective interventions.</div></div><div><h3>Methods</h3><div>The authors conducted cross-sectional survey of a representative sample of 43,936 Kaiser Permanente members in December 2019–September 2020. Study inclusion was based on membership, age, address, and absence of dementia. Modified Poisson regression models estimated respondents' social risks and needs overall and within domain (food, housing, finances, or transportation) and by intersectional strata on the basis of a combination of age, income, gender, and race and ethnicity.</div></div><div><h3>Results</h3><div>Of 10,274 participants who completed the survey, 52% reported any social risk, and 32% had any social need. Financial strain was the most prevalent risk (44%), followed by food insecurity (31%), housing instability (17%), and transportation (7%). These intersectional analyses generated 74 intersectional groups. Across the intersectional groups, higher-income (&gt;$50,000 per year) or older-age (&gt;60 years) adults consistently had lower risk and need. However, this pattern varied by race and ethnicity. In particular, older and lower-income, Pacific Islander, African-American/Black, and multiracial adults had the highest estimates of social risk and need.</div></div><div><h3>Conclusions</h3><div>Higher risk and need among particular intersectional groups suggest the importance of tailored interventions for social needs. The high aggregate prevalence of social risks and needs suggests that system and policy changes must compliment universal and population-based social health screening and assistance interventions in healthcare organizations.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 1","pages":"Article 100283"},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs and Healthcare Utilization of Heart Disease by COVID-19 Diagnosis and Race and Ethnicity","authors":"Jun Soo Lee PhD ,&nbsp;Yidan (Xue) Zhang PhD, MC ,&nbsp;Lisa M. Pollack PhD, MPH, MPT ,&nbsp;Feijun Luo PhD","doi":"10.1016/j.focus.2024.100285","DOIUrl":"10.1016/j.focus.2024.100285","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart disease poses a significant health and economic burden in the U.S., with considerable variations in outcomes across different racial and ethnic groups. The COVID-19 pandemic has further highlighted the disparities in healthcare utilization and costs associated with heart disease.</div></div><div><h3>Methods</h3><div>The authors used the 2021 Merative MarketScan Medicaid claims database to estimate the medical costs and healthcare utilization associated with heart disease by racial and ethnic groups and COVID-19 diagnosis status. This study focused on individuals aged ≥18 years continuously enrolled in a noncapitated insurance plan in 2021. The outcome measures included total medical expenditures and healthcare utilization, including the numbers of emergency department visits and inpatient admissions and length of inpatient stay. The authors employed a generalized linear model with a family of gamma and log links for medical costs, and a negative binomial regression was used for healthcare utilization. Three-way interactions of heart disease, COVID-19 diagnosis, and race and ethnicity categories were implemented after adjusting for age, sex, and comorbidities. The authors reported average marginal effects with 95% CIs.</div></div><div><h3>Results</h3><div>Among 1,008,166 Medicaid beneficiaries, 8% had heart disease in 2021. The cost associated with heart disease was $10,819 per beneficiary in 2021 (95% CI=10,292; 11,347; <em>p</em>&lt;0.001). The cost was $15,840 (95% CI=14,389; 17,291; <em>p</em>&lt;0.001) for non-Hispanic Black individuals; $9,945 (95% CI=9,172; 10,718; <em>p</em>&lt;0.001) for non-Hispanic White; and $8,511 (95% CI=7,490; 9,531; <em>p</em>&lt;0.001) for Hispanic individuals. Individuals with a COVID-19 diagnosis ($19,638) had $9,541 (95% CI=7,049; 12,032; <em>p</em>&lt;0.001) higher costs associated with heart disease than those without COVID-19 ($10,098) (<em>p</em>&lt;0.001). Individuals with heart disease had higher numbers of emergency department visits (0.937 per beneficiary, 95% CI=0.913; 0.960), inpatient admissions (0.463 per beneficiary, 95% CI=0.455; 0.471), and average length of stay (2.541 days per admission, 95% CI=2.405; 2.677) than those without heart disease.</div></div><div><h3>Conclusions</h3><div>The study's findings showed that costs and healthcare utilization associated with heart disease are substantial in all racial and ethnic groups and the highest among non-Hispanic Black individuals. Furthermore, individuals with a COVID-19 diagnosis had approximately 2 times higher costs associated with heart disease than individuals without a COVID-19 diagnosis.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 1","pages":"Article 100285"},"PeriodicalIF":0.0,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Underutilization of National Diabetes Prevention Program Among Women With a History of Gestational Diabetes Mellitus: An In-Depth Focus Group Analysis","authors":"Priyadharshini Narayanan MD, MPH ,&nbsp;Sahitya R. Kothapalli MPH ,&nbsp;Harmonie B. Strohl MDc ,&nbsp;Linda L. Hill MD, MPH","doi":"10.1016/j.focus.2024.100279","DOIUrl":"10.1016/j.focus.2024.100279","url":null,"abstract":"<div><h3>Introduction</h3><div>Gestational diabetes mellitus significantly increases the risk of developing Type 2 diabetes mellitus in women. However, the National Diabetes Prevention Program, effective in reducing Type 2 diabetes mellitus incidence, is underutilized among women with a history of gestational diabetes mellitus. This study aims to explore the factors contributing to this underutilization and propose strategies to increase National Diabetes Prevention Program's usage.</div></div><div><h3>Methods</h3><div>A qualitative study with narrative methodology was employed, involving focus group discussions with 18 women aged between 29 and 43 years, who had a history of gestational diabetes mellitus. Participants were recruited from a gestational diabetes mellitus registry through University of California, San Diego's online platform. The discussions were aimed at understanding their awareness of Type 2 diabetes mellitus risk after gestational diabetes mellitus and their knowledge about the National Diabetes Prevention Program.</div></div><div><h3>Results</h3><div>Thematic analysis of the discussions revealed 4 key themes: (1) challenges in navigating health information after gestational diabetes mellitus; (2) perceived facilitators for National Diabetes Prevention Program participation, including peer support, personalized guidance, and virtual options; (3) perceived barriers, such as time constraints, childcare responsibilities, and financial considerations; and (4) insights into patient perspectives on gestational diabetes mellitus care. Despite awareness of their increased Type 2 diabetes mellitus risk, there was a notable gap in knowledge about the National Diabetes Prevention Program among participants.</div></div><div><h3>Conclusions</h3><div>The study highlights the critical need for improved communication regarding postgestational diabetes mellitus risk of type 2 diabetes and the National Diabetes Prevention Program. Addressing communication gaps, offering personalized support, and accommodating the unique challenges faced by women with a history of gestational diabetes mellitus can enhance National Diabetes Prevention Program participation. The significance of a patient-centric approach in diabetes prevention is underscored, emphasizing that such an approach could significantly impact Type 2 diabetes mellitus prevention in this high-risk population.</div></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":"4 1","pages":"Article 100279"},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}