scholarly journals State-level weather pattern and utilization of skin cancer related procedures among Medicare beneficiaries.

2021 ◽  
Vol 27 (7) ◽  
Author(s):  
Y Duan ◽  
I Benlagha ◽  
BM Nguyen
Keyword(s):  
Skin Cancer ◽  
State Level ◽  
Medicare Beneficiaries ◽  
Weather Pattern

scholarly journals Temporal Trends in Opioid Prescribing Patterns Among Oncologists in the Medicare Population

2020 ◽  
Author(s):  
Vikram Jairam ◽  
Daniel X Yang ◽  
Saamir Pasha ◽  
Pamela R Soulos ◽  
Cary P Gross ◽  
...  
Keyword(s):  
Negative Binomial ◽  
Temporal Trends ◽  
State Level ◽  
Negative Binomial Regression ◽  
Time Frame ◽  
Prescribing Patterns ◽  
Annual Number ◽  
Medicare Beneficiaries ◽  
Care Providers ◽  
Opioid Prescribing

Abstract Background In the wake of the US opioid epidemic, there have been efforts to curb opioid prescribing. However, it is unknown whether these efforts have affected prescribing among oncologists, whose patients often require opioids for symptom management. We investigated temporal patterns in opioid prescribing for Medicare beneficiaries among oncologists and nononcologists. Methods We queried the Centers for Medicare and Medicaid Services Part D prescriber dataset for all physicians between January 1, 2013, and December 31, 2017. We used population-averaged multivariable negative binomial regression to estimate the association between time and per-provider opioid and gabapentinoid prescribing rate, defined as the annual number of drug claims (original prescriptions and refills) per beneficiary, among oncologists and nononcologists on a national and state level. Results From 2013 to 2017, the national opioid-prescribing rate declined by 20.7% (P < .001) among oncologists and 22.8% (P < .001) among non oncologists. During this time frame, prescribing of gabapentin increased by 5.9% (P < .001) and 23.1% (P < .001) among oncologists and nononcologists, respectively. Among palliative care providers, opioid prescribe increased by 15.3% (P < .001). During the 5-year period, 43 states experienced a decrease (P < .05) in opioid prescribing among oncologists, and in 5 states, opioid prescribing decreased more among oncologists than nononcologists (P < .05). Conclusions Between 2013 and 2017, the opioid-prescribing rate statistically significantly decreased nationwide among oncologists and nononcologists, respectively. Given similar declines in opioid prescribing among oncologists and nononcologists, there is concern that opioid-prescribing guidelines intended for the noncancer population are being applied inappropriately to patients with cancer and cancer survivors.

Lack of Association Between Costs of Care and Overall Survival (OS) Among Medicare Beneficiaries with Myelodysplastic Syndromes (MDS) in the United States (US)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 873-873
Author(s):  
Amer M. Zeidan ◽  
Rong Wang ◽  
Amy J. Davidoff ◽  
Steven D. Gore ◽  
Pamela R Soulos ◽  
...  
Keyword(s):  
Research Funding ◽  
State Level ◽  
Refractory Anemia ◽  
Study Cohort ◽  
Hypomethylating Agents ◽  
Medicare Beneficiaries ◽  
Related Cost ◽  
Disability Status ◽  
One Year

