Claims Analysis Research Articles

Trends in adolescent and adult vaccination in pharmacy and medical settings in the United States, 2018–2024: a database study

ABSTRACT Background Pharmacies can increase access to vaccines. This study aimed to describe US trends in the proportion of adolescent and adult vaccinations administered in pharmacies from 2018 to 2024. Research design and methods Retrospective cross-sectional analysis of medical and pharmacy claims from commercial health insurance enrollees. We recorded vaccinations received by enrollees ≥9 years of age from 2018 to 2023 (routine vaccines) or 2024 (seasonal vaccines). We calculated the annual proportion of vaccinations occurring in pharmacies, and the accumulated percent change in vaccination rate during each year from 2020 onward compared to 2018–2019. Results The proportion of routine vaccinations occurring in pharmacies was higher among adults than among adolescents. For most routine vaccines, this proportion increased during the study period. The lowest proportion was observed for adolescent human papillomavirus vaccination in 2018 (0.2%), and the highest for herpes zoster vaccination among adults ≥65 years of age in 2023 (88.6%). For all age groups, pharmacy-based vaccination was more common for seasonal influenza and SARS-CoV-2 vaccines than for all routine vaccines except herpes zoster. Conclusions Pharmacy-based vaccination is increasingly common in the US, particularly among adults and for seasonal vaccines, and can help increase the overall level of vaccine uptake.

Antiseizure medication prescribing in people with Dravet syndrome: An analysis of real-time administrative data.

Since 2018, three new antiseizure medications (ASMs) received FDA approval for Dravet syndrome (DS) in the U.S: cannabidiol, stiripentol, and fenfluramine. Yet, the uptake of these ASMs in routine clinical practice is unknown. We use new ICD-10 codes for DS (implemented in 2020) to estimate ASM receipt in patients with DS. We analyzed the TriNetX Network, a real-time electronic health record-based dataset linked to prescription data encompassing all 50 states of the U.S. After identifying patients with health care encounters for DS in 2021 and 2022 (via ICD-10 codes), we examined ASM prescribing in the year following a DS claim: 2022 and 2023, respectively. We retrieved 387 and 451 patients receiving claims for DS in 2021 and 2022, respectively. Clobazam, diazepam, valproate, midazolam, clonazepam, levetiracetam, and cannabidiol were the most common ASMs used (29%-44%). Stiripentol and fenfluramine prescribing was limited (7%-16%); these two ASMs, considered second-line therapies in DS, were prescribed less often than ASMs considered third-line or beyond. Cannabidiol, stiripentol, and fenfluramine prescribing rates remained nearly identical in the 2021 and 2022 cohorts. Our data suggests that stiripentol, fenfluramine, and, to an extent, cannabidiol may be underused in a large, diverse, primarily U.S.-based population of patients with DS. PLAIN LANGUAGE SUMMARY: In an analysis of routinely-collected health care claims in the U.S., we found that the uptake of new antiseizure medications for Dravet Syndrome (i.e., stiripentol, fenfluramine, and cannabidiol) has been limited since 2022. Even though stiripentol and fenfluramine are considered second-line treatments for Dravet syndrome, we found they were prescribed less frequently than medicines considered third-line or beyond. These findings raise concern for underutilization of new antiseizure medications for Dravet syndrome in the United States.

Clinical and economic outcomes with rivaroxaban versus warfarin in patients with nonvalvular atrial fibrillation and obstructive sleep apnea: retrospective analysis of US healthcare claims.

