2-year Panel Research Articles

Association of frailty with annual healthcare expenditures of older adults during cancer survivorship.

352 Background: Frailty contributes to healthcare expenditures. Cancer and its therapies can further increase or accelerate the rate of frailty. Addressing geriatric deficits contributing to frailty of older cancer survivors (ages 65+) could potentially reduce health expenditures. However, little is known about how frailty affects health expenditures during the continuing survivorship period, a period after initial treatment but before the end-of-life. Given that older adults with cancer can live for years, it is important to examine health expenditures during this period by levels of frailty. Methods: We used the 2-year longitudinal panels of the Medical Expenditure Panel Survey, a nationally representative survey, to identify cancer survivors who are likely in the continuing survivorship period. We created 5 cohorts who were surveyed in 2016, 2017, 2019, 2020, and 2021, and in the previous year. In each cohort, we selected older individuals with an invasive cancer diagnosis in both previous and current years who did not die in the current year. We pooled the cohorts to estimate annual healthcare expenditures, representing a cancer population of 11,802,386 in the US (n=2,206). We constructed a deficit accumulation frailty index using survey items and divided patients into 3 categories: robust, pre-frail, and frail. We used generalized linear regression to estimate the associations of frailty with annual healthcare expenditures during the continuing survivorship period for older adults, controlling for age, sex, race/ethnicity, marital status, immigration background, insurance coverage, family size, family income, and education. Costs were inflated to 2023 US dollars. Results: The per person annual healthcare expenditure among older adult survivors of all cancer types was $13499.13, $24698.77, and $34352.23 for those who were robust (75.2%), pre-frail (12.0%), and frail (12.8%), respectively, and being pre-frail and frail was associated with higher expenditures (P<0.001). In analyses by cancer type, being frail (vs. robust) was associated with higher expenditures for bladder (P<0.05), breast (P<0.01), cervical (P<0.01), and prostate (P<0.01) cancers. Pre-frail breast cancer patients also incurred more costs than those who were robust (P<0.01). Conclusions: Increased frailty was associated with higher annual healthcare expenditures among older cancer survivors during the continuing survivorship period. Addressing geriatric deficits and intervening to maintain function and prevent frailty progression during survivorship care could improve quality of life and reduce healthcare expenditures.

Decision-making involvement and onset of cognitive impairment in community-dwelling older care recipients: a 2-year longitudinal study.

The decision-making of older adults and people with dementia is attracting more attention among healthcare professionals. While cognitive impairment has been examined as a factor related to decision-making, it can also be assumed that involvement in decision-making leads to the maintenance of cognitive function. This study examined the association of the decision-making process with the onset of cognitive impairment. We analyzed data from a 2-year longitudinal panel survey of community-dwelling care recipients aged ≥65 years in Japan. The sample included 406 participants who responded to both baseline and follow-up surveys, were cognitively intact at baseline, and had no missing cognitive impairment data regarding onset at follow-up. The status of decision-making involvement was assessed using a single item and classified into four categories: 'very involved,' 'less involved,' 'unclear about desired care,' and 'having no one to share the decision.' Among the participants (women, 65.0%; ≥75 years old: 68.2%), the incidence of cognitive impairment during the follow-up was 26.6%. Multivariable logistic regression showed that, compared with highly involved participants, those who lacked clarity about desired care were more likely to develop an onset of cognitive impairment (odds ratio: 5.49; 95% confidence interval: 1.63-18.54; P = 0.006). Even among cognitively intact care recipients, those who are not able to formulate their desired care may be at risk of cognitive decline. Therefore, support for the decision-making process, not limited to the final decision, is essential to improving the prognosis of community-dwelling care recipients.

Body Uneasiness, Body Figure Perception, and Body Weight: Factor Structure and Longitudinal Measurement Invariance of a Set of Attitudinal and Perceptual Body Image Assessment Tools in Adolescents.

