­­Access to Health Insurance and Treatment Utilization for Opioid Use Disorder: Evidence From State Medicaid Expansions

Background. Medicaid is a major payer of substance use disorder treatment, yet the impact of Medicaid expansion on the opioid epidemic has not been sufficiently quantified. This study exploits state-level differences in Medicaid expansion to assess the impact of access to health insurance on treatment utilization for opioid use disorder (OUD) for adults in need.Method. We use admissions data from Treatment Episode Data Sets (TEDS) to fit a multivariate difference-in-difference model, with non-expanding states as controls, adjusting for age, gender, race/ethnicity, education, and other state-level factors. Results. Medicaid expansion led to substantial gain in OUD treatment utilization. Admissions for substance use disorder among Medicaid beneficiaries increased by 20-33 percentage points in expansion states. Admissions were significantly higher for the newly eligible Medicaid beneficiaries in the 30-34 age group. We also see an increase in treatment admissions for opioid and heroin use among the elderly over the age of 55. Uninsurance rates show a commensurate decline in the expansion states. Finally, we do not find strong evidence of crowding-out of private insurance. Conclusions. Overall, our findings suggest that Medicaid expansions had a positive impact on the financing and utilization of opioid use treatment.

Prevalence, predictors, and treatment of eating disorders in children: a national study

Background Although the prevalence rates of preadolescent eating disorders (EDs) are on the rise, considerably less is known about the correlates and treatment of EDs in this age group. Clarifying the epidemiology of EDs in preadolescent children is a necessary first step to understand the nature and scope of this problem in this age group. Methods Analysis of data collected in the ABCD Study release 2.0.1. The ABCD cohort was a population-based sample that consisted of 11 721 children ages 9–10 years. Measures included reports of a lifetime and current mental disorders determined using a diagnostic interview for DSM-5 disorders, sociodemographic factors, and psychiatric treatment utilization. Results The lifetime prevalence of EDs was 0.95%. Being Black, multiracial, having unmarried parents, and family economic insecurity were significant predictors for developing an ED. Among psychiatric conditions, the major depressive disorder was most robustly associated with EDs in both cross-sectional and temporal analyses. Only 47.40% of children who had a lifetime ED received some type of psychiatric treatment. EDs were not a significant predictor of psychiatric treatment utilization after accounting for sex, sexual orientation, parent marital status, economic insecurity, and all other psychiatric diagnoses. Conclusions Despite increasing prevalence rates of preadolescent EDs, the current findings suggest that the majority of children with these disorders remain untreated. Devoting increased attention and resources to reaching families of children with EDs with the least means for receiving care, and screening for EDs in children with depression, may be important steps for reducing this unmet need.

Treatment Utilization and Characteristics Among Patients with Higher-Risk Myelodysplastic Syndromes According to Hypomethylating Agent Use