Atrial fibrillation (AF) and obstructive sleep apnea (OSA) are often comorbid and associated with increased risk of cardiovascular events such as stroke. We evaluated the effectiveness, safety, healthcare resource utilization, and costs of rivaroxaban versus warfarin in patients with nonvalvular AF (NVAF) and comorbid OSA. We used the IQVIA PharMetrics® Plus adjudicated claims database to evaluate patients with NVAF, OSA, and moderate-to-severe stroke risk who initiated rivaroxaban or warfarin between November 2011 and December 2022. We adjusted for potential confounders with propensity score overlap weighting. Primary endpoints were evaluated based on intent-to-treat (ITT) and on-treatment follow-up to compare stroke or systemic embolism risk, major bleeding risk, all-cause healthcare resource utilization (inpatient hospitalizations, emergency department visits, outpatient visits, and pharmacy fills), and costs (per patient per year [PPPY]) by treatment cohort. In total, 14,765 patients were included (9133 received rivaroxaban; 5632 received warfarin). Rivaroxaban significantly reduced stroke or systemic embolism versus warfarin by 26% (ITT-hazard ratio, 0.74 [95% CI 0.60-0.91]; P = 0.004) and 30% (on-treatment-hazard ratio, 0.70 [95% CI 0.55-0.89]; P = 0.004). Major bleeding was not significantly different between rivaroxaban and warfarin in either analysis. All-cause healthcare resource utilization was significantly reduced with rivaroxaban versus warfarin, leading to significantly reduced PPPY costs. Among patients with NVAF and OSA, rivaroxaban was associated with a significant reduction in stroke or systemic embolism risk versus warfarin with no difference in major bleeding. Rivaroxaban significantly reduced healthcare resource utilization and costs compared with warfarin, providing support for the use of rivaroxaban in this population.

Epidemiology of narcolepsy and idiopathic hypersomnia in Japan: A retrospective analysis of health insurance claims from the Japan Medical Data Center

BackgroundEstimation of prevalence and incidence of narcolepsy and idiopathic hypersomnia (IH) is challenging owing to symptomatic overlap, underdiagnosis, and misdiagnosis, and epidemiological data are lacking in Asian populations. We estimated the prevalence and incidence of narcolepsy and IH in Japan. MethodsThe Japan Medical Data Center (JMDC) database includes healthcare claims data for employed individuals ≤74 years of age. Narcolepsy and IH cases were defined by ≥2 diagnosis codes within 12 months, or a multiple sleep latency test with ≥1 diagnosis code within 12 months. Estimated point-prevalences of diagnosed narcolepsy and IH were calculated for December 31, 2019. Incidences of narcolepsy and IH were estimated for the period January 1, 2014 to December 31, 2019. ResultsOf 7,075,869 individuals enrolled in the database on December 31, 2019, 6,110,751 (86.4 %) had ≥12 months’ continuous enrollment and were eligible for inclusion in the prevalence population. Age-sex standardized overall prevalences of narcolepsy and IH were 37.5 (95 % confidence intervals 35.9–39.1) and 7.7 (7.0–8.4) per 100,000 persons, respectively. Prevalence for both conditions peaked at age 20–29 years and declined with increasing age. Age-sex standardized overall incidences of narcolepsy and IH were 5.1 (4.8–5.4) and 1.2 (1.0–1.5) per 100,000 person-years, respectively. Narcolepsy and IH incidences peaked in the 10–19 and 20–29 years age groups then declined with increasing age. ConclusionsThis claims-based study provides updated estimates for the prevalence and incidence of narcolepsy in Japan, and the first estimates for prevalence and incidence of IH in Japan.

Insurer green financing for a supply chain under cap-and-trade regulation: a capped call contingent claim analysis

This paper introduces a contingent claim analysis to examine sustainable insurance practices. It investigates how life insurers participate in sustainable lending by financing borrowing firms committed to environmentally friendly practices for cleaner production. We establish a capped call option model, where the capped function explicitly considers credit risks associated with borrowing firms in a supply chain engaged in the cap-and-trade mechanism regulated by environmental policies. Our findings reveal that tightening the cap within the cap-and-trade system and reducing green loans can enhance insurer’s interest margins. Conversely, an escalation in the green input ratio across the supply chain may reduce these margins for the insurer. However, reducing low-margin insurance offerings could jeopardize the stability of insurance. The insurer faces financial challenges while supporting borrowing firms in their efforts toward carbon reduction and sustainable production. Notably, the substantial impact of climate change fueled by carbon emissions significantly influences the underwriting of life insurance policies related to human health. Policymakers need to navigate these intricacies to establish a careful balance between environmental objectives and the financial stability of sustainable insurance.

