scholarly journals Stroke Hospitalizations Before and During COVID-19 Pandemic Among Medicare Beneficiaries in the United States

Stroke ◽  
2021 ◽  
Author(s):  
Quanhe Yang ◽  
Xin Tong ◽  
Sallyann Coleman King ◽  
Benjamin S. Olivari ◽  
Robert K. Merritt
Keyword(s):  
United States ◽  
Patient Characteristics ◽  
The United States ◽  
Emergency Department Visits ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Percent Reduction ◽  
Stroke Patients ◽  
Race Ethnicity ◽  
National Emergency

Background and Purpose: Emergency department visits and hospitalizations for stroke declined significantly following declaration of coronavirus disease 2019 (COVID-19) as a national emergency on March 13, 2020, in the United States. This study examined trends in hospitalizations for stroke among Medicare fee-for-service beneficiaries aged ≥65 years and compared characteristics of stroke patients during COVID-19 pandemic to comparable weeks in the preceding year (2019). Methods: For trend analysis, we examined stroke hospitalizations from week 1 in 2019 through week 44 in 2020. For comparison of patient characteristics, we estimated percent reduction in weekly stroke hospitalizations from 2019 to 2020 during weeks 10 through 23 and during weeks 24 through 44 by age, sex, race/ethnicity, and state. Results: Compared to weekly numbers of hospitalizations for stroke reported during 2019, stroke hospitalizations in 2020 decreased sharply during weeks 10 through 15 (March 1–April 11), began increasing during weeks 16 through 23, and remained at a level lower than the same weeks in 2019 from weeks 24 through 44 (June 7–October 31). During weeks 10 through 23, stroke hospitalizations decreased by 22.3% (95% CI, 21.4%–23.1%) in 2020 compared with same period in 2019; during weeks 24 through 44, they decreased by 12.1% (95% CI, 11.2%–12.9%). The magnitude of reduction increased with age but similar between men and women and among different race/ethnicity groups. Reductions in stroke hospitalizations between weeks 10 through 23 varied by state ranging from 0.0% (95% CI, −16.0%–1.7%) in New Hampshire to 36.2% (95% CI, 24.8%–46.7%) in Montana. Conclusions: One-in-5 fewer stroke hospitalizations among Medicare fee-for-service beneficiaries occurred during initial weeks of the COVID-19 pandemic (March 1–June 6) and weekly stroke hospitalizations remained at a lower than expected level from June 7 to October 31 in 2020 compared with 2019. Changes in stroke hospitalizations varied substantially by state.

Abstract P76: Effect of Covid-19 Pandemic on Acute Ischemic Stroke Hospitalizations Among Medicare Beneficiaries in the United States

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Quanhe Yang ◽  
Xin Tong ◽  
Sallyann Coleman King ◽  
Robert K Merritt
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Primary Diagnosis ◽  
Emergency Department Visits ◽  
Fee For Service ◽  
Long Term Effects ◽  
Percent Reduction ◽  
Race Ethnicity

