Difference In Difference Analysis Research Articles

Did civilized city policy improve energy efficiency of resource-based cities? Prefecture-level evidence from China

Based on panel data of 114 prefecture-level resource-based cities in China from 2004 to 2018, this paper uses SBM model and super-efficiency SBM model to measure the energy efficiency of resource-based cities in China, and systematically analyzes the influence of Civilized City Policy on energy efficiency and the mechanism for that influence using difference-in-differences (DID) model and propensity score matching method. The findings show that the spatial distribution of energy efficiency of resource-based cities is higher in eastern China and lower in western China, and the energy efficiency was continually improved, with fluctuations, between 2004 and 2018. DID analysis and robustness analysis prove that Civilized City Policy is significantly conducive to improving energy efficiency of resource-based cities in China. This positive influence can also be achieved through the mechanism of technological innovation. In addition, there exists regional and type heterogeneity in the influence of Civilized City Policy on energy efficiency of resource-based cities.

Evaluation of a Multilevel Program to Improve Clinician Adherence to Management Guidelines for Acute Ischemic Stroke

Promotion of clinician adherence to stroke guidelines can improve stroke outcomes. To investigate the outcomes of a multilevel system program on clinician adherence to guidelines for treatment of patients with acute ischemic stroke (AIS). This quality improvement study used a prospective interrupted time series (ITS) and difference-in-difference (DID) design, from August 1, 2018, to January 31, 2020, divided into preprogram term and short and long postprogram terms; each term had 6 months. Data were collected during hospitalization and at discharge with an automated medical record data capture system in 58 public hospitals in Zhejiang province, China. Data were analyzed from August 2018 to January 2020. The multilevel system program included a modularized standard template for medical records, centrally supported continuing education, continuous monitoring and feedback, and collaborative workshops. The primary outcome was adherence to 12 key performance indicators (KPIs), expressed as (1) percentage of patient-applicable KPIs achieved in each participant and (2) percentage of participants among whom all applicable KPIs were achieved (dichotomous all-or-none measure). The secondary outcome was severe disability or death (modified Rankin Scale 5-6) at discharge. Among 45 091 patients (mean [SD] age, 69 [12] years; 18 347 female [40.7%]), 28 721 from 30 hospitals received the program and 16 370 from 28 hospitals continued routine care. In adjusted DID analysis, the program was associated with an increase in the absolute percentage of KPIs achieved per patient (6.46%; 95% CI, 5.49% to 7.43%), absolute rate of all-or-none success (8.29%; 95% CI, 6.99% to 9.60%), and decreased rate of severe disability or death at discharge (-1.68%; 95% CI, -2.99% to -0.38%). The ITS result showed the program was associated with an increase in KPIs achieved per patient per week (slope change in short-term period, 0.36%; 95% CI, 0.20% to 0.52%; level change in long-term period, (9.64%; 95% CI, 4.58% to 14.69%) and in all-or-none success (slope change in short-term period 0.34%; 95% CI, 0.23% to 0.46%; level change in long-term period 5.89%; 95% CI, 0.19% to 11.59%). The centrally supported program was associated with increases in clinician adherence to guidelines and reduced the proportion of severely disabled or deceased patients with AIS at discharge, providing support for its wider implementation.

The diabetes health plan and medication adherence among individuals with low incomes.

To test the impact of the Diabetes Health Plan (DHP), a diabetes-specific insurance plan that lowers out-of-pocket costs for diabetes-related medications and clinical visits, on adherence to oral hypoglycemic medications among low-income adults with Type 2 Diabetes (T2DM). Cohort of adults (18-64) with T2DM, an annual household income <USD 30,000, and who were continuously enrolled in an employer-sponsored UnitedHealthcare plan for at least two years between 2009 and 2014. We employed a linear regression Difference-In-Differences (DID) approach with a matched comparison group. To assess for differential DHP effects across adherent versus non-adherent patients, we ran a Difference-in-Difference-in-Differences (DDD) analysis by including an interaction term that included indicators for DHP exposure status and time, and low versus high baseline medication adherence. The analytic data set is limited to employer groups that purchased the DHP and standard benefit plans from UnitedHealthcare, had internal pharmacy contracts; complete pharmacy claims data, and sufficient medical claims and lab data to identify employees and their dependents with T2DM. Our DID analysis did not show improved medication adherence associated with employer DHP adoption. However, the DDD model suggested a difference between DHP-exposed and comparison beneficiaries when comparing the relative effect on individuals who were adherent versus non-adherent at baseline, as suggested by the significant three-way interaction term (10.2,p=0.028). This effect was driven by the 8.2 percentage point increase in medication adherence for the DHP subsample that was non-adherent at baseline. The DHP may benefit low-income patients with low baseline medication adherence. Value-based insurance design may be an important strategy for mitigating income disparities in T2DM outcomes.