Characteristics and Management of Uncontrolled Gout Prior to Pegloticase Therapy: A 2-year Claims Analysis.

Gout is a progressive form of arthritis that causes significant pain and disability. Patients with treatment-refractory (or uncontrolled) gout experience a higher prevalence and severity of comorbidities than those whose gout is controlled. Pegloticase is a recombinant PEGylated uricase indicated for the treatment of gout in patients refractory to conventional therapy. We evaluated the treatment journey of patients with chronic uncontrolled gout before initiation of pegloticase therapy. Using IQVIA's PharMetrics® Plus database, we conducted a retrospective observational analysis of adults with ≥ 1 pegloticase claim between April 1, 2011, and August 31, 2020. Demographics were assessed at baseline. Clinical outcomes, health care resource utilization (HCRU), and associated costs were compared over two 12-month periods (months 13-24 and 1-12) prior to the first pegloticase claim (index date). The study included 408 patients. Prevalence of all gout-associated conditions increased between months 1-12 and 13-24 (P < 0.05 for all). The percentage of patients with tophi increased from 15.4% to 61.5%, the percentage with ≥ 1 flare increased from 49% to 84%, and mean number of flares per patient increased from 1.0 to 2.1 (P < 0.0001 for all). The frequency of all categories of HCRU except emergency department visits also increased (P < 0.0001 for all), as did gout-related healthcare utilization (P£0.005). Patients with uncontrolled gout experienced an increase in the clinical burden of disease and HCRU in the 2years before the initiation of pegloticase. Earlier patient identification and initiation of potentially effective therapy may help alleviate these burdens.

Healthcare costs and resource utilization of patients with chronic post-traumatic stress disorder: a retrospective US claims analysis of commercially insured patients.

Aim: Exploring the healthcare costs and resource use among privately insured US patients with post-traumatic stress disorder (PTSD). Methods: This study used Merative MarketScan data. The index date was defined as the first PTSD claim. Study period included a 1-year pre-index and 2-year post-index follow-up. Cases with only acute PTSD, cancer, or insurance gap during the study period were excluded. The PTSD with (PwC) and PTSD without comorbidities (PwoC) cohorts were defined by the presence/absence of comorbid mental health conditions (schizophrenia, bipolar and major depressive disorder). Baseline PTSD (BP) cohort included PwoC cases with only index PTSD event and without FDA-approved PTSD medications or psychotherapy. Sub-analysis is conducted among patients with PTSD and substance/alcohol use disorder. Study cohorts were matched in a 1:1:1 ratio. Results: The matched sample included 5076 patients (1681 PwC, 1681 PwoC, 1714 BP). PwC patients had higher 2-year PTSD-related costs than PwoC and BP patients ($3762 vs $1750 and $841; all p<0.001). The same trend was noted among all-cause and anxiety-related costs. PwC patients had higher 2-year PTSD-related inpatient and emergency department (ED) rates than PwoC (10.2% vs 1.7% and 6.8% vs 2.6%, all p<0.001) and inpatient and outpatient rates than BP (10.2% vs 2.1% and 98.0% vs 93.1%; all p≤0.004). The sub-analysis had 3776 patients (3154 PwC, 537 PwoC, 85 BP). PwC had higher 2-year PTSD-related costs than PwoC and BP ($7668 vs $2919 and $1,483; all p<0.001). The same trend was noted in all-cause and anxiety-related costs. PwC also had higher 2-year PTSD-related inpatient and ED rates than PwoC (25.6% vs 10.4% and 12.7% vs 5.2%; all p<0.001) and inpatient and outpatient rates than BP (25.6% vs 8.2% and 95.5% vs 84.7%; all p<0.001). Conclusion: PTSD is associated with high healthcare costs and resource use. The highest economic burden was observed in patients with PTSD and mental health comorbidities.