Introduction: Emergency department visits and hospitalizations for acute ischemic stroke (AIS) declined significantly following the declaration of COVID-19 as a national emergency on March 13, 2020 in the United States. No study has examined the volume and nature of AIS hospitalizations among older adults in the U.S. amidst the COVID-19 pandemic. This study examined the trend and compared the characteristics of Medicare fee-for-service (FFS) beneficiaries ≥65 years hospitalized with a primary AIS diagnosis in the same timeframe before and after the COVID-19 pandemic. Methods: We included hospitalizations with a primary diagnosis of AIS (ICD-10 I63) among Medicare FFS beneficiaries from week 11 to 24 in 2019 and 2020. We estimated the percent reduction of AIS hospitalizations between 2019 and 2020 by age, sex, race/ethnicity, and state. We tested for difference in distribution by age group, sex and race/ethnicity between 2019 and 2020 based on χ 2 test. Results: During the 14-weeks from March 8 to June 13, 2020, AIS hospitalizations among FFS beneficiaries were reduced by 23.7% compared to weeks 11 to 24 in 2019 (March 10 to June 15) (49,607 in 2019 vs. 37,860 in 2020). A greater percent reduction in AIS hospitalizations was observed with older age (27.2% among ≥85 years vs. 20.6% among persons 65-74 years, p<0.001). The magnitude of reduction was similar between men (23.8%) and women (23.6%, p=0.791), and among non-Hispanic white (24.2%), non-Hispanic black (22.4%), Hispanic (19.3%), and other (22.4%, p=0.189). AIS hospitalization trends varied by state ranging from 1.6% in New Hampshire to 39.8% in Montana. Conclusion: Hospitalizations with a primary AIS diagnosis among Medicare FFS beneficiaries were reduced by 24% during weeks 11 to 24 of the COVID-19 pandemic compared to the previous year in the United States. AIS hospitalization reductions varied substantially by state. Further study is needed to examine the long-term effects of COVID-19 pandemic on stroke outcomes.

scholarly journals Real-World Utilization of Oral Anticancer Agents Costs in Older Adults with Metastatic Renal Cell Carcinoma in the United States

Kidney Cancer ◽  
2021 ◽  
pp. 1-13
Author(s):  
Lauren E. Wilson ◽  
Lisa Spees ◽  
Jessica Pritchard ◽  
Melissa A. Greiner ◽  
Charles D. Scales ◽  
...  
Keyword(s):  
United States ◽  
Anticancer Agents ◽  
Patient Characteristics ◽  
The United States ◽  
Socioeconomic Indicators ◽  
Economic Implications ◽  
Southern Us ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
Oral Anticancer Agents

Background: Substantial racial and socioeconomic disparities in metastatic RCC (mRCC) have persisted following the introduction of targeted oral anticancer agents (OAAs). The relationship between patient characteristics and OAA access and costs that may underlie persistent disparities in mRCC outcomes have not been examined in a nationally representative patient population. Methods: Retrospective SEER-Medicare analysis of patients diagnosed with mRCC between 2007–2015 over age 65 with Medicare part D prescription drug coverage. Associations between patient characteristics, OAA receipt, and associated costs were analyzed in the 12 months following mRCC diagnosis and adjusted to 2015 dollars. Results: 2,792 patients met inclusion criteria, of which 32.4%received an OAA. Most patients received sunitinib (57%) or pazopanib (28%) as their first oral therapy. Receipt of OAA did not differ by race/ethnicity or socioeconomic indicators. Patients of advanced age (>  80 years), unmarried patients, and patients residing in the Southern US were less likely to receive OAAs. The mean inflation-adjusted 30-day cost to Medicare of a patient’s first OAA prescription nearly doubled from $3864 in 2007 to $7482 in 2015, while patient out-of-pocket cost decreased from $2409 to $1477. Conclusion: Race, ethnicity, and socioeconomic status were not associated with decreased OAA receipt in patients with mRCC; however, residing in the Southern United States was, as was marital status. Surprisingly, the cost to Medicare of an initial OAA prescription nearly doubled from 2007 to 2015, while patient out-of-pocket costs decreased substantially. Shifts in OAA costs may have significant economic implications in the era of personalized medicine.

scholarly journals Rising Trends in Emergency Department Visits Associated With Hepatitis C Virus Infection in the United States, 2006-2014

2019 ◽  
Vol 134 (6) ◽  
pp. 685-694
Author(s):  
Shaoman Yin ◽  
Laurie Barker ◽  
Eyasu H. Teshale ◽  
Ruth B. Jiles
Keyword(s):  
United States ◽  
Emergency Department ◽  
Hepatitis C ◽  
Baby Boomers ◽  
The United States ◽  
Emergency Department Visits ◽  
Medicare Beneficiaries ◽  
Compensated Cirrhosis ◽  
Ed Visits ◽  
Medicaid Beneficiaries