Impact of the 2018 Japan Floods on benzodiazepine use: a longitudinal analysis based on the National Database of Health Insurance Claims.

Natural disaster has an impact on mental health. The 2018 Japan Floods, which took place in July 2018 were one of the largest water disasters in Japan's recorded history. We aimed to evaluate the change in the number of benzodiazepine prescriptions by physicians before and after the disaster. A retrospective cohort study based on the National Database of Health Insurance Claims was conducted in the flood-stricken areas between July 2017 and June 2019. The subjects were divided between victims and non-victims according to certification by local governments. Members of both groups were then categorized into three groups based on their pre-flood use of benzodiazepines: non-user, occasional user, and continuous user. Difference-in-differences (DID) analysis with a logistic regression model was conducted to estimate the effect of the disaster among victims by comparing the occurrence of benzodiazepine prescriptions before and after the disaster. Of 5,000,129 people enrolled, 31,235 were victims. Among all participants, the mean prescription rate for benzodiazepines in victims before the disaster (11.3%) increased to 11.8% after the disaster, while that in non-victims (8.3%) decreased to 7.9%. The DID analysis revealed that benzodiazepine prescription among victims significantly increased immediately after the disaster (adjusted ratio of odds ratios (ROR) 1.07: 95% confidence interval 1.05-1.11), and the effect of the disaster persisted even 1year after the disaster (adjusted ROR 1.2: 95% confidence interval 1.16-1.24). The flood increased the number of benzodiazepines prescriptions among victims, and the effect persisted for at least 1year.

Longitudinal Trends of Patient Demographics and Morbidity of Different Approaches in Lumbar Interbody Fusion: An Analysis Using the American College of Surgeons National Surgical Quality Improvement Program Database

The aims of this study were to determine the time trend of demographics, complications, and outcomes for patients undergoing posterior lumbar interbody fusion/transforaminal lumbar interbody fusion (PLIF/TLIF) or anterior lumbar interbody fusion/lateral lumbar interbody fusion (ALIF/LLIF) and to compare the differences in the time trends between both procedures. The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing PLIF/TLIF and ALIF/LLIF procedures. Outcomes were analyzed for differences between 2 time periods in the PLIF/TLIF and ALIF/LLIF cohorts separately (2009-2013 and 2015-2019). Longitudinal time trends of the 2 procedures were determined by difference-in-differences (DID) analysis. Statistical significance was defined as P<0.05. For both approaches, there was an increase in age and American Society of Anesthesiologists class over time, accompanied by a significant decrease in blood transfusions and morbidity. The DID analysis showed a greater change in age (DID:-1.8%; P < 0.001), and more patients were rated American Society of Anesthesiologists class 3 (DID:-2.4%; P= 0.033) in the ALIF/LLIF cohort than in the PLIF/TLIF cohort. Length of stay declined significantly over time in both cohorts, with a greater reduction observed for patients who underwent ALIF/LLIF than for patients who underwent PLIF/TLIF (DID: 0.2%; P= 0.014). There were no changes in readmission rates over time in either cohort (PLIF/TLIF DID: 0.6%; P= 0.080; ALIF/LLIF DID:-0.2%; P= 0.696). Time trends for PLIF/TLIF and ALIF/LIIF showed a significant increase in the number of older patients with complex medical status undergoing surgery. Despite these trends, there were decreases in overall postoperative morbidity, incidence of blood transfusion, and length of stay, without increasing readmission. These results suggest general improvement in surgical and perioperative management of lumbar fusion over time with greater gains found in ALIF/LLIF-specific care than in PLIF/TLIF.

The Affordable Care Act and suicide incidence among adults with cancer.