Abstract 4121840: Contemporary Safety of Ultrasound Enhancing Agents in a Nationwide Analysis

Background: Ultrasound enhancing agents (UEAs) are an important diagnostic tool for transthoracic or stress echocardiography (TTE/SE) but recent concerns have been raised about their safety in reports from individual health systems. Objectives: To identify if UEAs for TTE/SE are associated with serious adverse events within 48 hours of receipt in nationwide claims data. Methods: All-payor nationwide claims from 320 million insured individuals across the US, 2018-2022 from the Komodo Health database were used to evaluate rates of death or the composite of death, anaphylaxis, MI, coronary angiography, PCI, CABG, ventricular tachycardia or cardiac arrest within 48 hours of UEA receipt for TTE/SE among adults. Propensity score matching (PSM) was used to account for baseline imbalances. Results: Of the 11,421,463 individuals included (mean age 57.5 ± 16.2, 54.0% female, 46.2% White), a total of 500,073 (4.4%) received TTE/SE with UEAs. Individuals receiving Lumason™ or Definity™ more frequently had TTEs/SEs performed in the emergency department/inpatient setting and had more comorbidities than those receiving Optison™. After PSM, the odds of death were lower in those receiving UEAs (receipt vs. non-receipt, 0.02% vs. 0.14%, OR 0.23, 95% CI 0.19-0.28, p &lt; 0.001) and were similar across agents ( Table; Definity™: 0.02%, OR 0.22, 95% CI 0.18-0.28; Lumason™: 0.03%, OR 0.33, 95% CI 0.18-0.28; Optison™: 0.01%, OR 0.17, 95% CI 0.08-0.38; all p &lt; 0.001). Rates of the composite outcome were essentially unchanged after excluding claims for anaphylaxis. Rates of all outcomes were stable across study years, including considering pre-COVID (2018-2019) and post-COVID (2020-2022) periods. Conclusions: In this large nationwide claims analysis from 2018-2022, serious adverse events from UEAs for TTE/SE were uncommon and overall similar across agents and years of study. Receipt of UEAs was associated with a lower odds of death at 48 hours.

A Retrospective Claims Analysis of the Rate of Complications in Patients Undergoing Treatment for Paroxysmal Nocturnal Hemoglobinuria.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare blood disease associated with complications that increase morbidity, such as thrombosis and chronic kidney disease. Limited data exist regarding complications among treated patients outside of clinical trials, especially for patients treated with ravulizumab. This study leverages MarketScan claims data to examine the rate of complications in patients receiving PNH treatment. Patients with a diagnosis code of PNH [International Statistical Classification of Diseases and Related Health Problems (ICD-10) diagnosis code: D59.5] between October 2015 and December 2020, aged≥18 on the date of diagnosis, who had a≥6-month follow-up period of continuous enrollment and≥1 PNH-indicated treatment on or after the first PNH diagnosis were included. Among 211 patients diagnosed with PNH being treated with eculizumab or ravulizumab between October 2015 and December 2020, the most common complications were iron deficiency (20.4% of patients), arterial embolism and thrombosis (16.1%), and chronic kidney disease (11.8%). Overall, 44.1% of patients experienced≥1 complication. The high number of patients with PNH receiving treatment who nevertheless experienced complications demonstrates significant unmet medical need. Further analysis with larger sample sizes and including newer therapies, such as pegcetacoplan and iptacopan, is required to fully understand the scope and magnitude of this unmet need.

Economic Burden and Patterns of Care Among Patients with Follicular Lymphoma in the US: A Retrospective Claims Analysis

Economic Burden and Patterns of Care Among Patients with Follicular Lymphoma in the US: A Retrospective Claims Analysis

Real-world Use of AlloDerm Acellular Dermal Matrix in Head and Neck Procedures in the United States.

