Average Annual Consumption Research Articles

Prevalence and Annual Health Insurance Cost of Endometriosis in Hungary-A Nationwide Study Based on Routinely Collected, Real-World Health Insurance Claims Data.

Endometriosis is a disease that is often diagnosed late and that may lead to significant reduction in quality of life and serious complications (e.g., infertility). We aimed to assess the prevalence and the annual, nationwide health insurance treatment cost of endometriosis in Hungary using a quantitative, descriptive, cross-sectional method, focusing on the year 2019. We used claims data obtained from the Hungarian National Health Insurance Fund Administration (NHIFA). Patient numbers, total and age-specific prevalence, annual health insurance expenditure, and the distribution of costs across age groups were determined. The NHIFA spent a total of HUF 619.95 million (EUR 1.91 million) on endometriosis treatment. The highest number of patients and prevalence (10,058 women, 197.3 per 100,000) were found in outpatient care. In acute inpatient care, prevalence was substantially lower (23.5 per 100,000). Endometriosis, regardless of its type, affects 30-39-year-olds in the highest number: 4397 women (694.96 per 100,000) in this age group were affected in 2019. The average annual health insurance expenditure per capita was EUR 189.45. In addition to early detection and diagnosis of endometriosis, it is of pivotal importance to provide adequate therapy to reduce costs and reduce the burden on the care system.

Causes for Reducing Rivers Runoff in Azerbaijan

The results of research on four rivers flowing in the north-eastern and southern slopes of the Greater Caucasus are reflected in the article. It was determined that the average annual consumption of these rivers decreased by 1.05-1.60 times in the period from 2018 to 2021. Based on the analysis of climate factors, it was determined that the decrease in river flows, the decrease in atmospheric precipitation, the change in the nature of their fall, as well as the increase in the average multi-year air temperature and thus evaporation is related. Compared to the years 1961–1990, the average long-term air temperature in Azerbaijan increased by 0.7°C. As a result of the increase in temperature, the amount of evaporation on the water and soil surface in the country increased by an average of 31 mm per year, and the amount of water used for evaporation was 2.68 billion m3 per year. All these mentioned factors have led to water scarcity in the country.

Evaluation of the association between health insurance status and healthcare utilization and expenditures among adult cancer survivors in the United States.

Health care expenditures for cancer care has increased significantly over the past decade and is further projected to rise. This study examined the associations between health insurance status and total direct health care expenditures and health care utilization among cancer survivors living in the United States. A cross-sectional study of cancer survivors aged ≥18 years, identified from the Medical Expenditures Panel Survey (MEPS) during 2017 using International Classification of Diseases, Tenth Revision codes specific for cancer. Health insurance was categorized into Private, Medicare, Medicaid, and uninsured. Multivariable ordinary least squares regression was used to examine the association between log expenditures and health insurance. Negative binomial regression with log link was used to obtain adjusted incident rate ratios (AIRR) for health care utilization. Survey weights were used to produce nationally representative estimates of the US population. A total of 1140 (weighted=13.9 million) cancer survivors were identified. Compared to the adjusted mean annual health care expenditures for the private group ($14,265; 95% confidence interval (CI): $12,645 to $16,092), the adjusted mean annual health care expenditures for the Medicare group were higher ($15,112; 95%CI: $13,361 to $17,092). As compared to the private group, the average annual expenditures for uninsured cancer survivors ($2315; 95%CI:1038 to $3501) was significantly lower and so was their health care utilization. Adjusted rates of ER visits for Medicaid were twice (AIRR:2.04; SE:0.28; p=0.001) as compared to privately insured. A difference in the average total direct expenditures between uninsured and privately insured patients was found. Uninsured had the lowest health care utilization while Medicaid reported significantly higher number of ER visits. Despite differences in program structures, health care expenditures across insurance types were similar. Lower utilization of health care services among uninsured suggests cost maybe a barrier to accessing care.