Patients with cancer are at an increased suicide risk, and socioeconomic deprivation may further exacerbate that risk. The Affordable Care Act (ACA) expanded insurance coverage options for low-income individuals and mandated coverage of mental health care. Our objective was to quantify associations of the ACA with suicide incidence among patients with cancer. We identified US patients with cancer aged 18-74years diagnosed with cancer from 2011 to 2016 from the Surveillance, Epidemiology, and End Results database. The primary outcome was the 1-year incidence of suicide based on cumulative incidence analyses. Difference-in-differences (DID) analyses compared changes in suicide incidence from 2011-2013 (pre-ACA) to 2014-2016 (post-ACA) in Medicaid expansion relative to non-expansion states. We conducted falsification tests with 65-74-year-old patients with cancer, who are Medicare-eligible and not expected to benefit from ACA provisions. We identified 1,263,717 patients with cancer, 812 of whom died by suicide. In DID analyses, there was no change in suicide incidence after 2014 in Medicaid expansion vs. non-expansion states for nonelderly (18-64years) patients with cancer (p = .41), but there was a decrease in suicide incidence among young adults (18-39years) (- 64.36 per 100,000, 95% CI = - 125.96 to - 2.76, p = .041). There were no ACA-associated changes in suicide incidence among 65-74-year-old patients with cancer. We found an ACA-associated decrease in the incidence of suicide for some nonelderly patients with cancer, particularly young adults in Medicaid expansion vs. non-expansion states. Expanding access to health care may decrease the risk of suicideamong cancer survivors.

Effect of partial closure of an emergency department on utilization of emergency departments

Background: As a result of multiple recommendations from the Danish Health Authority during 2005-2006, the structure of emergency care was reconfigured, including a reduction in the number of entry points in the form of EDs. The reconfiguration process was set to start in 2007, with a goal of completion within 5-10 years. The aim of this study is to shed light on the effect of partial closure of an ED on the utilization of EDs.&#x0D; Methods: Our population-based historic cohort study was based on data from Statistics Denmark and from Danish health registries, including the Danish Civil Registration System and the Danish National Patient Registry. We included all non-psychiatric ED contacts in citizens of Vejle municipal in the period 2014 to 2015 as Vejle ED on 5 January 2015 ceased its intake of acute orthopedic injuries between 10 pm and 7 am. As of 2015, Vejle municipality had 111,138 citizens. Contacts were excluded if patients where below 18 years old. For each contact emergency department utilized, residential municipal, and date of contact was extracted. Difference-in-difference (DID) estimation based on linear regression was employed, the dependent variable being aggregated daily ED contacts. The control group was defined as contacts between 7 am and 11 pm, and the cases being contacts between 11 pm and 7 am.Results: The study included a total of 39,659 contacts. Out of these 34,901 where between 7 am and 11 pm, and 4,758 where between 11 pm and 7 am. In days before 5 January 2015 there was on average 7.33 contacts between 11pm and 7am, in days after the average was 5.75 contacts, resulting in a 21.6% drop. The DID analysis’ comparison of contacts before and after 5 January 2015 resulted in a coefficient of -2.07, p&lt;0.01, 95%CI [-3.44, -0.70].&#x0D; Conclusion: In conclusion, the negative DID coefficient found shows a drop of 2 contacts per day between 11pm and 7am. This drop in utilization of EDs could indicate an inequality in accessibility to healthcare. This begs the question; which citizens does not utilize the EDs after reconfiguration, and what conquests this brings?

Impact of the introduction of a low-cost uterine balloon tamponade (ESM-UBT) device for managing severe postpartum hemorrhage in India: A comparative before-and-after study.

To evaluate the impact of introducing a uterine balloon tamponade (ESM-UBT) device for managing severe postpartum hemorrhage (PPH), mainly due to uterine atony, in health facilities in India on the rates of PPH-related maternal death and invasive procedures for PPH control. We used a quasi-experimental, difference-in-difference (DID) design to compare changes in the rates of a composite outcome (PPH-related maternal death and/or artery ligation, uterine compression sutures, or hysterectomy) among women delivering in nine intervention facilities compared with those delivering in two control facilities, before and after the introduction of ESM-UBT. The study sample included 214 123 deliveries (n=78 509 before ESM-UBT introduction; n=47 211 during ESM-UBT introduction; and n=88 403 after ESM-UBT introduction). After introduction of ESM-UBT, there was a significant decline in the rate of the primary composite outcome in intervention facilities (21.0-11.4 per 10000 deliveries; difference -9.6, 95% confidence interval -14.0 to -5.4). Change in the rate of the primary composite outcome was not significant in control facilities (11.7-17.2 per 10000 deliveries; difference 5.4, 95% confidence interval -3.9 to 14.9). DID analyses showed there was a significant reduction in the rate of the primary composite outcome in intervention facilities relative to control facilities (adjusted DID estimate -15.0 per 10000 points, 95% confidence interval -23.3 to -6.8; P=0.005). Introduction of the ESM-UBT in health facilities in India was associated with a significant reduction in PPH-related maternal death and/or invasive procedures for PPH control.