Objective: Emergency departments (EDs) are critical settings for hepatitis C care in the United States. We assessed trends and characteristics of hepatitis C–associated ED visits during 2006-2014. Methods: We used data from the 2006-2014 Nationwide Emergency Department Sample to estimate numbers, rates, and costs of hepatitis C–associated ED visits, defined by either first-listed diagnosis of hepatitis C or all-listed diagnosis of hepatitis C. We assessed trends by demographic characteristics, liver disease severity, and patients’ disposition by using joinpoint analysis, and we calculated the average annual percentage change (AAPC) from 2006 to 2014. Results: During 2006-2014, the rate per 100 000 visits of first-listed and all-listed hepatitis C–associated ED visits increased significantly from 10.1 to 25.4 (AAPC = 13.0%; P < .001) and from 484.4 to 631.6 (AAPC = 3.4%; P < .001), respectively. Approximately 70% of these visits were made by persons born during 1945-1965 (baby boomers); 30% of visits were made by Medicare beneficiaries and 40% by Medicaid beneficiaries. Significant rate increases were among visits by baby boomers (first-listed: AAPC = 13.8%; all-listed: AAPC = 2.6%), persons born after 1965 (first-listed: AAPC = 14.3%; all-listed: AAPC = 9.2%), Medicare beneficiaries (first-listed: AAPC = 18.0%; all-listed: AAPC = 3.9%), and persons hospitalized after ED visits (first-listed: AAPC = 20.0%; all-listed: AAPC = 2.3%; all P < .001). Increasing proportions of compensated cirrhosis were among visits by baby boomers (first-listed: AAPC = 11.5%; all-listed: AAPC = 6.3%). Annual hepatitis C–associated total ED costs increased by 400.0% (first-listed) and 192.0% (all-listed) during 2006-2014. Conclusion: Public health efforts are needed to address the growing burden of hepatitis C care in the ED.

scholarly journals Nonprescription Antimicrobial Use in a Primary Care Population in the United States

2016 ◽  
Vol 60 (9) ◽  
pp. 5527-5532 ◽  
Author(s):  
Roger Zoorob ◽  
Larissa Grigoryan ◽  
Susan Nash ◽  
Barbara W. Trautner
Keyword(s):  
United States ◽  
Primary Care ◽  
Random Sample ◽  
Latin American ◽  
Patient Characteristics ◽  
Antibiotic Use ◽  
Multivariate Regression Analysis ◽  
The United States ◽  
Race Ethnicity ◽  
Intended Use

ABSTRACTCommunity antimicrobial resistance rates are high in communities with frequent use of nonprescription antibiotics. Studies addressing nonprescription antibiotic use in the United States have been restricted to Latin American immigrants. We estimated the prevalence of nonprescription antibiotic use in the previous 12 months as well as intended use (intention to use antibiotics without a prescription) and storage of antibiotics and examined patient characteristics associated with nonprescription use in a random sample of adults. We selected private and public primary care clinics that serve ethnically and socioeconomically diverse patients. Within the clinics, we used race/ethnicity-stratified systematic random sampling to choose a random sample of primary care patients. We used a self-administered standardized questionnaire on antibiotic use. Multivariate regression analysis was used to identify independent predictors of nonprescription use. The response rate was 94%. Of 400 respondents, 20 (5%) reported nonprescription use of systemic antibiotics in the last 12 months, 102 (25.4%) reported intended use, and 57 (14.2%) stored antibiotics at home. These rates were similar across race/ethnicity groups. Sources of antibiotics used without prescriptions or stored for future use were stores or pharmacies in the United States, “leftover” antibiotics from previous prescriptions, antibiotics obtained abroad, or antibiotics obtained from a relative or friend. Respiratory symptoms were common reasons for the use of nonprescription antibiotics. In multivariate analyses, public clinic patients, those with less education, and younger patients were more likely to endorse intended use. The problem of nonprescription use is not confined to Latino communities. Community antimicrobial stewardship must include a focus on nonprescription antibiotics.