Body image is a multifaceted construct that includes attitudinal and perceptual components, but its attention has mainly been focused on the facet of body dissatisfaction. The present longitudinal study extended the validation of a multifacet attitudinal questionnaire, the Body Uneasiness Test (BUT), against perceptions of body shape and weight. A convenient sample of adolescents took part in a 2-year unbalanced panel study (5 waves). The participants completed the BUT questionnaire and selected their perceived actual, ideal, and reflected body figures along the Contour Drawing Rating Scale; ideal/actual and ideal/normative body mass index discrepancies were also included. After replicating the expected five-factor structure of the BUT items, results from confirmatory factor analysis revealed that the five BUT scales loaded on an attitudinal dimension, whereas the perceived body figures and the discrepancy indices were on a perceptive domain. Such a two-domain structure of body image measures showed gender and seasonal (1-year) measurement invariance, whereas longitudinal 6-month and 18-month invariance partially failed. Overall, the present findings support the validity of the Body Uneasiness Test in adolescence, further demonstrating a preliminary multidimensional structure of body image onto which attitudinal and perceptual body image-related measures were projected.

Lung function and air pollution exposure in adults with asthma in Beijing: a 2-year longitudinal panel study.

The effect of air pollution on the lung function of adults with asthma remains unclear to date. This study followed 112 patients with asthma at 3-month intervals for 2 years. The pollutant exposure of the participants was estimated using the inverse distance weight method. The participants were divided into three groups according to their lung function level at every visit. A linear mixed-effect model was applied to predict the change in lung function with each unit change in pollution concentration. Exposure to carbon monoxide (CO) and particles less than 2.5 micrometers in diameter (PM2.5) was negatively associated with large airway function in participants. In the severe group, exposure to chronic sulfur dioxide (SO2) was negatively associated with post-bronchodilator forced expiratory flow at 50%, between 25% and 75% of vital capacity % predicted (change of 95% CI per unit: -0.34 (-0.55, -0.12), -0.24 (-0.44, -0.03), respectively). In the mild group, the effect of SO2 on the small airways was similar to that in the severe group, and it was negatively associated with large airway function. Exposure to CO and PM2.5 was negatively associated with the large airway function of adults with asthma. The negative effects of SO2 were more evident and widely observed in adults with severe and mild asthma than in adults with moderate asthma. Patients with asthma react differently to air pollutants as evidenced by their lung function levels.

Beyond Prevalence: Annual Cumulative Incidence of Kidney Stones in the United States.

It is well documented that the prevalence of nephrolithiasis is increasing in adults in the United States over time. Approximately 11% of men and 7% of women have reported a lifetime history of nephrolithiasis in cross-sectional studies. However, the burden of acute management may be better assessed from annual cumulative incidence. This accounting of new stone occurrences, however, is not well described on a national scale. The Medical Expenditure Panel Survey is a set of large-scale health care utilization surveys of families, individuals, their health care providers and employers, with surveys administered every 6 months for the duration of each individual's 2-year panel. We queried the survey data of adult participants between 2005 and 2015, with analysis conducted with provided weights and strata to allow our findings to be representative of the civilian noninstitutionalized U.S. adult population. Those with diagnosed renal or ureteral calculi as noted by ICD-9 codes were included as our incident stone formers. In 2005, the mean age of stone formers was 45 years. Of stone formers 52.2% were male, 91% were White and 47.6% were in the Southern U.S. The incidence of stone occurrences was 0.6% (177/33,961 individuals, weighted to represent population of 1,923,322/296,185,002 individuals). By 2015, the mean age was 51.7 years, with 52% male, 83% White and 38.2% residing in the Southern U.S. Between 2005 and 2015, the overall incidence increased from 0.6% to 0.9% (p <0.001). Based on this large-scale, nationally representative analysis of adults in the United States, the estimated annual cumulative incidence of stone occurrence is approaching 1%. Moreover, this incidence appears to be increasing over time, rising from 0.6% in 2005 to 0.9% in 2015. These data may help to better anticipate the need for urological care for stone disease and direct resource distribution.