Abstract Background: Blood products, supportive care, and hypomethylating agents (HMAs) are frequently used to improve outcomes of patients with MDS, and they may incur substantial costs. It is unclear whether disease-related costs of care are associated with OS in MDS patients. We evaluated the relationship between MDS-specific costs and survival among Medicare-enrolled beneficiaries with MDS in the US. Methods: The study cohort consisted of patients aged ≥66 years who were diagnosed with MDS (International Classification of Diseases for Oncology, 3rd edition, codes: 9980, 9982, 9983, 9985-7, 9989) between 1/1/2005 and 12/31/2011 in the linked Surveillance, Epidemiology, and End Results (SEER) - Medicare database. Only patients with continuous enrollment in Medicare Parts A and B from one year before MDS diagnosis through death or end of study follow up (12/31/2012) were included. OS was calculated from date of diagnosis to date of death, and patients alive at the end of the study were censored. Medicare payments were used to estimate costs and adjusted to 2012 US dollars. Cumulative costs in a matched group of cancer-free Medicare beneficiaries were subtracted from costs in the MDS cohort in each of the 12 SEER states to estimate MDS-related costs for each state. Comorbidities within one year before diagnosis were identified and used to calculate a modified Elixhauser comorbidity score and a disability status score (a proxy measure of performance status). We used 2-year OS for primary analysis as it was the major endpoint in several clinical trials evaluating MDS therapies. States were separated into 3 tertiles according to 2-year MDS-related costs per patient. Kaplan-Meier methods were used to compare OS probabilities at various time points, stratified by MDS-related cost groups (3 levels). Cox proportional hazard regression models were used to assess the impact of MDS-related costs (3 levels) on survival, controlling for age at diagnosis, sex, race, comorbidities, disability status, pre-diagnosis cost, median household income at the zip code level, "ever" use of HMA, and MDS histologic subtype. We also performed a sensitivity analysis involving patients who did not use any HMAs (HMA non-user subcohort) and separate analyses using 3-year MDS-related costs. Results: Of 24,347 patients diagnosed with MDS, 8,564 met eligibility criteria. Of those, 86.7% were white, 53.0% males, 52.5% ≥80 years at diagnosis, and 15.7% received hypomethylating agents (HMAs). By end of follow-up, 6,011 patients (70.2%) had died. Median follow-up was 1.57 years for all patients and 3.17 years for living patients. The 2-year OS was 48.7% and the median OS was 1.84 years. The median 2-year MDS-related cost of care per patient was $67,717 (California), and it ranged between $43,950 and $83,961 across 12 states. As expected, the costs were higher among HMA-users (Range: $109,447 - 156,156) than non-users (Range: $36,250 - 55,446). In a multivariate model of the entire study cohort, factors associated with improved survival included female gender, non-white race, younger age at diagnosis, refractory anemia and refractory anemia with ring sideroblasts histologic subtypes, pre-diagnosis health costs, and lower Elixhauser comorbidity and lower disability status scores. The 2-year state-level MDS-related cost was not associated with MDS survival [reference: lowest tertile, hazard ratio (HR) for middle tertile was 1.02, 95% confidence interval (CI): 0.93-1.12, p = 0.74, and HR for the highest tertile was 0.99, 95% CI: 0.92-1.06, p = 0.73] (Figure 1). Among the HMAs non-users (n=7,222), there was also no association between the 2-year MDS-related costs and MDS survival (Figure 2). When we conducted separate analyses using 3-year MDS-related costs, we observed no association between costs and survival in the overall study cohort or in the HMA non-user subcohort. Conclusions: Medicare expenditures for elderly patients with MDS varied substantially across states, but were not associated with overall survival. The lack of association between costs and outcome warrants additional research, as it may help identify potential areas for cost saving interventions without compromising outcomes. Figure 1. Survival of MDS patients by two-year state-level MDS-related costs per patient (in 3 levels); p=0.50. Figure 1. Survival of MDS patients by two-year state-level MDS-related costs per patient (in 3 levels); p=0.50. Figure 2. Survival of MDS patients who did not use any HMAs, by two-year state-level MDS-related costs per patient (in 3 levels); p = 0.15. Figure 2. Survival of MDS patients who did not use any HMAs, by two-year state-level MDS-related costs per patient (in 3 levels); p = 0.15. Disclosures Davidoff: Celgene: Consultancy, Research Funding. Gore:Celgene: Consultancy, Research Funding. Gross:21st-Century Oncology LLC: Research Funding; Johnson and Johnson: Research Funding; Medtronic: Research Funding. Ma:Incyte Corp: Consultancy; Celgene Corp: Consultancy.

scholarly journals 0654 Obstructive Sleep Apnea in Older Adults: Geographic Variation in CPAP Treatment

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A249-A250
Author(s):  
Y Yu ◽  
R S Levine ◽  
T J Braley ◽  
J F Burke ◽  
R D Chervin ◽  
...  
Keyword(s):  
Older Adults ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
State Level ◽  
Medicare Beneficiaries ◽  
Geographic Variations ◽  
Southern States ◽  
Cpap Treatment ◽  
Obstructive Sleep ◽  
Hospital Referral

Abstract Introduction Obstructive sleep apnea (OSA) is prevalent and consequential among older adults. Positive airway pressure (PAP) is likely to reduce associated morbidity, but adherence is inconsistent. Regional treatment variations that may reflect addressable differences in care are not sufficiently studied. We examined geographic variations in PAP treatment among older US adults. Methods A representative 5% sample of all Medicare beneficiaries, age 65+, enrolled in fee-for-service program in 2013 was analyzed. OSA diagnosis was defined by ICD-9 codes. PAP treatment was identified by HCPCS codes. Treatment adherence was defined as ≥2 HCPCS claims for PAP supplies on separate months. We examined state-specific proportions of Medicare beneficiaries with OSA who obtained PAP and showed adherence. Maps were created to represent state-specific proportions of beneficiaries who were treated and adherent, by quantiles. To examine more granular regional variations, we created maps representing hospital referral region (HRR)-specific proportions of treated among diagnosed, and adherent among treated. Scatterplots were used to identify the relationship between proportions of PAP treatment and adherence, by state. Results For the state-level data, PAP treatment and adherence rates were between 54%-87% and 59%-81%, respectively. Midwest states had higher CPAP treatment proportions (>80%), while Northeast, Southwest and Southern states had CPAP treatment rates <73%. State-level CPAP adherence showed similar patterns, with lowest rates in southern states and California (<70%). Within-state variability of treatment patterns were observed, especially along the east and the west coasts. A scatterplot revealed that state-level CPAP treatment and adherence rates were linearly correlated, with Washington D.C., NY and NJ ranked lowest. In contrast, MT, ND and VT had the highest treatment and adherence rates. Conclusion These data show substantial state-level and regional variability of CPAP treatment and adherence among Medicare beneficiaries. Some geographic areas may merit prioritization in efforts to improve OSA treatment and adherence. Support This study was supported by The American Sleep Medicine Foundation Strategic Research Award 115-SR-15