Effects of the Eating Habits of Romanian Residents on the Water Footprint

Water footprint assessment is an analytical tool that helps us understand how activities, actions, and products from human activity influence the scarcity and pollution of water resources. The objectives of the paper are to study the water footprint that is necessary for the production of food for human consumption as an effective way to determine how food habits put pressure on water resources and to identify ways to reduce the stress found on them. To calculate the water footprint of food products consumed by Romanian residents, two types of data were used: information on the average annual net food consumption of each type of food considered during the research and the water footprint per unit of food consumed. In addition, an analysis was carried out based on the structure of the water footprint and the structure of food consumption. In terms of the structure of the water footprint, the contribution rate of the green water footprint is the highest, reaching 83.5%. This is followed by the blue water footprint and the gray water footprint, accounting for 9.04% and 7.46%, respectively. From the perspective of the structure of food consumption, the consumption of cereals, meat, milk, and dairy products contributed the most to the water footprint of residents’ food consumption, reaching 21.8% and 26.6%, respectively, and contributing 24.2% to the total water footprint of food consumption. Our research is useful for water management, improving the efficiency of use in agricultural technologies, and optimizing the structure of food consumption, such as reducing grain and meat consumption.

Net-Positive Energy Buildings: Empirical Insights Towards Achieving the SDGs

Buildings impact multiple United Nations (UN) Sustainability Development Goals (SDGs). Net-positive energy buildings (NPEBs) present an opportunity for the built sector to offer climate solutions and habitable environments with improved energy efficiency, responsible consumption, sustainable energy production, and sustainable communities. Case study analysis of a multi-tenant office NPEB demonstrates decisions made to realize the SDGs. Average annual energy consumption of 83 kWh/m2 was one-third that of typical office buildings and the generation of 871 kWh of solar electricity achieved the net-positive goal. This mixed methods performance assessment used four years of energy meter data and key informant interviews to provide a holistic understanding of building energy performance and contributions to the SDGs.

Waste heat recovery and utilization of cement rotary kiln based on biomass energy

A rotary kiln is a central piece of equipment for the calcination of clinker in the production of cement. Biomass energy has been applied to rotary kilns, and solar energy has been introduced to assist the energy supply. Coupled optimization results for biomass energy and solar energy applications are compared to the single fossil energy used in the base period. A field survey and statistical analysis and integration of cement clinker production sites in China’s Central Plains Economic Zone revealed a negative linear correlation between the consumption of raw coal in the cement production process and the environmental temperature and humidity parameters of the production lines. The energy consumption is large and the energy utilization of the system is low, with goodness of fit of R=0.962. Coupled solar and biomass energy use in the audit period and single energy use in the base period comparison revealed a 19.5% reduction in electricity consumption, a 25.4% reduction in coal consumption and a 4.39% increase in heavy oil consumption. From 2017 to 2020, the average annual consumption cost of electricity and raw coal decreased, while the average annual consumption cost of heavy fuel oil slowly increased. After verification during the audit period, compared with the base period, the total production cost of the case enterprise can be reduced approximately 5.17%, in which the energy cost decreased 0.9%.

P826 Economic impact of inflamatory bowel disease in Catalonia. A population-based analysis