scholarly journals The Incidence and Cumulative Risk of Major Surgery in Older Persons in the United States

2020 ◽  
Author(s):  
Robert D. Becher ◽  
Brent Vander Wyk ◽  
Linda Leo-Summers ◽  
Mayur M. Desai ◽  
Thomas M. Gill
Keyword(s):  
United States ◽  
Older Persons ◽  
Cumulative Risk ◽  
The United States ◽  
Community Living ◽  
Major Surgery ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Prospective Longitudinal Study ◽  
Prospective Longitudinal

ABSTRACTImportanceAs the population of the United States (US) ages, there is considerable interest in ensuring safe and high-quality surgical care for older persons. Yet, valid, generalizable data on the occurrence of major surgery in the geriatric population are sparse.ObjectiveTo estimate the incidence and cumulative risk of major surgery in older persons over a 5-year period and evaluate how these estimates differ according to demographic and geriatric characteristics.DesignProspective longitudinal study.SettingContinental US from 2011 to 2016.Participants5,571 community-living fee-for-service Medicare beneficiaries, aged 65+, from the National Health and Aging Trends Study (NHATS).Main Outcomes and MeasuresMajor surgeries were identified through linkages with data from the Centers for Medicare & Medicaid Services. Data on frailty and dementia were obtained from the baseline NHATS assessment.ResultsThe nationally-representative incidence of major surgery per 100 person-years was 8.8 (95% confidence interval [CI], 8.2-9.5), with estimates of 5.2 (95% CI, 4.7-5.7) and 3.7 (95% CI, 3.3-4.1) for elective and non-elective surgeries. The adjusted incidence of major surgery peaked at 10.8 (95% CI, 9.4-12.4) in persons 75-79 years, increased from 6.6 (95% CI, 5.8-7.5) in the non-frail group to 10.3 (95% CI, 8.9-11.9) in the frail group, and was similar by sex (males 8.6 [95% CI, 7.7-9.6]; females 8.3 [95% CI, 7.5-9.1]) and dementia (no 8.6 [95% CI, 7.9-9.3]; possible 7.8 [95% CI, 6.3-9.6]; probable 8.1 [95% CI, 6.7-9.9]). The 5-year cumulative risk of major surgery was 13.8% (95% CI, 12.2%-15.5%), representing nearly 5 million unique older persons (4,958,048 [95% CI, 4,345,342-5,570,755]), including 12.1% (95% CI, 9.5%-14.6%) in persons 85-89 years, 9.1% (95% CI, 7.2%-11.0%) in those ≥90 years, 12.1% (95% CI, 9.9%-14.4%) in those with frailty, and 12.4% (95% CI, 9.8%-15.0%) in those with probable dementia.Conclusions and RelevanceMajor surgery is a common event in the lives of community-living older persons, including high-risk vulnerable subgroups such as the oldest old, those with frailty or dementia, and those undergoing non-elective surgery. The burden of major surgery in older Americans will add to the challenges ahead for the US health care system in our aging society.KEY POINTSQuestionWhat is the incidence and cumulative risk of major surgery in older persons in the United States?FindingsIn this prospective longitudinal study, data from 5,571 community-living fee-for-service Medicare beneficiaries were used to calculate nationally-representative estimates for the incidence and cumulative risk of major surgery over a 5-year period. Nearly 9 major surgeries were performed annually for every 100 older persons, and more than 1 in 7 Medicare beneficiaries underwent a major surgery over 5 years, representing nearly 5 million unique older persons.MeaningMajor surgery is a common event in the lives of community-living older persons.