Real-world literature evaluating the use of AlloDerm SELECT Regenerative Tissue Matrix in head- and neck-related procedures is limited. To inform patient care decisions, this study evaluated healthcare resource utilization (HCRU) in US adults undergoing head- and neck-related procedures using AlloDerm. A retrospective claims analysis was conducted using MarketScan Commercial and Medicare Supplemental Databases (study period: October 1, 2015, to March 31, 2022; index period: November 1, 2015, to March 1, 2022). Adults aged 18 years or older with (1) medical claims for AlloDerm and a skin substitute on the same day during the index period, (2) a head/neck procedure diagnostic code, and (3) 30 or more days of continuous enrollment before and after first AlloDerm use index date. Descriptive statistics were used to describe surgery types and 30-day follow-up reoperations, graft complications, and all-cause HCRU. Among 431 patients (51.7% women), mean (SD) age was 52.2 (15.8) years. AlloDerm was most used with oral cavity reconstruction (35.3%), septal perforation repair/rhinoplasty (16.5%), and parotidectomy (13.0%). Most procedures were performed in outpatient settings (hospital, 90.0%; ambulatory surgical center, 8.6%). Over 30 days, less than 1% of patients (4 of 431) required reoperation with AlloDerm; 0.5% (2 of 431) had graft-related complications. Most (75.6%) patients had an outpatient visit; few had an emergency room visit (7.9%) or inpatient claim (3.0%). Real-world evidence indicates that AlloDerm is used in head- and neck-related procedures in US adults, particularly oral reconstruction. Postprocedure complications and reoperations are uncommon during the follow-up period.

Treatment patterns and characteristics of patients with Post-Traumatic Stress Disorder (PTSD): A retrospective claims analysis among commercially insured population.

This retrospective claims analysis explored the treatment utilization and characteristics among patients with post-traumatic stress disorder (PTSD) of different severity. The index date was the first PTSD claim. The analysis observed 12 months pre- and 24 months post-index. Adults with insurance gaps, cancer, or acute PTSD during the observation were excluded. Patients were categorized into three severity cohorts based on treatment and healthcare services utilization for PTSD: 1. Baseline PTSD (BP) (no PTSD visits post-index, no FDA-approved medications/ psychotherapy, and no severe mental health comorbidities); 2. PTSD without Comorbidities (PwoC) (≥1 PTSD visits post-index and no severe mental health conditions); 3. PTSD with Comorbidities (PwC) (≥1 PTSD visits post-index and severe mental health comorbidities present). For the primary analysis, cohorts were propensity-score matched. A sub-analysis examined patients with PTSD and Substance or Alcohol Use Disorder (SUD/AUD). The primary analysis observed 1714 BP, 1681 PwoC, and 1681 PwC patients. Treatment utilization rates were highest among PwC vs. other cohorts (84.5% psychotherapy, 76.1% off-label medications, and 26.1% FDA-approved medications [p<0.001]). PwC cohort also had the highest number of psychotherapy sessions and medication prescriptions per patient (20.1 sessions, 12.6 off-label prescriptions, and 2.0 FDA-approved prescriptions [p<0.001]). The proportion of days covered (PDC) indicated low medication adherence (0.25-0.40) with adherent patient rates (PDC ≥0.80) between 8.0-17.5%. The SUD/AUD sub-analysis identified 85 BP, 537 PwoC, and 3154 PwC patients. Conclusions were similar, with PwC cohort having highest treatment utilization rates (87.1% psychotherapy, 85.0% off-label medications, 28.2% FDA-approved medications [p≤0.013] with 24.4 sessions, 16.1 off-label prescriptions, and 2.0 FDA-approved prescriptions per patient [p≤0.002]). Only 4.7-11.4% of patients were adherent. PwC patients received psychotherapy and pharmacotherapy more frequently than PwoC and BP patients. Medication adherence among treated patients was low. Patients with SUD/AUD had numerically higher treatment utilization and lower medication adherence.