Innovation and energy productivity: An empirical study of the innovative city pilot policy in China✰

• The effects of China's innovative city pilot policy (ICPP) on energy productivity are investigated. • The empirical findings show that the ICPP leads to an economically and statistically significant improvement in energy productivity. • The magnitude of increase is estimated to be around 15% using the DID and matched DID methods. • The heterogeneous effects, robustness checks and mechanism analysis are also examined. Technological innovation reduces energy costs, accelerates energy transition, and is a key driver of economic growth. However, it has inconclusive effects on energy productivity, which is calculated as the ratio of economic output to energy consumption. In this study, we empirically investigated the effects of China's innovative city pilot policy (ICPP) on energy productivity using a difference-in-differences (DID) framework. The empirical findings revealed that in China, the implementation of the ICPP has led to an economically and statistically significant improvement in energy productivity and the magnitude of increase was estimated to be approximately 15% based on DID and matched DID analyses. We tested and confirmed the robustness of our results and conducted mechanism analysis to examine the three channels through which the ICPP exerts its effect on energy productivity, namely innovation quality, research and development expenditure, and innovation behavior.

Abstract P109: Association Of The 2017 ACC/AHA Blood Pressure Guideline With Blood Pressure Change In Community-dwelling Older Adults Between 2016-2019: A Difference-in-differences Analysis In The ARIC Study

Introduction: In 2017, the ACC/AHA revised the blood pressure (BP) guideline to lower the BP threshold for diagnosing and treating hypertension in older adults. Pharmacologic treatment is recommended for systolic BP (SBP) ≥130 mmHg in all older adults aged ≥65 years. Data on BP changes before and after publication of the guideline are needed to inform quality of care initiatives. Methods: We included participants from the Atherosclerosis Risk in Communities Study who attended a pre-guideline (2016-2017) and post-guideline (2018-2019) visit with a pre-guideline SBP between 120-159 mm Hg. We categorized participants based on their pre-guideline SBP according to the 2017 guideline: not reclassified to treatment (SBP 120-129), reclassified to stage 1 hypertension (SBP 130-139), or reclassified to stage 2 hypertension (SBP 140-159). To estimate the association of the 2017 guideline with SBP change, we performed a quasi-experimental analysis using difference-in-differences (DiD) regression. We compared changes in SBP between participants affected (SBP 130-139, 140-159) and those not affected (SBP 120-129) by the new SBP target, adjusted for traditional risk factors. Results: Of 2195 participants aged 71-94 years, mean (SD) SBP was 137.2 (10.8) mm Hg, and 77% were on antihypertensive therapy at the pre-guideline visit. Among participants with SBP ≥130 pre-guideline, 31% were at goal SBP &lt;130 post-guideline. In adjusted DiD analyses, participants with SBP ≥130 pre-guideline had significantly lower mean SBP at the post-guideline visit (Stage 1 hypertension: -5.0 [95% CI: -6.7, -3.3]; Stage 2 hypertension: -9.7 [-11.3, -8.0]) compared with participants with SBP 120-129 pre-guideline ( Table ). Results were similar when stratified by sex and race. Conclusions: In a sample of community-based older adults, the post-guideline period was associated with significantly lower SBP in those reclassified to Stage 1 or Stage 2 hypertension. However, significant gaps exist in BP control and only a minority met the updated treatment goal.

Randomized controlled trial study examining positive emotions and hope in solution-focused brief therapy with substance using parents involved in child welfare system

ABSTRACT Objective This study examines whether parents involved in the child welfare system, due to substance abuse, who receive solution-focused brief therapy (SFBT) counseling experience more hope and positive emotions than those receiving treatment-as-usual counseling services. Methods Randomized controlled trial design was used to evaluate the effectiveness of SFBT in primary substance use treatment services for parents (n = 123). Difference-in-Difference (DiD) estimation was used to assess the effect of SFBT intervention on hope, positive emotions, and negative emotions. Results DiD analyses showed SFBT parents had slightly worse scores on hope and emotion subscales at baseline and demonstrated slightly greater positive changes on all scales at posttest, though these findings were not statistically different from control group. Positive associations between SFBT and hope sub-scales were found; however, effects were not statistically significant. Conclusion SFBT may help increase positive emotions and hope in parents through a solution-building approach, but more research is needed.