The Negative Effect of Smartphone Use on Academic Performance May Be Overestimated: Evidence From a 2-Year Panel Study

In this study, we monitored 470 university students’ smartphone usage continuously over 2 years to assess the relationship between in-class smartphone use and academic performance. We used a novel data set in which smartphone use and grades were recorded across multiple courses, allowing us to examine this relationship at the student level and the student-in-course level. In accordance with the existing literature, our results showed that students’ in-class smartphone use was negatively associated with their grades, even when we controlled for a broad range of observed student characteristics. However, the magnitude of the association decreased substantially in a fixed-effects model, which leveraged the panel structure of the data to control for all stable student and course characteristics, including those not observed by researchers. This suggests that the size of the effect of smartphone usage on academic performance has been overestimated in studies that controlled for only observed student characteristics.

Longitudinal associations of social group engagement with physical activity among Japanese older adults

BackgroundAlthough social group engagement (SGE) has been suggested to affect physical activity (PA) in older age, the longitudinal relationship between these variables is unclear. This study used 2-year panel data to investigate the link between changes in SGE and changes in PA among community-dwelling older adults. MethodsThis study was a 2-year community-based longitudinal study enrolling older adults living in a rural municipality in Japan. The subjects were all residents in the study area aged ≥ 65 at the baseline. Mail surveys were administered in 2016 and 2018. The 3688 subjects responding to both surveys were included in the analyses. PA was evaluated with the International Physical Activity Questionnaire, and weekly time and metabolic equivalent were computed. SGE was assessed in each wave and classified as consistent engagement (engagement reported in both surveys), new engagement (non-engagement at baseline and engagement at follow-up), leaving the group (engagement at baseline and non-engagement at follow-up), and consistent non-engagement (non-engagement in both surveys). Analysis of covariance was performed to examine the associations of changes in SGE with changes in PA. ResultsCompared with those with consistent non-engagement, who showed declines in every PA category, subjects with consistent engagement or new engagement showed significantly smaller changes in total PA, moderate-intensity PA, and brisk walking. Leaving the group (vs. consistent non-engagement) was associated with maintaining moderate-intensity PA. ConclusionsSGE helps to suppress the age-associated decline in PA in older age, with new engagement and continuous engagement, especially, mitigating decreasing PA.

PMU11 ASSOCIATION BETWEEN DEPRESSION AND HEALTHCARE EXPENDITURES AMONG STROKE SURVIVORS

Approximately 33% of stroke survivors suffer depression and depression is associated with disability, poor quality of life and mortality. However, assessments of association with healthcare expenditures among stroke survivors were not found. We examined association between depression and healthcare expenditures among stroke survivors. A retrospective cohort study was conducted using pooled data of 2-year panels from the 2012 through 2016 Medical Expenditure Panel Survey. The panel year-one was used to identify stroke survivors, depression diagnosis and baseline characteristics. The panel year-two was the follow-up period. Inclusion criteria were being 18 years old or older, and stroke diagnosis. Exclusion criteria were institutionalization or death. Stroke was identified based on having ICD-9 diagnosis codes (430 - 438), or ever being told by a healthcare provider they had a stroke. Depression was identified based on ICD-9 diagnosis codes (296, 300, 309 or 311) only, since there was no self-report of depression variable in the data. In-patient, out-patient, emergency room, prescription medicines and total healthcare expenditures were examined in panel year-two. Associations between depression and each expenditure category were estimated using a two-part Logit GLM model in STATA, to account for excess zeros and adjusting for age, sex, race, education, marital status, employment status, insurance type, region, income, perceived health, smoking status and comorbidity with an alpha of 0.05 for significance. The final sample (unweighted N = 1,498) was mostly female (58%) and non-Hispanic whites (48%); and 30% (95% CI = 27.9% - 32.6%) had depression. The mean (± standard deviation) age was 64 (± 14.4) years. Depression was associated with an average increment of $3,275 (95% CI = $1,157- $5,393) in prescription expenditures (p=0.003). Depression was not associated with in-patient, out-patient, emergency room, or total healthcare expenditures. Depression in stroke survivors was associated with increased prescription expenditure, but not other expenditures.

Assessing Health Care Burden in Glaucoma Patients with and Without Physical or Mental Comorbidities.