Burden of vaccine-preventable diseases in adults (50+) in the United States: a retrospective claims analysis

BackgroundIn adults aged 50 + years, vaccine-preventable diseases (VPDs) pose a significant health burden and can lead to additional ‘downstream effects’ of infection beyond the acute phase e.g., increasing the risk for non-communicable disease and exacerbating chronic conditions. The aim was to understand and quantify the burden of VPD downstream effects in hospitalised adults in the United States.MethodsThis retrospective observational study analysed hospitalisation claims data (2016–2019) with 1-year follow-up, in adults with a VPD diagnosis versus matched controls (using Optum’s de-identified Clinformatics Data Mart Database). Outcomes included mortality; increase in Charlson Comorbidity Index (CCI) score; new diagnosis of comorbidities; and loss of independence (defined by need for home health/home care and/or move to long-term facility).ResultsMortality was significantly increased in VPD cases versus controls at 30-day (risk ratio [RR] of 4.08 [95% CI 3.98–4.18]) and 1-year follow-up (RR 2.76 [2.73–2.80]). Over a 1-year follow-up period, morbidity increased following VPD hospitalisation: 65–86% of VPD cases had new comorbidities diagnosed (versus 13–41% of controls); with a significantly higher mean increase in CCI score versus baseline (3.23 in VPD cases versus 0.89 in controls, p < 0.001). Adults were observed to experience a worsening of their health status and were less likely to return to their original health state. In addition, 41% of VPD cases had a loss of independence following hospitalisation versus 12% of controls; as seen by an increased need for home assistance (in 25% versus 9% of controls) and/or a move to a long-term care facility (in 29% versus 6% of controls).ConclusionsThis analysis suggests that VPD hospitalised cases suffer significantly worse clinical outcomes than controls, with downstream effects that include increased mortality and morbidity, and greater loss of independence. Evidence on potential downstream effects of infection is relatively new, and this additional burden is generally not considered in vaccine decision-making. More research is needed to disentangle the effect of VPDs on new comorbidities versus the natural course of the condition. Increasing awareness among adults, healthcare providers and decision makers could help to increase adult vaccination coverage, and reduce the clinical burden of VPDs.

Factors Affecting Treatment Persistence in Japanese Patients with Psoriasis Prescribed Biologics: A Real-World Study Using an Insurance Claim Database.

Poor persistence to biologics can result in suboptimal health outcomes and increased economic burden for chronic conditions, including psoriasis (PsO). In Japan, studies evaluating factors responsible for biologic treatment persistence in patients with PsO are limited. We assessed biologic treatment persistence (median treatment duration and overall treatment survival) and associated factors in patients with PsO in a real-world setting. This retrospective analysis of insurance claims records from the Japan Medical Data Center (JMDC) database included patients with PsO [International Classification of Diseases (ICD) code: L40.x] ≥ 18years of age who had received biologic treatment. Treatment persistence was analyzed using data from 2016 to 2020 by biologic class and by individual biologics (infliximab, adalimumab, ustekinumab, guselkumab, secukinumab, ixekizumab, and brodalumab) in bio-naïve (who initiate first biologic at index) and bio-experienced patients. Kaplan-Meier survival (treatment persistence), and multivariate Cox proportional hazard regression (predictive factors) analyses were used. Overall, 1528 patients with PsO were included (mean age 47.4years). Infliximab had the longest median treatment duration (33.6months), while brodalumab had the shortest (9.7months) among biologics evaluated. Of the biologics evaluated, 1-year treatment survival was highest with guselkumab (83%), and lowest with brodalumab (45%). Bio-experienced patients showed slightly longer median treatment duration than bio-naïve patients (22.8 versus 18.1months). Factors predictive of treatment persistence were sex [male; hazard ratio (HR) 0.84, p = 0.016] and specific PsO diagnostic codes, such as L40.0 (PsO vulgaris; HR 0.69; p = 0.006), L40.1 (generalized pustular PsO; HR 0.75; p = 0.034), and L40.9 (PsO unspecified; HR 0.72; p = 0.001). Meanwhile, age and Charlson Comorbidity Index score were significantly associated with adalimumab and infliximab treatment persistence, respectively. Among biologics evaluated, infliximab had the longest median treatment duration, and guselkumab had the highest 1-year treatment survival. Sex and specific PsO diagnostic codes influenced overall treatment persistence. These findings could inform long-term treatment plans for PsO in real-world clinical settings.