Abstract Background Background: Inflammatory Bowel Disease (IBD) has an important economic impact in healthcare costs and resources utilization. Population data on this topic are scarce. The aim of this study was to evaluate the current healthcare expenditures of IBD in a population-wide study Catalonia. Methods Methods: All patients with IBD included in the Catalan Health Surveillance System (CHSS) were included. CHSS includes data on more than 7 million individuals in 2020, 34,823 of them being diagnosed of IBD. Data on prevalence, incidence, comorbidities, stratification of risk, use of healthcare resources and economic impact were extracted from the CHSS according to ICD-10-CM codes. Health expenditure was calculated according to the standard costs of each service provided by the Department of Health (Generalitat de Catalunya). The utilization of healthcare services and associated expenditure of IBD were compared with a control group of patients not identified as IBD adjusted by age, sex, and income level (hereinafter referred to as “non-IBD”). IBD costs were separately provided for Crohn’s Disease (CD) and Ulcerative Colitis (UC). Results Results: The prevalence and incidence of IBD in 2020 was 405.6 and 27.2 per 100,000 inhabitants, respectively. Total number of IBD patients in 2020 was 37,381. Prevalence of comorbidities (neoplasia, arthritis, chronic obstructive pulmonary disease, asthma, cardiac disease, ictus and mental disease) was higher in IBD patients’ when compared to non-IBD population. The risk of hospitalization in IBD was twice those of the non-IBD individuals. The global healthcare expenditures of patient with IBD was 164M€. The average annual expenditure for an IBD patient was 4M€ versus 1M€ for non-IBD population; being more than 3.4-fold higher. Cost in UC was 3,360€ and 5,699€ for CD patient. Conclusion Conclusion: Patients with IBD presented a higher risk of comorbidities (1.5-2 fold) and healthcare resources utilization. Healthcare expenditure per patient were approximately 3.4 times higher than the non-IBD population.

Socioeconomic Evaluation of Common Bean (Phaseolus vulgaris L.) Cultivation in Providing Sustainable Livelihood to the Mountain Populations of Kashmir Himalayas.

Phaseolus vulgaris L. is the major pulse cultivated and culturally inculcated in the food habits of the locals in the Himalayan mountainous region of Azad Jammu and Kashmir (AJK), Pakistan. The current study was designed to investigate the role of P. vulgaris cultivation in providing livelihood support and to evaluate its production and consumption patterns correlated with the household variables in the state of AJK. The socio-economic data was collected from nine bean cultivated areas in six districts of AJK. The data was acquired by administrating a total of 522 detailed semi structured questionnaires from a diverse array of the respondents following the snowball technique focusing on yield, consumption, revenue generation and livelihood support provided by bean cultivation. The results revealed that common bean cultivation provided significant livelihood support to the local mountainous populations with an average annual income of 50.80 $/family. Subsequently, bean production contributed an average annual per capita income of 6.81 $ in the area, which was attributed to the large family size. Local populations showed an average bean production of 33.93 kg/family, whereas the average annual bean consumption was recorded as 31.99 kg/family in the region. Bean crops were recorded to have an average price of $1.49/kg, with significant variations in the study area correlated with local yield. A data analysis indicated a strong correlation in bean production and consumption patterns. Common bean farmers had a very small farm size, averaging 0.24 ha, where 100% of farmers cultivated common beans as an intercrop with Maize as the primary crop. A Pearson’s test (p value < 0.05) revealed significant correlations between land holding and bean production as well as consumption, and bean production with annual per capita income. Small farm size, declining soil fertility, low bean pricing and the unavailability of market mechanisms were identified as the major challenges faced by the common bean farmers. It is recommended to employ an integrated bean farming approach to enhance the economic impact of common bean cultivation in the socioeconomic appraisal of the local populations.

Impact of Farm Diversification on Income and Expenditure of Small Scale Farm Households in Rangpur District of Bangladesh

Farm production diversification has the potential to broaden and strengthen the sources of farm and non-farm incomes of rural households. This study intends to estimate the impact of farm diversification on income and expenditure of smallholder farm households. A total sample of 100 farmers were randomly selected from the three villages namely South Panapukur, Gaghottari and Betgari under Gangachara upazila of Rangpur district in Bangladesh. Both tabular and quantitative analyses were done to achieve the major objectives of the study. The findings show that the socioeconomic characteristics, cropping pattern, land type, soil type of Gangachara upazila are suitable for farm diversification. From 100 farmers about 55 percent farmers practiced 11-16 numbers of crops, vegetables, livestock and fish. Smallholder farm households were also involved in both farm and non-farm activities which were 71 percent of farm households. Average annual income from farm and non-farm activities were Tk. 75150.00 and Tk. 23350.00 respectively. Average annual expenditure on farm and non-farm practices was Tk. 43000.00 and Tk. 12000.00, respectively. In the present findings, the average annual expenditure on food and non-food items was Tk. 41000.00 per family. The Poisson regression was run to predict the determinants of farm diversification in the last 12 months where soil type, farm size and employment member of family were statistically significant at one percent level of significance and education was statistically significant at five percent level of significance. The Multiple regressions were done to estimate the impact of farm diversification on income and expenditure where farm size and combination of farm and non-farm practices were statistically significant at one percent probability level. But all the explanatory variables included in the model were not statistically significant as were generally expected. Farmers faced different problems and constraints in diversifying farm. In spite of the entire problems, this study has thrown light on some important issues regarding farm diversification of the study areas. Overall results indicate that rather than farm diversifications, diversification of income from farm to non-farm sources positively and significantly affect the household income and expenditure.