Health promotion intervention to prevent risk factors of chronic diseases: Protocol for a cluster randomized controlled trial among adolescents in school settings of Chandigarh (India).

Chronic diseases like diabetes, cardiovascular diseases and cancers are on the rise. Most of the risk factors of these diseases commence in Adolescence. Therefore, a cluster randomised controlled trial is designed to evaluate the effect of school-based health promotion intervention on the risk factors of chronic diseases. Considering school as a cluster, twelve schools will be randomly selected from the public schools of Chandigarh, a city in India. After baseline assessment, six schools will be randomly allocated to intervention and six to the control arm. Study participants will be students of 8th grade (age 10-16 years), their parents and teachers. A sample of 360 students (12 clusters x 30 students) has been estimated to provide statistically valid inference. The PRECEDE PROCEED Model will be used to develop health promotion interventions to prevent the use of an unbalanced diet, physical inactivity, alcohol, and tobacco. Interventions will be implemented for six-months in the school setting. For students, the intervention will comprise interactive learning sessions of 30 minutes duration per week and physical activity sessions of 30 minutes duration four times every week. Educational sessions will be conducted for parents and teachers for 30 minutes, four times during the intervention period. Primary outcomes will be changes in the prevalence of behavioural risk factors from pre- to post-intervention. Changes in anthropometric, physiological, and biochemical measures will be the secondary outcomes. The difference-in-difference (DID) method will be used to measure the net change in the outcomes. It is essential to understand whether health promotion interventions implemented in the school setting simultaneously targeting adolescents, teachers, and parents are effective. Using the PRECEDE-PROCEED model for planning, implementing, and evaluating the intervention as part of a cluster Randomized Controlled Trial design with DID analysis, could objectively assess the impact.

Abstract TMP35: Prehospital Bypass Policies Increase The Proportion Of Stroke Patients Transported To Primary Stroke Centers - A Quasi-experimental Study In A National Sample Of Medicare Beneficiaries.

Objective: Prehospital bypass policies were designed to encourage transport of eligible stroke patients to stroke centers in order to receive rapid assessment and treatment. In a national dataset we examined the relationship between implementation of bypass policies and the proportion of patients transported to stroke centers. Methods: We included EMS transported ischemic stroke patients aged 66+ from a 20% sample of Medicare claims (2007 - 2014). We excluded patients not admitted through the ED, and those not continuously enrolled in parts A/B in the prior year. The outcome measure was transport to PSC. Stroke certification status was validated by multiple stroke certification databases; policy implementation details were obtained from review of statutes and regulations. We employed difference-in-differences (DID) analyses with a state-level random intercept. Results: A total of 20,345 patients were included in the study with 7,239 from policy states and counties and 13,106 from non-policy states and counties. The proportion of patients arriving at PSCs increased from 28% to 43% in non-policy areas and 33% to 57% in policy areas. The DID analysis revealed a net effect of 11% (p&lt;.001): policy areashad 17% higher probability of transporting stroke patients to PSCs after policy implementation (p&lt;.001) while non-policy areas demonstrated a 6% increase (p&lt;.001). Patients from rural areas had 49% lower odds of transport to PSC (OR 0.51, p&lt;.001). Discussion: In pre-thrombectomy era, statewide prehospital bypass policies were related to significant increases in proportion of stroke patients transported to stroke centers. Future analyses will assess if these effects occur in the thrombectomy era, and if these policies influence delivery of stroke treatments.

Repeal of state laws permitting denial of health claims resulting from alcohol impairment: Impact on treatment utilization.