General unemployment and serious workplace injury rates: Workers compensation claims analysis from the Canadian province of Saskatchewan, 2007-2018.

There is conflicting published evidence that unemployment impacts workplace safety. Some studies suggest that the workplace injury rate decreases during economic contractions, while others propose an increased rate of injuries during periods of economic contractions. This study investigated the association between unemployment rates and traumatic work-related non-fatal injury (WRNFI) in Saskatchewan, 2007-2018, in order to provide new insight into injury prevention. Saskatchewan's retrospective linked workplace claims data from 2007 to 2018 were grouped by year, season, and worker characteristics (e.g., age and sex). Total employment, total labour force, and the number of unemployed workers from the Statistics Canada Labour Force Survey were grouped by year, season, sex, and age. These data were linked to the worker's compensation board injury claim data to determine the number of people at risk, serving as the denominator (offset term) for WRNFI rates, calculated as WRNFI cases per total employed workers. A negative binomial generalized additive model was used to examine the association between unemployment rates and WRNFI, adjusted for age, sex, industry types, and seasons. The WRNFI rate has declined since 2007. On average, workers aged 20-29years had the highest WRNFI rate (541.6 ± 84.8/100,000). Men had 3.2 times higher WRNFI risk than women (RR = 3.2, 95% CI 3.12-3.22), with the highest WRNFI risk observed in the manufacturing (RR = 1.68, 95% CI 1.63-1.73) and construction (RR = 1.67, 95% CI 1.63-1.72) industries. WRNFI risk decreased non-linearly with an increasing unemployment rate, indicating a pro-cyclic pattern. This analysis showed that WRNFI rates tracked unemployment rates. This suggests a need to increase prevention strategies and reduce disincentives for under-reporting during an economic downturn.

Association between exposure to proton pump inhibitors and delirium: a descriptive and disproportionality analysis of VigiBase

ObjectivesProton pump inhibitor (PPI) exposure can lead to hyponatraemia, which is a common cause of delirium. An association between PPI exposure and delirium without hyponatraemia has been suggested in the...

Treatment With Bilevel PAP Is Associated With a Reduction in Severe Exacerbations in COPD-OSA Overlap: A Retrospective Claims Analysis

BACKGROUNDThere are no guidelines for obstructive sleep apnea (OSA) assessment in patients with chronic obstructive pulmonary disease (COPD). Home non-invasive ventilation (NIV) studies have excluded patients with comorbid OSA. Thus, it is unclear whether home NIV is associated with reduced exacerbation risk in patients with overlap syndrome (COPD-OSA). RESEARCH QUESTIONDoes home NIV impact the rate of severe exacerbations in patients with overlap syndrome 1 year post therapy initiation? STUDY DESIGN AND METHODSA retrospective analysis was performed on administrative claims data from patients with COPD and OSA who received a NIV device claim between 2015 and 2020. Patients were characterized 1 year before NIV initiation and 1 year after NIV initiation. A modified Poisson regression model was built to identify predictors for severe exacerbation occurrence during follow-up. RESULTSA total of 23,992 patients were included in the analysis (mean age 61.3±10.1 years, 44.9% female). The proportion of patients with ≥1 severe exacerbation was 10.2% in the year before NIV initiation and 5.9% in the year after NIV initiation (χ2 440.5, P < 0.0001). Occurrence of a severe exacerbation in the year prior to NIV was associated with a nearly 5-fold higher risk of severe exacerbation during follow-up [risk ratio 4.91; 95% confidence interval 4.39–5.48; P < 0.0001]. Heart failure, pneumonia, and anxiety were the comorbidities most associated with increased severe exacerbation risk. INTERPRETATIONThis is the first study to describe risk factors for severe exacerbations and to examine home NIV claims in this specific population. Results may be informative for overlap syndrome management, especially for preventing a first severe exacerbation and to treat OSA as part of COPD management. Additional information is needed to optimize the access, timing, and benefits of NIV treatment in patients with overlap syndrome.