Glaucoma is a collection of eye diseases that damage the eye's optic nerve resulting in vision loss and blindness. Treatment for glaucoma is primarily pharmacologic; however, studies have shown patients have difficulty adhering to topical regimens. The reasons for potentially poor adherence are numerous, including influence from a myriad of either physical or mental comorbid conditions faced by many glaucoma patients. Neither adherence nor associated outcomes have been estimated in these 2 groups of glaucoma patients. To (a) characterize glaucoma patients with and without select physical or mental comorbidities and (b) estimate differences between the 2 groups for 3 types of outcomes: health care resource use (HCRU; office-based/outpatient-based provider visits, emergency room visits, inpatient stays, home health provider days, prescription fills); health care expenditures; and health-related quality of life (HRQoL) as measured by the physical and mental component scores of the Short Form-12. We used first-year data from each glaucoma patient's 2-year panel survey in the Medical Expenditure Panel Survey (MEPS) database, 2003-2014. Two groups were created using ICD-9-CM codes collected by MEPS to compare glaucoma patients with and without at least 1 selected physical or mental comorbid condition. Between-group comparisons in the outcomes of interest (HCRU, expenditure, HRQoL) were estimated using multivariable regression analyses while adjusting for socio-demographic and clinical characteristics at baseline. We identified 2,928 unique glaucoma patients during the 11 years of collected data, including 1,539 (53%) who had at least 1 physical or mental comorbid condition of interest. Comparing those with at least 1 select physical or mental comorbidity to those without (n = 1,389), unadjusted HCRU and expenditures were greater in patients with a physical or mental comorbidity (all P < 0.05). After adjustment, significant associations with increased HCRU remained for office-based provider visits and home health provider days (each P < 0.01). Average total expenditures were $12,324 in those with comorbidities and $8,590 for those without. HRQoL (unadjusted and adjusted) was lower in those with a physical or mental comorbid condition (all P < 0.05). Some differences in HCRU and expenditures were accounted for by differences in baseline characteristics between those with and those without 1 or more physical or mental comorbid conditions, but differences remained after adjustment. Results suggest that glaucoma patients with physical and mental comorbidities may experience greater HCRU and associated expenditures, and lower HRQoL, when compared with glaucoma patients without these comorbidities With this knowledge, future work may include estimating the effect of the number of these comorbid conditions on each of the 3 types of outcomes. This study received funding support from Allergan. During the time this work was conducted, Serbin was a postdoctoral fellow who was supported by a training grant from Allergan to the University of Washington. Campbell is an employee of Allergan. Serbin, Devine, and Basu each have nothing to disclose. This study was presented as a poster at the International Society for Pharmacoeconomics and Outcomes Research Meeting; May 20-24, 2017; Boston, MA.

Credit and Ethnic Consumption Inequality in the Central Highlands of Vietnam

Credit is commonly considered an important instrument to relieve financial capital constraints of poor households and subsequently to improve their welfare. However, the empirical impact of credit on consumption inequality remains ambiguous. We use a 2-year panel dataset collected in Daklak, a province in the Central Highlands of Vietnam, to investigate the differences in access to credit and its impact on household consumption and consumption inequality between ethnic groups. Our results show that the differences in access to credit and in its impacts on household consumption between the ethnic majority and the migrant ethnic minority groups are insignificant. However, households from the indigenous ethnic minority group face more disadvantages in accessing formal credit and rely more on informal credit than those from the ethnic majority. They also face a higher collateral ratio and the amount of formal loans they could access is lower. The impact of formal credit on consumption of the majority is also higher than that of the indigenous minority, consequently causing a significant increase in consumption inequality between the ethnic groups. Our findings call for assistance programs to support indigenous households to improve their access to formal credit as well as to enhance the effectiveness of these loans.