Hydrochemical assessment of transboundary rivers (on the example of the Narva border river)

The purpose of the study is to establish the regularities of the formation of the biogenic regime of the Narva River. Based on experimental data on the determination of concentrations of chemical elements for the long-term observation period from 1992 to 2019, a trend of reducing the content of biogenic elements over the past 14 years has been revealed. This is a consequence of reducing the anthropogenic load due to the reconstruction of treatment facilities on the Estonian and Russian sides. Analysis of intra-annual changes in the content of biogenic elements showed a steady increase in the content of nitrogen compounds during high water with maximum water runoff and an increase in phosphorus content in the autumn period. This indicates a significant influence of the waters of Lake Peipus and the Narva reservoir, which determine the intra-reservoir processes that intensify at the end of the warm season. The calculation of runoff based on experimental data of average annual water consumption and monthly determinations of concentrations of mineral, biogenic and organic substances for the period from 1992 to 2019. The calculated values of the runoff indicators are: ionic runoff 43,1 t/km2, total phosphorus 9,8 kg/km2, total nitrogen 142 kg/km2, organic carbon 2,75 t/km2, according to the background values of the runoff indicators of the Baltic region. It is important to note that for the period from 1993 to 2006; significantly higher runoff rates for phosphorus phosphates and nitrogen nitrates corresponded to the literature data on runoff from reclaimed agricultural areas, which also indicates a significant decrease in the biogenic load on the Narva River in the last decade from 2006 to 2019.

USE OF GROWTH REGULATORS AND MICROBIAL PREPARATIONS FOR CUCUMBER GROWING IN FILM GREENHOUSES

Vegetable growing is one of the leading branches of the agro-industrial complex. However, the production of vegetable products does not satisfy the average annual consumption of fresh vegetables by humans. The use of plant growth regulators of synthetic and organic origin in different periods of ontogenesis provide stimulation of a wide range of processes related to the vegetative and reproductive sphere of plants, contribute to increasing productivity, improving product quality, and increasing resistance to adverse environmental factors and therefore is a promising direction of modern vegetable growing. The purpose of the research – to determine the effect of plant growth regulators and biological products on the growth and development of Lyrik F1 hybrid cucumber plants and crop formation in film greenhouses without additional heating. The research included the following stages and methods: 1) determining the effectiveness of plant growth regulators based on humic acids, biologically active substances and complex microfertilizers; 2) research on the effectiveness of growth regulators of microbial origin. The research scheme for the first stage (2016–2018) provided for the following options: control (water treatment), application of plant growth regulators based on humic substances (Hydrohumin (1,5 l/ha), Gulliver Stimul (1,0 l/ha), Vympel Maxi (1,0 l/ha)), based on biologically active substances (Epin extra (0,08 l/ha), salicylic and succinic acids (0.1 kg/ha each) and complex microfertilizer KompleMet (1,0 l/ha). Treatment with drugs was carried out in four stages: seed soaking (12-hour exposure) and 3-time spraying of plants in the ontogenesis phase: 3-4 real leaves, the beginning of flowering and the beginning of fruiting. The research scheme for the second stage (2019–2021) included different treatment options for cucumber seeds with 12-hour exposure: control (water), Azotophyt - p (30 ml/kg), Mycofriend (30 ml/kg) and HelpRost for seeds ( 20 ml/kg). The technology of growing the new parthenocarpic cucumber hybrid Lyrik F1 is generally accepted for film greenhouses without heating. Protection against diseases and pests is chemical (Previkur) at the beginning of the growing season, and biological (Mycohelp, Fitocide, Actoverm formula, Actofit). The results. For growing cucumbers in film greenhouses, it is effective to use the plant growth regulators Gulliver Stimul, Vimpel Maxi, Epin extra, salicylic acid and microfertilizers (seed treatment and 3-time spraying of plants in the phase of 3-4 true leaves, the beginning of flowering and the beginning of fruiting) A supplement that provides an increase in fruit yield by 1,63–2,48 kg/m2 or 12,3–18,7%. Seed treatment with the microbial preparation Azotophyt-r and organo-mineral fertilizer HelpRost rooted is also effective, which contributes to the growth of the length of the main stem by 13,6–48,4%, the number of leaves – by 7,0–20,9%, the area of the leaves – by 17,8–39,3% and an increase in productivity by 2,05–3,77 kg/m2 or 13,9–25,6% relative to control.