Public Health Implications of Google Searches for Sunscreen, Sunburn, Skin Cancer, and Melanoma in the United States

2018 ◽  
Vol 33 (4) ◽  
pp. 611-615 ◽  
Author(s):  
Zachary H. Hopkins ◽  
Aaron M. Secrest
Keyword(s):  
Public Health ◽  
United States ◽  
Skin Cancer ◽  
Search Engine ◽  
State Level ◽  
The United States ◽  
Google Trends ◽  
Search Term ◽  
Melanoma Incidence ◽  
Google Search

Purpose: Google Trends (GT) offers insights into public interests and behaviors and holds potential for guiding public health campaigns. We evaluated trends in US searches for sunscreen, sunburn, skin cancer, and melanoma and their relationships with melanoma outcomes. Design: Google Trends was queried for US search volumes from 2004 to 2017. Time-matched search term data were correlated with melanoma outcomes data from Surveillance Epidemiology and End Results Program and United States Cancer Statistics databases (2004-2014 and 2010-2014, respectively). Setting: Users of the Google search engine in the United States. Participants: Google search engine users in the United States. This represents approximately 65% of the population. Measures: Search volumes, melanoma outcomes. Analysis: Pearson correlations between search term volumes, time, and national melanoma outcomes. Spearman correlations between state-level search data and melanoma outcomes. Results: The terms “sunscreen,” “sunburn,” “skin cancer,” and “melanoma” were all highly correlated ( P < .001), with sunscreen and sunburn having the greatest correlation ( r = 0.95). Sunscreen/sunburn searches have increased over time, but skin cancer/melanoma searches have decreased ( P < .05). Nationally, sunscreen, sunburn, and skin cancer were significantly correlated with melanoma incidence. At the state level, only sunscreen and melanoma searches were significantly correlated with melanoma incidence. Conclusions: We conclude that online skin cancer prevention campaigns should focus on the search terms “sunburn” and “sunscreen,” given the decreasing online searches for skin cancer and melanoma. This is reinforced by the finding that sunscreen searches are higher in areas with higher melanoma incidence.

1521-P: State-Level Trends in Lower Extremity Amputations among U.S. Medicare Beneficiaries with Diabetes, 2000-2017

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1521-P
Author(s):  
LINDA J. ANDES ◽  
JESSICA HARDING ◽  
DEBORAH B. ROLKA ◽  
GIUSEPPINA IMPERATORE ◽  
YANFENG LI ◽  
...  
Keyword(s):  
Lower Extremity ◽  
State Level ◽  
Medicare Beneficiaries

scholarly journals National and State-Level Trends in Nontraumatic Lower-Extremity Amputation Among U.S. Medicare Beneficiaries With Diabetes, 2000–2017

Diabetes Care ◽  
2020 ◽  
Vol 43 (10) ◽  
pp. 2453-2459 ◽  
Author(s):  
Jessica L. Harding ◽  
Linda J. Andes ◽  
Deborah B. Rolka ◽  
Giuseppina Imperatore ◽  
Edward W. Gregg ◽  
...  
Keyword(s):  
Lower Extremity ◽  
State Level ◽  
Lower Extremity Amputation ◽  
Medicare Beneficiaries ◽  
Extremity Amputation

scholarly journals Beyond Black and White: Mapping Misclassification of Medicare Beneficiaries Race and Ethnicity

2020 ◽  
pp. 107755872093573
Author(s):  
Irina B. Grafova ◽  
Olga F. Jarrín
Keyword(s):  
Health Care ◽  
Health Disparities ◽  
Administrative Data ◽  
Home Health Care ◽  
Asian American ◽  
Minority Health ◽  
Health Care Disparities ◽  
State Level ◽  
Home Health ◽  
Medicare Beneficiaries

The Centers for Medicare and Medicaid Services administrative data contains two variables that are used for research and evaluation of health disparities: the enrollment database (EDB) beneficiary race code and the Research Triangle Institute (RTI) race code. The objective of this article is to examine state-level variation in racial/ethnic misclassification of EDB and RTI race codes compared with self-reported data collected during home health care. The study population included 4,231,370 Medicare beneficiaries who utilized home health care services in 2015. We found substantial variation between states in Medicare administrative data misclassification of self-identified Hispanic, Asian American/Pacific Islander, and American Indian/Alaska Native beneficiaries. Caution should be used when interpreting state-level health care disparities and minority health outcomes based on existing race variables contained in Medicare data sets. Self-reported race/ethnicity data collected during routine care of Medicare beneficiaries may be used to improve the accuracy of minority health and health disparities reporting and research.

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