Introduction: Hypomethylating agents (HMAs) are standard of care treatment for patients with higher-risk myelodysplastic syndromes (HR-MDS) who are ineligible for stem-cell transplantation or intensive chemotherapy. Until recently, approved HMAs included intravenous or subcutaneous azacitidine and decitabine, which should be administered for a minimum of 4-6 cycles to elicit response in the absence of progression or unacceptable toxicity. In real-world clinical practice, underutilization of HMA therapy has been documented; however, prior estimates have utilized data preceding 2016. The study objectives were to understand recent treatment utilization and characteristics among patients newly diagnosed with HR-MDS in the United States (US). Methods: This retrospective observational study utilized the IQVIA PharMetrics ® Plus database which comprises adjudicated claims for more than 190 million unique patients across the US. Adult patients newly diagnosed with HR-MDS from July 1, 2016 through December 31, 2019 were included. Patients had ≥1 inpatient claim or ≥2 outpatient claims >60 days apart with diagnosis codes for high grade MDS lesions and/or refractory anemia with excess blasts (RAEB), and continuous enrollment for 6 months prior to and ≥180 days following the index date (index date = first diagnosis claim). Patients had a variable follow-up period up to 1 year post-index, and were followed through June 30, 2020. Patient characteristics at baseline, and treatment utilization based on observed MDS-related therapy (HMAs and supportive care), over the variable follow-up period were evaluated. Results: A total of 371 patients were included; the mean age of patients at baseline was 69.2 years and 57.7% were male. Of these, 61 (16.4%) patients received no HMA and no supportive care over the variable follow-up period following diagnosis. Half (n=182, 49.1%) received no HMA but received supportive care, and the remainder (n=128, 34.5%) received HMA therapy over the variable follow-up period; 45 (12.1%) received decitabine as the first HMA in a mean of 89.2 days from diagnosis, and 83 (22.4%) received azacitidine as the first HMA in a mean of 51.1 days from diagnosis (Table). Patients receiving no HMA therapy but with supportive care were older (mean age 70.6 years; 45.6% aged ≥75 years) and had higher comorbidity burden (mean Charlson Comorbidity Index [CCI] 2.5) than the other cohorts (mean age 66.6-68.8 years; 24.4-37.7% aged ≥75 years; CCI 1.2-2.0). For example, a higher proportion of patients receiving no HMA therapy but with supportive care had baseline renal disease (21.4%) compared to the other cohorts (4.9-15.6%). Patients receiving no HMA or supportive care in this study had a similar mean age compared to those who received HMAs (68.8 vs 66.6-68.0 years), but tended to have lower comorbidity burden (CCI 1.2 vs 1.9-2.0). Conclusions: In this real-world study using contemporary data, utilization of HMA therapy among patients with HR-MDS in the US was low, with only around one-third of patients receiving HMAs. Patients who did not receive HMAs but received supportive care tended to be older and have higher comorbidity burden than those who received HMAs, suggesting potential barriers for physicians in prescribing HMAs to older, frailer patients. Figure 1 Figure 1. Disclosures Zeidan: Pfizer: Other: Travel support, Research Funding; Jazz: Consultancy; Jasper: Consultancy; AstraZeneca: Consultancy; Janssen: Consultancy; Novartis: Consultancy, Other: Clinical Trial Committees, Travel support, Research Funding; Loxo Oncology: Consultancy, Other: Clinical Trial Committees; Ionis: Consultancy; Kura: Consultancy, Other: Clinical Trial Committees; Incyte: Consultancy, Research Funding; Gilead: Consultancy, Other: Clinical Trial Committees; Genentech: Consultancy; Epizyme: Consultancy; Daiichi Sankyo: Consultancy; Geron: Other: Clinical Trial Committees; BMS: Consultancy, Other: Clinical Trial Committees, Research Funding; Cardiff Oncology: Consultancy, Other: Travel support, Research Funding; Boehringer Ingelheim: Consultancy, Research Funding; BioCryst: Other: Clinical Trial Committees; BeyondSpring: Consultancy; Astex: Research Funding; Astellas: Consultancy; Aprea: Consultancy, Research Funding; Amgen: Consultancy, Research Funding; Agios: Consultancy; ADC Therapeutics: Research Funding; Acceleron: Consultancy, Research Funding; AbbVie: Consultancy, Other: Clinical Trial Committees, Research Funding. Divino: IQVIA: Current Employment, Other: IQVIA received funding for this study from Epstein Health in connection with this study. DeKoven: IQVIA: Current Employment, Other: IQVIA received funding for this study from Epstein Health in connection with this study. Shah: IQVIA: Current Employment, Other: IQVIA received funding for this study from Epstein Health in connection with this study. Wang: IQVIA: Current Employment, Other: IQVIA received funding for this study from Epstein Health in connection with this study. Bey: Taiho Oncology: Current Employment. Salimi: Taiho Oncology: Current Employment. Epstein: Epstein Health: Current Employment; Fate Therapeutics: Other: Holds leadership position; Veracyte: Other: Holds leadership position; Illumina: Other: Holds leadership position; Merck: Consultancy; Radius Health: Consultancy; Halozyme: Consultancy; Intra-Cellular Therapies: Consultancy; Taiho Oncology: Consultancy; Otsuka: Consultancy.

Oral Health Status, Oral Hygiene Practices, and Factors Affecting Dental Treatment Utilization among Pregnant Women in Dubai

<b><i>Objective:</i></b> Oral health is an integral part of preventive healthcare for pregnant women. This study aimed to determine the oral health problems and oral hygiene practices and identify the factors affecting dental treatment utilization among a representative population of pregnant women in Dubai. <b><i>Methods:</i></b> A cross-sectional study was conducted using data from anonymous structured questionnaires filled by 1,450 pregnant women attending primary health centers across different geographical locations in Dubai. <b><i>Results:</i></b> Of the 1,450 women, 97.8% brushed at least once a day. At least one dental problem during pregnancy was reported by 49.9%, but dental attendance during pregnancy was only 17.4%. Factors associated with dental visits were nationality, previous pregnancy, oral health problems, brushing habits, routine dental visits, and professional advice on oral care. The odds of dental attendance increase for UAE national women by 1.48, women who had other children before the current pregnancy by 1.35, those having oral health problems by 1.85, those who brush more than once a day by 1.51, those who visited the dentist routinely at least once a year by 1.92, and those who received oral health education by 2.82. The most cited reasons for not going to the dentist were no perceived dental problem (51.8%) and concerns regarding the safety of dental treatment during pregnancy (33.9%). <b><i>Discussion/Conclusion:</i></b> In spite of acceptable oral hygiene practices, a significant number of pregnant women (49.9%) experience dental problems. However, only a few women (17.4%) visit the dentist during their pregnancy. It is critical to design and implements strategic oral health programs for pregnant women in Dubai.