Many states in the U.S. still have Alcohol Exclusion Laws (AELs), which allow insurance companies to deny health claims resulting from alcohol impairment. There are concerns that this form of structural stigmatization affects alcohol treatment-seeking behaviors. We examined the effects of AEL repeal on treatment admissions for alcohol use disorder (AUD). Data on alcohol treatment admissions from 1992 to 2017 were obtained from the Treatment Episode Data Set. The state-level aggregate number of treatment admissions was derived, including healthcare professional referrals only, self-referrals only, and both self-referral and healthcare professional referrals. The number of treatment admissions by health insurance status (private, public, and uninsured) was also calculated. The study used a difference-in-differences (DID) quasi-experimental design. The DID analysis showed that the number of admissions for alcohol treatment from healthcare professional referrals increased 16% in the AEL repeal states compared to states with AELs or that never had AELs (IRR=1.16, 95% CI=1.07, 1.25). These results were consistent for analysis by payment sources. In particular, treatment admissions from healthcare professional referrals for patients covered by private insurance increased about 38% in states with AEL repeal (IRR=1.38, 95% CI=1.17, 1.64) compared to states without AEL repeal. However, the findings were no longer significant when the state-specific time trends were taken into account. This study documented that AEL repeal may have had a significant impact on the number of treatment admissions for AUD. These findings suggest that AELs function as a barrier to treatment-seeking behavior.

The Association Between Bariatric Surgery and Psychiatric Disorders: a National Cohort Study.

Previous studies have shown that bariatric surgery reduces the risk of cardiovascular outcomes. Less is known about the effects of bariatric surgery on psychiatric disorders. This cohort study compared the differential risk of psychiatric disorders between those who did and did not undergo bariatric surgery, from before until after the surgery. We used PearlDiver-Mariner, a national all-payor claims database. Patients were followed for 1year before and after the index date and a difference-in-differences (DiD) study design was executed. We included 56,661 bariatric surgery patients matched to 56,661 individuals with obesity. Among bariatric surgery patients, the risk of psychiatric was 18% 1year before and increased to 70% 1year after surgery. Among individuals with obesity, the risk of psychiatric disorders also increased from 1year before to 1year after, but by less (21% versus 46%). DiD analysis suggested that bariatric surgery was associated with a 27 percentage point differential increase in the risk of psychiatric disorders across all patients, representing a 135% relative increase. Results using 3years as the pre- and post-periods lead to similar inferences. Preexisting psychiatric disorders are similarly prevalent among bariatric surgery patients and individuals with obesity. The prevalence of psychiatric disorders increased over time for both groups, but to a larger extent among bariatric surgery patients. Adequate treatment for psychiatric disorders and appropriate implementation of behavioral health interventions may be needed to reduce the burden of psychiatric disorders following bariatric surgery.

The effect of the two-child policy on cesarean section in China: Identification using difference-in-differences techniques

BackgroundChina has one of the highest rates of cesarean section in the world. One of the possible reasons for such high rates was China's one-child policy. Relaxation of the one-child policy might be associated with a reduction in the rate of cesarean section. ObjectivesTo assess the effect of China's universal two-child policy on cesarean section rates using patient-level data from one large municipal-level obstetrics and gynecology hospital in Shanghai, East China. Data sourcesThe study used inpatient hospital records data on all infants delivered between January 1, 2013 and May 31, 2018 at the Shanghai First Maternity and Infant Hospital, which is one of the largest obstetrical hospitals in China. Study designA quantitative study design with difference-in-differences (DID) estimation techniques were used to control for socio-economic and health-related factors in order to identify the impact of the universal two-child policy on cesarean section rates in China. Moreover, DID analysis stratified by maternal migrant status and age were conducted. ResultsAnalysis of 133,358 deliveries suggests that China's universal two-child policy resulted in a statistically significant reduction in cesarean section rates from 49.5 to 43.3 per 100 deliveries over the study period. ConclusionOur findings suggest that the significant reduction in cesarean section rates may be due to a shift in health risk perceptions resulting from the relaxation of the one-child policy when mothers consider the possibility of having a second child. Health education on the risk of repeat cesarean section in pregnant women should be enhanced.

Association of State-Imposed Restrictions on Gabapentin with Changes in Prescribing in Medicare.

