Eligibility Age Research Articles

Factors Associated with Parents' COVID-19 Vaccination Decisions for Their Children in an Economically Marginalized, Diverse Community.

COVID-19 vaccine hesitancy is a significant public health concern, particularly among parents who serve as gatekeepers for their child(ren)'s vaccination status. This study adds to the literature by examining COVID-19 vaccine decisions among parents living in a mid-size, lower-income, racially/ethnically diverse, community. Parents of children, < 18 years and enrolled in the public schools system, were invited to complete a questionnaire offered in English, Spanish, and Portuguese. The questionnaire included questions about their child(ren)'s vaccination status, as well as factors which, based on the literature, might impact parents' vaccination decisions. Parents (n = 277) were mostly Hispanic/Latinx, females, with a high school degree/GED as their highest level of education achieved, a mean age of 40 years, and an average of two children < 18 years. Four-fifths (78.6%) of parents reported being vaccinated against COVID-19, but only 40.8% reported having all of their children vaccinated; 14.8% had some of their children get the COVID-19 vaccine, and 44.4% had none of their children get the COVID-19 vaccine. In bivariate associations, parents' vaccination status, parents age, the CDC website as a COVID-19 information source, awareness of age eligibility for the COVID-19 vaccine, parents reporting knowing someone who does not want to vaccinate their child, and parents' perceived social norm score were associated with children's vaccination status. However, when multivariate analyses were conducted, only parents' age and perceived social norms increased parents' odds of choosing to vaccinate their child. These findings have implications for those promoting COVID-19 vaccination among parents in lower-income, diverse communities.

Acceptability of de-intensified screening for women at low risk of breast cancer: a randomised online experimental survey

BackgroundRisk-stratified approaches to breast screening show promise for increasing benefits and reducing harms. But the successful implementation of such an approach will rely on public acceptability. To date, research suggests that while increased screening for women at high risk will be acceptable, any de-intensification of screening for low-risk groups may be met with less enthusiasm. We report findings from a population-based survey of women in England, approaching the age of eligibility for breast screening, to compare the acceptability of current age-based screening with two hypothetical risk-adapted approaches for women at low risk of breast cancer.MethodsAn online survey of 1,579 women aged 40–49 with no personal experience of breast cancer or mammography. Participants were recruited via a market research panel, using target quotas for educational attainment and ethnic group, and were randomised to view information about (1) standard NHS age-based screening; (2) a later screening start age for low-risk women; or (3) a longer screening interval for low-risk women. Primary outcomes were cognitive, emotional, and global acceptability. ANOVAs and multiple regression were used to compare acceptability between groups and explore demographic and psychosocial factors associated with acceptability.ResultsAll three screening approaches were judged to be acceptable on the single-item measure of global acceptability (mean score > 3 on a 5-point scale). Scores for all three measures of acceptability were significantly lower for the risk-adapted scenarios than for age-based screening. There were no differences between the two risk-adapted scenarios. In multivariable analysis, higher breast cancer knowledge was positively associated with cognitive and emotional acceptability of screening approach. Willingness to undergo personal risk assessment was not associated with experimental group.ConclusionWe found no difference in the acceptability of later start age vs. longer screening intervals for women at low risk of breast cancer in a large sample of women who were screening naïve. Although acceptability of both risk-adapted scenarios was lower than for standard age-based screening, overall acceptability was reasonable. The positive associations between knowledge and both cognitive and emotional acceptability suggests clear and reassuring communication about the rationale for de-intensified screening may enhance acceptability.

Geographic Variation of Prevalence of Alzheimer's Disease and Related Dementias in Central Appalachia.

Alzheimer's disease and related dementias (ADRD) prevalence varies geographically in the United States. To assess whether the geographic variation of ADRD in Central Appalachia is explained by county-level sociodemographics or access to care. Centers for Medicare and Medicaid Services Public Use Files from 2015- 2018 were used to estimate county-level ADRD prevalence among all fee-for-service (FFS) beneficiaries with≥1 inpatient, skilled nursing facility, home health agency, hospital outpatient or Carrier claim with a valid ADRD ICD-9/10 code over three-years in Central Appalachia (Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia). Negative binomial regression was used to estimate prevalence overall, by Appalachian/non-Appalachian designation, and by rural/urban classification. Models were then adjusted for county-level: 1) FFS demographics (age, gender, and Medicaid eligibility), comorbidities; 2) population sociodemographics (race/ethnicity, education, aging population distribution, and renter-occupied housing); and 3) diagnostic access (PCP visits, neurology visits, and imaging scans). Across the 591 counties in the Central Appalachian region, the average prevalence of ADRD from 2015- 2018 was 11.8%. ADRD prevalence was modestly higher for Appalachian counties both overall (PR: 1.03; 95% CI: 1.02, 1.04) and after adjustment (PR: 1.02; 95% CI: 1.00, 1.03) compared to non-Appalachian counties. This difference was similar among rural and urban counties (p = 0.326) but varied by state (p = 0.004). The relative variation in ADRD prevalence in the Appalachian region was smaller than hypothesized. The case mixture of the dual eligible population, accuracy of the outcome measurement, and impact of educational attainment in this region may contribute to this observation.