Some peculiarities of hydroecological features of the Seversky Donets River (Rostov region)

Climate change leads to the transformation of the water regime of rivers. This paper examines the changes that occur with the Seversky Donets River in the Rostov region. To assess the influence of meteorological factors, studies of temperature changes (1974 - 2020) and precipitation (2001 - 2020) were conducted. An increase in the average annual (from 8 °C to 9.7 °C) and winter (-5.3 °C to -3.6 °C), spring (8.6 °C to 9.9 °C), summer (20.6 °C to 23.1 °C) and autumn (8.1 °C to 9.3 °C) were revealed. Precipitation data showed multidirectional processes; 2001-2010 were drier (294 mm) than the average (419 m), and 2011-2020 wetter (436 mm). Water flow changes analyse in the River Seversky Donets from 1982 to 2020. The assessment of the influence of hydrometeorological factors on the transformation of river flow is an important aspect. There is a tendency to decrease the average annual expenditure. The highest and lowest annual flow of the river was recorded in the 2000s. The minimum water flow in the river was recorded in 2020 (33.95 m3/s), and the maximum in 2006 (211.2 m3/s). The territory is experiencing high anthropogenic pressure in an arid climate. Significant seasonal changes are characteristic of the water flow in the River Seversky Donets. The maximum impact on changes in water levels in the river is provided by snow nutrition, which is associated with uneven water consumption throughout the year.

Antibiotic use in township hospitals during the COVID-19 pandemic in Shandong, China

BackgroundThe overuse of antibiotics in primary healthcare settings (PHSs) has caused a serious public health problem in China. The outbreak of the Coronavirus Disease-19 (COVID-19) pandemic brought about dramatic changes in the supply of and demand for medical services in PHSs, possibly resulting in unprecedented changes in antibiotic use.ObjectiveThis study aims to assess the immediate and long-term impacts of the COVID-19 pandemic on the changes in antibiotic consumption in PHSs.MethodThe data on antibiotic consumption were collected from selected township hospitals in Shandong, China from January 2019 to December 2021. Antibiotic consumption was quantified by using the defined daily doses (DDDs) and the WHO Access, Watch, Reserve category. A segmented regression model was established to analyze the immediate and long-term impacts of the COVID-19 pandemic on antibiotic use by using the interrupted time series analysis.ResultsThe overall antibiotic consumption in all PHSs decreased by 32.04% and 16.69% in 2020 and 2021 respectively compared to the corresponding period in 2019. Over the entire study period, the use of penicillins (J01C) and cephalosporins (J01D) accounted for more than 50% of the total antibiotic consumption. The average annual consumption of Watch category antibiotics decreased by 42.02% and 33.47% in 2020 and 2021 respectively compared to that in 2019. According to the interrupted time series analysis, the total antibiotic consumption decreased significantly immediately after the COVID-19 pandemic outbreak (coef. = − 2.712, p = 0.045), but it then increased significantly over a long-term (coef. = 0.205, p = 0.005). Additionally, the consumption of Access category antibiotics increased significantly in PHSs in the long-term (coef. = 0.136, p = 0.018). However, the consumption of Watch category antibiotics declined sharply immediately after the pandemic (coef. = − 1.222, p < 0.001), but then it increased slightly over a long-term (coef. = 0.073, p < 0.001).ConclusionThe extensive use of penicillin and cephalosporins should be of great concern. After the outbreak of COVID-19 pandemic, the total antibiotic consumption decreased generally and the use pattern was improved to some extent in the PHSs in Shandong, China. This provides an opportunity for improving the misuse of antibiotics in PHSs in China.