Multiple shocks and households' choice of coping strategies in rural Cambodia

A detailed understanding of households' shock-coping capacity is needed to design appropriate social safety net programs and interventions. We use a 2-year panel dataset from rural Cambodia to seek answers to the following research questions: (i) are rural households forced to reduce their consumption due to shocks? and (ii) what are the factors affecting households' choice of shock-coping strategies in response to shocks? The results of econometric models reveal that most covariate shocks have significant and negative effects on household consumption. In particular, total consumption expenditure and food consumption expenditure are negatively affected by floods, whereas household education expenditure is negatively affected by livestock diseases. These shocks also force households to use coping strategies of selling durable assets and extracting natural resources. Although droughts appear not to significantly affect household consumption, these shocks push households into using child labor, selling durable assets or extracting natural resources. Household consumption is shown to be not significantly affected by health shocks. Borrowing and receiving assistance from friends and relatives are identified as major coping strategies in response to health shocks. Our findings call for assistance programs to support households in preventing and mitigating the effects of floods, droughts and livestock diseases.

Associations between structures and resources of primary care at the district level and health outcomes: a case study of diabetes mellitus care in Thailand

BackgroundThe structural factors of primary care potentially influence its performance and quality. This study investigated the association between structural factors, including available primary care resources and health outcomes, by using diabetes-related ambulatory care sensitive conditions hospitalizations under the Universal Coverage Scheme in Thailand.MethodsA 2-year panel study used secondary data compiled at the district level. Administrative claim data from 838 districts during the 2014–2015 fiscal years from the National Health Security Office were used to analyze overall diabetes mellitus (DM) hospitalizations and its three subgroups: hospitalizations for uncontrolled diabetes, short-term complications, and long-term complications. Primary care structural data were obtained from the Ministry of Public Health. Generalized estimating equations were used to estimate the influence of structural factors on the age-standardized DM hospitalization ratio.ResultsA higher overall DM and uncontrolled diabetes hospitalization ratio was related to an increasing concentration of outpatient utilization (using the Herfindahl–Hirschman Index) (overall DM; beta [standard error, SE]=0.003 [0.001], 95% CI 0.000, 0.006) and decreasing physician density and bed supply (overall DM; beta [SE]=−1.350 [0.674], 95% CI −2.671, −0.028), beta [SE]=−0.023 [0.011], 95% CI −0.045, −0.001, respectively). Hospitalizations for short-term complications increased with a decrease in health care facility density, whereas hospitalizations for long-term complications increased as that density increased. Rurality was strongly associated with higher hospitalization ratios for all DM hospitalizations except short-term complications.ConclusionsThis study identified structural factors associated with health outcomes, many of which can be changed through reorganization at the district level.

Opioid Prescription Patterns for Adults With Longstanding Disability and Inflammatory Conditions Compared to Other Users, Using a Nationally Representative Sample

ObjectivesTo investigate the opioid prescription patterns for adults with longstanding physical disability and inflammatory conditions, compared to a mixed group of other opioid users, after excluding cancer patients. DesignNationally representative cross-sectional study, 2010-2014. SettingMedical Expenditure Panel Survey (MEPS). ParticipantsThe participants (N=7134) were adults who participated in MEPS and had at least 1 opioid prescription, did not have cancer, and were between 18 years and 64 years of age. The participants were grouped as longstanding physical disability (group 1), inflammatory conditions (group 2), and a mixed group with at least 1 opioid prescription during the 2-year study period (comparison group). Participants with both groups of conditions were excluded. InterventionsNot applicable. Main Outcome MeasureMorphine milligram equivalent (MME) doses for each participant were cumulated over a 2-year panel period. ResultsBy using quantile regression, cumulative MME in groups 1 and 2 was higher than the comparison group across all the percentiles, and differences between condition groups and comparison group became larger in higher percentiles. Participants in group 1 had the highest cumulative MME in 75th and 90th percentiles after controlling for other covariates. ConclusionsThis study documented the opioid prescription patterns for patients with longstanding physical disability or inflammatory conditions. All indexed groups (groups 1 and 2) had higher MME use compared to the comparison group.