Between August 2016 and July 2018, three states classified gabapentin as a Schedule V drug and nine states implemented prescription drug monitoring program (PDMP) regulation for gabapentin. It is highly unusual for states to take drug regulation into their own hands. The impact of these changes on gabapentin prescribing is unclear. To determine the effect of state-imposed regulation on gabapentin prescribing for Medicare Part D enrollees from 2013 to 2018. Population-based difference-in-difference(DID) analysis study utilizing the Medicare Part D Prescriber Public Use File. All eligible Medicare Part D prescribers excluding those outside of the fifty states and the District of Columbia were included in our analysis. Prescriber data and key sociodemographic variables were organized by state and year. States with a gabapentin schedule change or PDMP regulation enacted before 2019 were included in the intervention group. For the Schedule V DID analysis, a control group of the ten highest opioid-prescribing states was used. States with gabapentin schedule changes or PDMP regulation before January 1, 2019, were included and compared to control states that did not implement these policies. Total days' supply of gabapentin per enrollee per year was the primary outcome variable. The mean total days' supply of gabapentin per enrollee increased 41% from 19.71 to 27.81 total days' supply per enrollee per year between 2013 and 2018. After adjustment, Schedule V gabapentin regulation resulted in a reduction of 8.37 total days of gabapentin prescribed per enrollee (95% confidence interval of - 10.34 to - 6.39). In contrast, PDMP regulation resulted in a reduction of 1.01 total days of gabapentin prescribed per enrollee (95% confidence interval of - 1.74 to - 0.29). Classifying gabapentin as a Schedule V drug results in substantial reduction in total days prescribed whereas PDMP regulation results in modest reduction.

Exploring the causal role of intimate partner violence and abuse on depressive symptoms in young adults: a population-based cohort study

BackgroundPrevious studies have shown an association between experience of intimate partner violence and abuse (IPVA) and depression. Whether this is a causal relationship or explained by prior vulnerability that influences the risk of both IPVA and depression is not known.MethodsWe analysed data from the Avon Longitudinal Study of Parents and Children prospective cohort (N = 1764 women, 1028 men). To assess the causal association between IPVA at 18–21 years old and logged depressive symptom scores at age 23, we used (i) multivariable linear regression, (ii) inverse probability of treatment weighting (IPTW), and (iii) difference-in-difference (DiD) analysis, which compared the mean change in logged depressive symptom scores between ages 16 and 23 between those who experienced IPVA and those who did not.ResultsWomen who experienced IPVA had on average 26% higher depressive symptom scores after adjustment for measured confounders (ratio of geometric means 1.26, 95% CI 1.13 to 1.40). In men, the difference was 5% (ratio of geometric means 1.05, 95% CI 0.92 to 1.21). Results from IPTW analysis were similar. In the DiD analysis, there was no evidence that being exposed to IPVA affected the change in depressive symptom scores over time compared to being in the non-exposed group for either women (difference-in-differences 1%, −12 to 16%) or men (−1%, −19 to 20%).ConclusionsMultivariable linear regression and IPTW suggested an association between IPVA and higher depressive symptom score in women but not men, but DiD analysis indicated a null effect in both women and men. This suggests the causal origins of higher depressive symptoms in this young adult population are likely to reflect prior vulnerability that leads to both higher depressive symptoms and increased risk of IPVA exposure.

Effectiveness of a collaborative model in improving maternal and child health outcomes among urban poor in Chandigarh, a North Indian city.

BACKGROUND:To ascertain the effectiveness of a collaborative model between the Department of Community Medicine and state health department to improve MCH outcomes among the urban poor in Chandigarh.MATERIALS AND METHODS:A quasi-experimental study was conducted from 2011–12 to 2015–16 in the intervention and control areas. A collaboration was established between the state health department and the Department of Community Medicine of an autonomous institute. The intervention and control areas were mainly inhabited by the poor migrant population. Critical elements of an efficient collaboration such as the early engagement of partners, clearly stated purpose with common goals, effective communication, and no financial conflict were implemented in the intervention area. MCH program's implementation was strengthened through supportive supervision, enhanced community engagement, male partner involvement, tracking of high-risk pregnant women, and identification of problem families. Trend analysis of MCH indicators was done. The difference-in-difference (DID) analysis was done to measure the net effect of the intervention.RESULTS:All the MCH indicators improved significantly in the intervention area compared to the control area (P < 0.05). DID analysis depicted a net increase in the early registration of pregnancies by 18%, tetanus toxoid immunization by 9.2%, and fully immunized children by 8.6%. There was also an improvement in the maternal mortality ratio by 121.1 points, infant mortality rate by 2.2 points, and neonatal mortality rate by 2.6 points in the intervention area.CONCLUSION:An innovative, collaborative model between the state health department and the Department of Community Medicine effectively improved the MCH outcomes in Chandigarh.

The Quasi-Experimental Effects of Maternal Health, Severe Maternal Morbidity, and Extreme Climate Disasters: A Difference-In Difference Analysis of the South Carolina 2015 Extreme Floods

The Quasi-Experimental Effects of Maternal Health, Severe Maternal Morbidity, and Extreme Climate Disasters: A Difference-In Difference Analysis of the South Carolina 2015 Extreme Floods