The Goal of Carbon Peaking, Carbon Emissions, and the Economic Effects of China's Energy Planning Policy: Analysis Using a CGE Model.

This study focuses on the effects of China's carbon peaking policy, investigating how to balance nonfossil energy consumption and coal consumption to achieve China's carbon peaking policy goal. The research applies the recursive dynamic computable general equilibrium model to simulate the impact of China's energy planning policies using five scenarios to analyze the carbon emissions and economic effects of China's energy planning policy from the perspectives of energy use, carbon emissions, the macroeconomy, and institutional income. The simulation results indicate that to achieve the goal of carbon peaking by 2030, the annual installed capacity of nonfossil energy must reach 112.29 gigawatts, and average annual coal consumption in the China 15th Five-Year Plan and 16th Five-Year Plan should be reduced by 20 million and 40 million tons, respectively, which will result in the proportion of nonfossil energy in primary energy consumption reaching about 25%. Limiting coal consumption will slow economic growth, whereas increasing the installed capacity of nonfossil energy will stimulate economic growth. The combined policies will have a significant impact on reducing carbon emissions and achieving the carbon peaking goal and will also offset the adverse effects of such policies on the macroeconomy.

Investigation on air conditioning load patterns and electricity consumption of typical residential buildings in tropical wet and dry climate in India

The residential sector accounts for around 24% of the total electricity consumption in India. Recent studies show that air conditioners (ACs) have become a significant contributor to residential electricity consumption. Further, it is predicted that by 2037, the demand for ACs will increase by four times due to their affordability and availability. Not many studies have been found on residential AC usage patterns and the factors (AC load, setpoint, hours of usage) that influence household electricity consumption. This paper investigates the residential AC usage patterns and AC’s contribution to total residential electricity consumption. Twenty-five urban homes from a wet and dry climatic region of India were monitored for nine months (in 2019) to determine overall household electricity consumption patterns, AC usage, and indoor environment during summer, monsoon, and winter. Analysis of seasonal consumption patterns shows a significant difference in electricity usage between homes with ACs and homes without ACs during the summer season. The average electricity consumption for AC homes was 15.1 kWh/day during summer, 6.6 kWh/day during monsoon, and 6.1 kWh/day during the winter season. Results showed that AC alone contributed to 39% of the total household consumption in summers. The peak AC usage in all homes is observed during sleep hours which was generally between 10:00 pm and 6:00 am and the average AC runtime was 6.2 h. The average indoor temperature was recorded as 26.9 °C during the AC ON period. The AC peak load, i.e., the maximum electricity demand during the AC ON period, is 1.7 kW on average during the study period. The average annual consumption of homes with ACs was 2881 kWh, and for non-AC homes, the consumption was 2230 kWh. Findings from our analysis provide a detailed understanding of AC consumption profiles and the difference in electricity consumption characteristics between AC and non-AC homes across different seasons.