PHP25 - Pharmaceutical Expenditures, out of Pocket Costs, and Impact of Provider Factors: Intersection of Health Economics and the Marketing Mix

Community/Retail pharmacies accounted to 168,624 million U.S. dollars of pharmaceutical expenditures in 2013. The purpose of this study was to summarize and determine the extent to which pharmaceutical expenditures are affected by various market segments. Pharmaceutical expenditures and out of pocket costs should be conditioned on participation, due to the large zero outcomes. Thus, predictors of pharmaceutical expenditures can be best evaluated as segments of a market (usage, business type, or consumer), with health economic spending behavior, conditioned on the marketing mix (predicting pharmaceutical purchase event). A retrospective, 2-year panel study design was used, and conducted using data from the 2013-14 Medical Expenditures Panel Survey (MEPS) to analyze pharmaceutical events. A fixed effects, two-part model with clustered, robust standard errors was used to analyze pharmaceutical expenditure by controlling for the complex, stratified, weighted, clustered sample design. The outcome measure was total prescription drug expenditures and patient level out of pocket costs; the key predictor used was pharmacy provider (online, mail order, retail, hospital/HMO/clinic, and store). Individuals who used online and mail order pharmacies were slightly more likely (5-20%) to have out of pocket costs on their medications; while those who used hospital/clinic based pharmacies or retail, or store based pharmacies were 10-20% less likely to have out of pocket costs. Insurance-based incentives are likely to have a major role in pharmaceutical expenditures and utilization of various pharmacy provider types, due to the various tiers of pharmaceutical coverage. Online pharmacies resulted in increased pharmaceutical expenditures, likely due to the increased use of these pharmacies for high cost medications. This paper illustrated how pharmaceutical expenditures are affected by numerous market factors, including patient characteristics, pharmacy type, and medication characteristics. The use of a two-part model had high predictive value for predicting the presence of pharmaceutical expenditures.

Experiencing Financial Hardship Associated With Medical Bills and Its Effects on Health Care Behavior: A 2-Year Panel Study.

Using 2-year panel data, this study examined (1) whether experiencing financial hardship associated with out-of-pocket medical expenditures affected delaying/missing necessary health care in the following year; (2) whether such financial hardship mediated the effects of predisposing, enabling, and need characteristics on timely health care access (i.e., significant indirect effects); and (3)whether such mediating effects are different by chronic health status (i.e., moderated mediation) among U.S. adults. The 2011 National Health Interview Survey was linked to the 2012 Medical Expenditure Panel Survey. The sample includes 8,993 adults aged between 26 and 64 years. Among them, 1,089 reported having at least one chronic health condition that had caused activity limitations. Multiple-group path analysis was conducted using Mplus 7.2. Approximately 35% experienced financial difficulties paying medical bills, including 28% who were currently paying off medical debts. Almost 14% of the respondents reported delayed/missed necessary medical treatments. In addition to direct effects, predisposing, enabling, and need factors affected access to care indirectly via financial hardship, although significant moderated mediation was found by chronic health status. However, different from the Andersen's behavioral model of health service utilization, the effect of financial hardship due to medical bills as a barrier to the timely use of necessary health services was not smaller among adults with chronic health conditions. Policy alternatives should be explored to provide affordable financing programs and adequate safety net health services to reduce the financial burden of health care for those who are financially vulnerable, especially those suffering from chronic health conditions.

Temporary Employment and the Future Labor Market Status

The aim of this article is to describe and explain the development of temporary employment in Sweden between 1992 and 2010, and to investigate the effect of temporary employment for individuals’ future career on the labor market. The article analyzes temporary employees’ status transitions on the labor market using Swedish Labour Force Survey (LFS) data for the period 1992–2010. Each cohort consists of 2-year panels and focuses on changes between the first and last measuring points. The findings indicate that the specific type of temporary employment is crucial as regards whether or not it constitutes a stepping-stone toward permanent employment. The chances are greater in the case of, for example, substitutes, but are considerably less in the case of on-call employment. Certain types of temporary employment thus seem to be used by the employer to screen the employability of the employee, while others are used for achieving flexibility