The impact of targeted local outreach clinics to improve COVID-19 vaccine uptake: controlled interrupted time series in South West England

BackgroundOutreach clinics were part of efforts to maximise uptake in COVID-19 vaccination.MethodsWe used controlled interrupted time series, matching on age, sex, deprivation and vaccination eligibility date, to determine the effect of outreach clinics on time to first COVID-19 vaccine, using a population-based electronic health record database of 914,478 people, from December 2020 to December 2021; people living within 1 mile of each outreach clinics were exposed.Results50% of 288,473 exposed citizens were white British, and 71% were aged 0–49 years. There was no evidence for an overall statistically significant increase in cumulative percentage vaccinated due to the outreach clinic at 6 weeks, with an overall pooled effect estimate of -0.07% (95% CI: -1.15%, 1.02%). The pooled estimate for increased cumulative vaccine uptake varied slightly depending on how the analysis was stratified; by ethnic group it was − 0.12% (95% CI: -0.90%, 0.66%); by age group it was − 0.06% (95% CI: -0.41%, 0.28%); and by deprivation it was 0.03% (95% CI: -0.74%, 0.79%).ConclusionsLiving within a mile of an outreach clinic was not associated with higher vaccine uptake. Evaluation of future outreach clinics should consider the relative importance of travel amongst other barriers to accessing vaccines.

The effect of the US Child Tax Credit advance payments in 2021 on adolescent mental health: Changes in depression symptoms and suicidality

ObjectiveChild poverty is associated with poor adolescent mental health. Changes to the Child Tax Credit (CTC) in 2021 in the U.S. were historic and introduced a new model of distributing the credit in advance of tax filing, providing families with stable, supplemental monthly income. This policy shift offers a unique opportunity to examine the mental health effects for adolescents. MethodsWe use electronic health record data from a large pediatric primary care network in Columbus, Ohio, which collected adolescent depression screening scores in real time as the CTC advance payments were introduced. We utilized differences in age of eligibility for the CTC to examine the changes in the probability of depression screening outcomes (positive depression screen, any depression symptom, any suicidal ideation), for adolescents eligible for the credit (turned 18 first quarter of 2022), relative to those not eligible (turned 18 last quarter of 2021) (n = 1,423). ResultsWe did not observe a significant association between the policy change and study outcomes in the overall sample. However, the percentage of adolescents with a positive depression screen significantly declined for Non-Hispanic Black (13.4 percentage point reduction, p = 0.01) and publicly insured (9.7 percentage point reduction, p = 0.04) adolescents. ConclusionsOur findings suggest reductions in depression symptoms for subgroups of adolescents who were age-eligible for the CTC compared to their counterparts who were not eligible. The CTC advance payments were a brief experiment in universal basic income and may offer a policy solution for addressing both poverty and a growing adolescent mental health crisis.

Enhancing adult learner success in higher education through decision tree models: A machine learning approach

This article explores the use of machine learning, specifically Classification and Regression Trees (CART), to address the unique challenges faced by adult learners in higher education. These learners confront socio-cultural, economic, and institutional hurdles, such as stereotypes, financial constraints, and systemic inefficiencies. The study utilizes decision tree models to evaluate their effectiveness in predicting graduation outcomes, which helps in formulating tailored educational strategies. The research analyzed a comprehensive dataset spanning the academic years 2013–2014 to 2021–2022, evaluating the predictive accuracy of CART models using precision, recall, and F1 score. Findings indicate that attendance, age, and Pell Grant eligibility are key predictors of academic success, demonstrating the strong capability of the model across various educational metrics. This highlights the potential of machine learning (ML) to improve data-driven decision-making in educational settings. The results affirm the effectiveness of Decision Tree (DT) models in meeting the educational needs of adult learners and underscore the need for institutions to adapt their strategies to provide more inclusive and supportive environments. This study advocates for a shift towards nuanced, data-driven approaches in higher education, emphasizing the development of strategies that address the distinct challenges of adult learners, aiming to enhance inclusivity and support within the sector.