Modeling the impact of a family structure on household water consumption

Abstract Household water consumption plays an important role in addressing the problem of water shortage and achieving sustainable water development. To identify, assess, and analyze the impact of a family structure on household water consumption, this study develops a mathematical statistical method to conduct multi-scenario simulations of average annual household water consumption based on data from the 2016 China Family Panel Studies (CFPS). The Kolmogorov–Smirnov test and the two independent sample t-tests were used to obtain the distribution with the highest degree of fitting, and the probability distribution and expected value of average annual household water consumption were obtained from the distribution probability function. The results demonstrated that the Birnbaum–Saunders distribution was the optimal distribution; families comprising one and two generations were dominant in terms of water consumption; and the number of water-saving households was far less than that of households with high levels of water consumption. The findings of this study have valuable implications for water governance and the domestic water planning.

Healthcare Services for Undocumented Migrants: Organisation and Costs from the Italian NHS Perspective.

Based on the principle of health equity, the Italian National Health Service is known worldwide for being a universalistic system that guarantees healthcare services for all its population, among which there are undocumented migrants. A commitment for their health needs is further motivated by their lower utilisation rates of healthcare services, which becomes even more crucial when considering chronic conditions such as diabetes that require adherence and continuity of care. However, the need for more official data has resulted in little research documenting these healthcare usage patterns. For this reason, our objective has been to deepen, from the Italian NHS perspective, the quantity, costs, type, preventability and organisation of healthcare services directed to undocumented migrants. We used official healthcare data from the Lombardy Region, which enable the identification of people receiving the STP code (undocumented migrants) and of people with foreign citizenship (documented migrants). After quantifying the average annual amount and expenditure for healthcare services grouped by Italian citizens, documented migrants and undocumented migrants for all clinical conditions (quantity and costs), we performed three primary investigations where we enlightened differences between the three mentioned groups focusing on the diagnosis of diabetes: (i) mapping the types of healthcare services used and their characteristics (type); (ii) quantifying the impact of preventable hospital admissions (preventability); (iii) examining the healthcare patterns linking pharmaceutical prescriptions with hospital accesses (organisation). Our results reveal significant differences among the three groups, such as more urgent hospital admissions, more preventable complications, and a higher recurrence in terms of access and costs to hospital services rather than pharmaceutical prescriptions for undocumented migrants. These findings can represent the leverage to raise awareness toward the emerging challenges of the migrant health burden.

Spatial and Temporal Evolution of Vegetation Water Consumption in Arid and Semi-Arid Areas against the Background of Returning Farmland to Forestland

Sustainable development in arid and semi-arid areas is largely constrained by water resources. Expanding ecological space is considered an effective way to conserve water resources. The innovation of this study is the analysis of water consumption in different land-use types from a complete watershed scale, which can evaluate space management against the background of returning farmland to forestland during the past 20 years, and provide suggestions for future space management in semi-arid areas. Based on meteorological data and GIS technology, the current study quantitatively analyzes the spatial and temporal variation characteristics of the water consumption of different vegetation growth stages in the Yanhe River Basin by using the improved Penman formula. The results show that the water consumption of vegetation in the Yanhe River Basin increased from 0.44 km³ in 2000 to 0.68 km³ in 2020. The water consumption of vegetation showed obvious spatial heterogeneity, with the highest value in the central Baota area (1.094 km³) followed by the western Ansai region (0.727 km³), whereas the consumption in the eastern Yanchang area is relatively low (0.483 km³). In addition, the annual average water consumption is (0.381 km³). The cultivated land consumes the most water (0.21 km3), while the woodland consumes the least (0.072 km³). The water consumption per unit area of forested land is the highest, reaching 190 m, and the water consumption of low-coverage grassland is the lowest, only reaching 50 m. Vegetation distribution change could be the main influencing factor of vegetation water consumption change in the Yanhe River Basin. Through the establishment of the sustainable development path of ecological space with water as the core, the high-quality development of ecological environments in arid and semi-arid areas will be achieved.

A Comparison of US Medicare Expenditures for Hemodialysis and Peritoneal Dialysis.