Temporary Employment and the Future Labor Market Status

&lt;div class="page" title="Page 1"&gt;&lt;div class="layoutArea"&gt;&lt;div class="column"&gt;The aim of this article is to describe and explain the development of temporary employment in Sweden between 1992 and 2010, and to investigate the effect of temporary employment for individuals’ future career on the labor market. The article analyzes temporary employees’ status transitions on the labor market using Swedish Labour Force Survey (LFS) data for the period 1992–2010. Each cohort consists of 2-year panels and focuses on changes between the first and last measuring points. The ndings indicate that the specific type of temporary employment is crucial as regards whether or not it constitutes a stepping-stone toward permanent employment. The chances are greater in the case of, for example, substitutes, but are considerably less in the case of on-call employment. Certain types of temporary employment thus seem to be used by the employer to screen the employability of the employee, while others are used for achieving flexibility &lt;/div&gt;&lt;/div&gt;&lt;/div&gt;

South African Labour Market Transitions Since the Global Financial and Economic Crisis: Evidence from two Longitudinal Datasets

This paper studies individual labour market mobility and its determinants in South Africa since 2008 using two large, nationally representative longitudinal datasets: a set of 2-year panels based on the National Income Dynamics Study (NIDS) and quarter-to-quarter matched Quarterly Labour Force Survey (QLFS) cross-sections. We find considerable mobility in the South African labour market, with men and women transitioning in and out of employment and between different forms of employment and non-employment, both in the short and medium run. Our econometric analysis shows that at least part of this mobility is explained by demand-side factors outside of individuals’ direct control. Matric or post-matric level education and, to some extent, older age increased workers’ job security, above and beyond the influence of other, job-related variables. Higher education also helped individuals find jobs, independent of their initial labour market status and earlier work experience. On the whole, our findings suggests that in South Africa labour market segmentation manifests itself through selective rather than indiscriminate rigidities: higher-educated and/or more experienced labour market participants more easily break through the barriers to entry into the most valued jobs and, once there, benefit more from downward rigidity in the labour market than others. We further show how, following the global financial and economic crisis, short-term labour market mobility gradually decreased and segmentation became somewhat less selective on the level of education.

Low-Cost Generic Program Use by Medicare Beneficiaries: Implications for Medication Exposure Misclassification in Administrative Claims Data.

BACKGROUND: Administrative claims data are used for a wide variety of research and quality assurance purposes; however, they are prone to medication exposure misclassification if medications are purchased without using an insurance benefit. Low-cost generic drug programs (LCGPs) offered at major chain pharmacies are a relatively new and sparsely investigated source of exposure misclassification. LCGP medications are often purchased out of pocket; thus, a pharmacy claim may never be submitted, and the exposure may go unobserved in claims data. As heavy users of medications, Medicare beneficiaries have much to gain from the affordable medications offered through LCGPs. This use may put them at increased risk of exposure misclassification in claims data. Many high-risk medications (HRMs) and medications tracked for adherence and utilization quality metrics are available through LCGPs, and exposure misclassification of these medications may impact the quality assurance efforts reliant on administrative claims...

Intestinal infection associated with future onset of an anxiety disorder: Results of a nationally representative study

Recent research involving mice suggests a possible relationship between intestinal infection and future anxiety-like behavior. However, there has been little epidemiological research showing such a connection in humans. This study uses the Medical Expenditure Panel Survey (MEPS) to assess longitudinally the association between intestinal infection and later onset of an anxiety disorder, through a nationally representative sample. Six 2-year panel datasets, each comprised of 5 consecutive rounds, were pooled from 2007 to 2013 to gather records for all respondents 18years of age or older that did not have an anxiety disorder in Round 1 (n=63, 133 people). Within the study sample, there were 2577 individuals with an intestinal infection in Round 1 and 4239 individuals with an anxiety disorder that began in Round 2, 3, 4, or 5. Overall, intestinal infection in Round 1 was associated with a 1.34 (P<0.01) odds ratio of having an anxiety disorder that began in Round 2, 3, 4, or 5. Separate analyses were performed to determine whether the association applied to other infection types, including respiratory infection, urinary tract infection, hepatitis infection, and skin infection. Respiratory infection was associated with a 1.36 (P<0.01) odds ratio of having an anxiety disorder that began in Round 2, 3, 4, or 5; no other infection type showed a significant association. More research on human populations is needed to examine the apparent association and explore potential mechanisms by which gut pathogens might influence anxiety.