How does AI perform in industry chain? A patent claims analysis approach

The development trajectory of AI within the industry chain can offer valuable insights for managers and policymakers. Because the industry chain includes multiple complex nodes, it becomes difficult to showcase the subtle changes in AI at each node. Since patent claims are authoritative legal documents describing technology, we first theoretically demonstrate that integrating them with deep learning can effectively reveal the development of AI within complex nodes. And then, based on claim types and dependencies, we construct a more robust AI Recognition Multiple Attention Mechanism (A&C-Mechanism). Finally, using the battery industry chain (BIC) as a case study, the A&C-Mechanism reveals differences in AI development within the industry chain: (1) The A&C-mechanism can calculate the adjustment weights of patent claims based on variations in claim types and dependencies. Therefore, integrating the A&C-mechanism into NLP models can enhance the models' robustness and sensitivity to the nuanced variations of AI within patent claims; (2) Based on the A&C mechanism, our analysis indicates that AI indeed drives technological upgrades within four BIC nodes of mineral resource extraction (MRE), raw material processing (RMP), finished product manufacturing (FPM), usage, and recycling (UR). However, there is a phenomenon of non-uniform AI development emerging across these nodes; (3) Analyzing the patent application volume and growth rates across the four nodes, we identify that AI development progresses through distinct stages within the industrial chain: early, mid-term, and improvement. With the establishing two coefficients, the AI claim dependency variation coefficient and the AI-NE variation coefficient, we demonstrate that each stage exhibits unique characteristics. AI is used directly in the early stages. As the mid-term stage approaches, AI starts to be optimized and enhanced. During the improvement stage, AI structures, procedures, etc., are adaptively adjusted to better serve each company's goals; (4) Constructing an interaction network of AI with the four nodes based on high-frequency AI named entities within patent claims, we discover that AI development within the industrial chain exhibits iteration and continuity. Moreover, Convolutional Neural Networks (CNNs) and Recurrent Neural Networks (RNNs) remain the cornerstone, serving as the foundation upon which many cutting-edge technologies are built. Digital image processing and machine learning enhance problem-solving across multiple nodes. We discuss our findings and derive implications for research, managers and policymakers.

Clinical Burden of Native vs. Post-transplant Complement 3 Glomerulopathy (C3G) in the United States: A Retrospective Claims Analysis

Clinical Burden of Native vs. Post-transplant Complement 3 Glomerulopathy (C3G) in the United States: A Retrospective Claims Analysis

Infodemic, Ignorance, or Imagination? The Problem of Misinformation in Health Emergencies

Abstract In understanding and responding to the problem of misinformation during global health emergencies, health experts and organizations such as the WHO have relied on the concept of the “infodemic,” or the idea that there is such an overabundance of information that ascertaining trustworthy sources and reliable guidance is difficult. Is this the best way to understand the problem of misinformation, however? A large and multidisciplinary literature has argued that such an approach misses the important role of individual psychological factors and societal “mega-trends” such as hyperpolarization, structural shifts in the media, and public mistrust in elites. This article argues that such contributions are important in understanding the multifaceted problem of misinformation but may miss another, equally important component: the politics of emergency. Specifically, the prominent role of speculation during moments of emergency—the need to respond to “what ifs” rather than just “what is”—provides a conducive context for misinformation, facilitating its production and spread while also problematizing efforts to correct it. The article illuminates this relationship through a discourse analysis of prominent misinformation claims during the US responses to Ebola in 2014 and COVID-19 in 2020.