Observations that peritoneal dialysis (PD) may be an effective, lower-cost alternative to hemodialysis for the treatment of ESKD have led to policies encouraging PD and subsequent increases in its use in the United States. In a retrospective cohort analysis of Medicare beneficiaries who started dialysis between 2008 and 2015, we ascertained average annual expenditures (for up to 3 years after initiation of dialysis) for patients ≥67 years receiving in-center hemodialysis or PD. We also determined whether differences in Medicare expenditures across dialysis modalities persisted as more patients were placed on PD. We used propensity scores to match 8305 patients initiating PD with 8305 similar patients initiating hemodialysis. Overall average expenditures were US$108,656 (2017) for hemodialysis and US$91,716 for PD (proportionate difference, 1.11; 95% confidence interval [CI], 1.09 to 1.13). This difference did not change over time (P for time interaction term=0.14). Hemodialysis had higher estimated intravenous (iv) dialysis drug costs (1.69; 95% CI, 1.64 to 1.73), rehabilitation expenditures (1.35; 95% CI, 1.26 to 1.45), and other nondialysis expenditures (1.34; 95% CI, 1.30 to 1.37). Over time, initial differences in total dialysis expenditures disappeared and differences in iv dialysis drug utilization narrowed as nondialysis expenditures diverged. Estimated iv drug costs declined by US$2900 per patient-year in hemodialysis between 2008 and 2014 versus US$900 per patient-year in PD. From the perspective of the Medicare program, savings associated with PD in patients ≥67 years have remained unchanged, despite rapid growth in the use of this dialysis modality. Total dialysis expenditures for the two modalities converged over time, whereas nondialysis expenditures diverged.

Comparison of health services utilization, medical costs, and activity limitations between cancer survivors with and without a disability.

21 Background: Cancer survivors are one of the most vulnerable cohorts regarding health status and financial hardship. They are also more likely to have a disability than individuals without a cancer history. No prior research has systematically examined whether and how disability interacts with cancer survivorship. This study examines the association of disability with health services utilization, medical costs, and activity limitations among cancer survivors. Methods: We constructed a nationally representative cohort of cancer survivors using 2015-2019 Medical Expenditure Panel Survey Household Component File. Outcomes included health services utilization, measured by six service types (inpatient, institutional outpatient, office-based physician, office-based non-physician, ED, and prescription), total health care expenditure for all services combined and for each service type, and activity limitations (work at job, housework, and social relationship). Primary independent variables included six binary variables of functional disability conditions (hearing, vision, cognition, ambulation, self-care, and independent living) in the first model and a categorized total number of disabilities (0, 1, 2, 3, ≥4) in the second model. We employed multivariable generalized linear models and two-part models, adjusting for socio-demographics, general health status, and chronic conditions as well as accounting for complex survey design. Results: On average, cancer survivors (n = 9,359; weighted n = 21,046,285) had 0.57 days of hospital stays, 6.07 physician visits, and 16.3 prescriptions annually. The average annual health care expenditure for all services were $10,840, and 7.1% had one or more activity limitation. Notably, 38.8% of cancer survivors had at least one disability condition (ambulation 24.5%, hearing 13.8%, independent living 12.7%, cognition 11.5%). Compared to survivors without any disability, disability in self-care and ambulation was most strongly associated with the higher utilization of inpatient care (adjusted average marginal effect [AME] 0.85 days; 95% confidence interval [CI] 0.44-1.27) and physician visits (AME 1.03 visits; 95% CI 0.53-1.53), respectively. Disability in independent living (AME $5,046; 95% CI $2,638-7,455) and ambulation (AME $3,702; 95% CI $2,029-5,375) substantially increased total health care expenditure of all services. Survivors with four or more disabilities were 21.4 times more likely to have any activity limitations than those without a disability. Conclusions: Disability was associated with higher health services utilization and medical costs, and more activity limitations among cancer survivors, with the magnitude of increase varying by type of disability. Strategies to mitigate cancer disparities and financial hardship should take into account of the patients’ disability profiles.