A Review on Dental Age Estimation in Children and Adolescents

Abstract Children are seen as beings who exist from birth through puberty, while teenagers are regarded as existing from puberty until around the age of 20 years. For a number of legal processes, including child labor, employment, the age of majority, rape, adoption, marriage eligibility, and situations where the birth certificate is unavailable, age estimation in children and adolescents is crucial. Despite the wide range of methods available, dental age estimation techniques that take into account tooth maturation are thought to be the most reliable predictors of chronological age in subadults. This is because genetic factors predominate and environmental factors, particularly between birth and age ten, tend to have little impact on tooth maturation. The eruption of teeth holds greater significance in the deciduous dentition, where genetic factors predominantly govern the process, compared to the permanent dentition. Conversely, tooth calcification serves as a viable indicator for estimating dental age in both primary and permanent dentitions. Current dental age estimation methods are based on age-related changes in teeth, such as tooth growth and development, changes that occur after teeth form, and biochemical changes. Therefore, in this review article, we will explore the several methodologies used for dental age assessment in children and adolescents.

Extended foster care and homelessness: Assessing the impact of the Fostering Connections to Success and Increasing Adoptions Act on rates of homelessness among youth

Youth aging out of foster care experience high rates of homelessness during young adulthood. This study assessed the impact of states’ extension of foster care through age 21 under the federal Fostering Connections to Success and Increasing Adoptions Act of 2008 on state-level rates of homelessness among all youth ages 18–24, which we used as a proxy to assess impact on the legislation’s target population. To do so, we leveraged data from the U.S. Department of Housing and Urban Development, the Census Bureau and several other publicly available data sources to construct a novel state-level panel dataset that allowed us to capture changes in rates of homelessness among youth ages 18–24 and extended foster care policies in all 50 states for the eight-year period from 2013 to 2020. Employing a difference-in-difference approach, we found evidence of an anticipated lagged effect of extended foster care, wherein the implementation of extended foster care is associated with a 23 % reduction in the total rate of youth homelessness four years later. This effect persists in years five to six after states adopt this policy change. We found no evidence of a similar effect of extended foster care on rates of homelessness among persons not between the ages of 18–24. Our findings provide important evidence about the impact of the Fostering Connections Act and suggest that extending the age of foster care eligibility may create important safety nets and pathways that support a reduction in rates of homelessness among former foster youth.

Frailty, Specialized Care, and Sociodemographic Factors: Disparities in Oral Pharmacotherapy Class Utilization Among Medicare Part D Beneficiaries With Overactive Bladder in the United States

ObjectivesTo describe the prevalence of frailty among Medicare beneficiaries with overactive bladder (OAB), analyze oral therapy patterns, and examine potential disparities in treatment. MethodsThis retrospective cohort study utilized the 20% Research Identifiable File Medicare Part D prescription claims dataset (2013-2018). Using the Claims-Based Frailty Index (CFI), Medicare beneficiaries ≥65 years old with OAB were categorized as not frail (CFI <0.15), prefrail (0.15 ≤CFI <0.25), and frail (CFI >0.25). Logistic regression models assessed associations between frailty and pharmacotherapy utilization. ResultsAmong 111,761 patients (15.8% of the OAB cohort) receiving oral pharmacotherapy (anticholinergic oral medications or mirabegron), 71% were women, 83% were White, and 11.9% were frail. After controlling for age, co-payments and dual eligibility status, frail status (OR 1.16; 95% CI [1.09 - 1.24]), urology (OR 2.05 (95% CI [1.94 - 2.16]) or gynecology (OR 1.74; 95% CI [1.6 - 1.9]) prescribers and residing in the Southern United States (OR 1.53; CI [1.49 - 1.61]) were associated with higher likelihood of mirabegron utilization. Black (OR 0.79; 95% CI ([0.74 - 0.85]) and American Indian/Alaska Native (OR 0.54, 95% CI ([0.39 - 0.74]) patients were less likely to utilize mirabegron than White beneficiaries. ConclusionFrail beneficiaries and those with urology and gynecology prescribers showed higher likelihoods of beta-3 agonist utilization. Despite adjustments, Black and AI/AN patients were less likely to fill mirabegron prescriptions, suggesting disparities in treatment. Our findings highlight the need for policies, interventions, and initiatives to promote equitable OAB oral therapy utilization in vulnerable populations.