Abstract 236: Trends in Hospitalization for Digoxin Toxicity and Subsequent Outcomes Among Medicare Beneficiaries in the United States, 1999-2011

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Sudhakar V Nuti ◽  
Frederick A Masoudi ◽  
James V Freeman ◽  
Karthik Murugiah ◽  
Nihar R Desai ◽  
...  
Keyword(s):  
United States ◽  
Hospital Mortality ◽  
The United States ◽  
National Sample ◽  
Digoxin Toxicity ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Annual Change ◽  
Hospital Discharge Diagnosis ◽  
Annual Decline

Objective: To characterize changes in rates of hospitalization for digoxin toxicity and trends in the associated mortality and readmission among older adults over a 12-year period in the United States. Methods: We studied 33,952,331 Medicare fee-for-service beneficiaries 65 years or older with a hospital discharge diagnosis of digoxin toxicity in the United States from 1999 to 2011. Outcome measures were rates of hospitalization for digoxin toxicity; in-hospital mortality; 30-day mortality; and 30-day readmission. Results: There were 20,957 hospitalizations for a principal or secondary diagnosis of digoxin toxicity between 1999 and 2011. The rate declined significantly from 15.2 per 100,000 person-years (95% confidence interval [CI]: 14.7-15.7) in 1999 to 2.1 per 100,000 person-years (95% CI: 1.9-2.3) in 2011 (p<0.001), representing an adjusted annual decline of 17.0% (95% CI: 16.2-17.0) (Figure 1). Between 1999 and 2011, the observed in-hospital and 30-day mortality rates associated with hospitalization for digoxin toxicity declined significantly, from 6.0% (95% CI: 5.2-6.8) to 3.3% (95% CI: 2.0-5.1) (p<0.01) and 14.0% (95% CI: 13.0-15.2) to 10.6% (95% CI: 8.2-13.4) (p<0.05), respectively, representing an annual decline for in-hospital mortality of 5.0% (95% CI: 3.7-7.2) and for 30-day mortality of 4.0% (95% CI: 3.1-5.7). The overall observed 30-day readmission rate declined significantly from 23.5% (95% CI: 22.1-24.9) in 1999 to 18.9% (95% CI: 15.6-22.3) in 2011 (p<0.05), but there was no significant decline in the adjusted annual change in 30-day readmission (1.0%, 95% CI: 0.0-1.7). Conclusions: In a national sample of Medicare beneficiaries, the rate of hospitalization for digoxin toxicity and subsequent mortality declined significantly between 1999 and 2011.

Health Care Use and Outcomes in Assisted Living Communities: Race, Ethnicity, and Dual Eligibility

2021 ◽  
pp. 107755872110501
Author(s):  
Helena Temkin-Greener ◽  
Yunjiao Mao ◽  
Brian McGarry ◽  
Sheryl Zimmerman ◽  
Yue Li
Keyword(s):  
United States ◽  
Assisted Living ◽  
Fixed Effects ◽  
The United States ◽  
Health Care Use ◽  
Fee For Service ◽  
Term Care ◽  
Race Ethnicity ◽  
Dual Eligibility ◽  
Racial Ethnic

Assisted Living (AL) has become an important residential long-term care option in the United States, yet very little is known about the nature and quality of care received in this setting by racial/ethnic minorities or residents dually eligible for Medicare and Medicaid. Using calendar year 2018 Medicare data, we identified 255,564 fee-for-service Medicare beneficiaries age 55+ who resided in 24,108 ALs across the United States. We fit several logistic regression models with individual-level covariates and AL-level fixed effects, to examine the association between race/ethnicity and dual status with inpatient hospital admission, 30-day readmission, emergency room use, and nursing home placement. Significant variations in these measures were found both within and across ALs for racial/ethnic minority and dual residents. Our results suggest that disparities in outcomes are most significant by dual eligibility status rather than by race/ethnicity alone. These findings provide important implications for providers, policy makers, and researchers.

scholarly journals Abortion-related emergency department visits in the United States: An analysis of a national emergency department sample

BMC Medicine ◽  
2018 ◽  
Vol 16 (1) ◽  
Author(s):  
Ushma D. Upadhyay ◽  
Nicole E. Johns ◽  
Rebecca Barron ◽  
Alice F. Cartwright ◽  
Chantal Tapé ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
The United States ◽  
Emergency Department Visits ◽  
National Emergency
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