POLITICAL SATIRE ON SOCIAL MEDIA RESPONDING TO THE CONSTITUTIONAL COURT'S DECISION ON VICE PRESIDENT AGE ELIGIBILITY FOR THE 2024 ELECTIONS

This research explains the political satire on Indonesian social media, focusing on the public's response to the constitutional court's decision regarding the vice president's age eligibility for the 2024 elections. Utilising Indonesia's three most prominent social media platforms, such as TikTok, Twitter, and YouTube, the research aims to unravel the various techniques for crafting and delivering political satire through visual and audiovisual media. A comprehensive analysis of 40 distinct satirical pieces was conducted to identify the different techniques. These pieces were collected using digital observation techniques across the specified platforms, supplemented by searches on Google. The methodological framework for the analysis is grounded in Buijzen and Valkenburg's (2004) typology for delivering humour. Our findings unveil a rich tapestry of satirical strategies employed by Indonesian netizens. At least seven distinct techniques were identified: irony, sarcasm, parody, puns, juxtaposition, slapstick, and metaphor. Irony emerged as the most prevalently used technique, indicating its effectiveness in nuanced political critiques. This research contributes to a deeper understanding of the interaction between humour and political discourse in the digital age, especially within the Indonesian context. It highlights the significance of satire as a powerful tool for political expression and engagement on social media.

Racial disparities in colorectal cancer outcomes and access to care: a multi-cohort analysis.

Non-Hispanic Black (NHB) Americans have a higher incidence of colorectal cancer (CRC) and worse survival than non-Hispanic white (NHW) Americans, but the relative contributions of biological versus access to care remain poorly characterized. This study used two nationwide cohorts in different healthcare contexts to study health system effects on this disparity. We used data from the Surveillance, Epidemiology, and End Results (SEER) registry as well as the United States Veterans Health Administration (VA) to identify adults diagnosed with colorectal cancer between 2010 and 2020 who identified as non-Hispanic Black (NHB) or non-Hispanic white (NHW). Stratified survival analyses were performed using a primary endpoint of overall survival, and sensitivity analyses were performed using cancer-specific survival. We identified 263,893 CRC patients in the SEER registry (36,662 (14%) NHB; 226,271 (86%) NHW) and 24,375 VA patients (4,860 (20%) NHB; 19,515 (80%) NHW). In the SEER registry, NHB patients had worse OS than NHW patients: median OS of 57 months (95% confidence interval (CI) 55-58) versus 72 months (95% CI 71-73) (hazard ratio (HR) 1.14, 95% CI 1.12-1.15, p = 0.001). In contrast, VA NHB median OS was 65 months (95% CI 62-69) versus NHW 69 months (95% CI 97-71) (HR 1.02, 95% CI 0.98-1.07, p = 0.375). There was significant interaction in the SEER registry between race and Medicare age eligibility (p < 0.001); NHB race had more effect in patients <65 years old (HR 1.44, 95% CI 1.39-1.49, p < 0.001) than in those ≥65 (HR 1.13, 95% CI 1.11-1.15, p < 0.001). In the VA, age stratification was not significant (p = 0.21). Racial disparities in CRC survival in the general US population are significantly attenuated in Medicare-aged patients. This pattern is not present in the VA, suggesting that access to care may be an important component of racial disparities in this disease.

Racial and gender disparities in utilization of outpatient total shoulder arthroplasties

Utilization in outpatient total shoulder arthroplasties (TSAs) has increased significantly in recent years. It remains largely unknown whether utilization of outpatient TSA differs across gender and racial groups. This study aimed to quantify racial and gender disparities both nationally and by geographic regions. 168,504 TSAs were identified using Medicare fee-for-service inpatient and outpatient claims data and beneficiary enrollment data from 2020 to 2022Q4. The percentage of outpatient cases, defined as cases discharged on the same day of surgery, was evaluated by racial and gender groups and by different census divisions. A multivariate logistics regression model controlling for patient sociodemographic information (White vs. non-White race, age, gender, and dual eligibility for both Medicare and Medicaid), hierarchical condition category (HCC) score, hospital characteristics, year fixed effects, and patient residency state fixed effects was performed. The TSA volume per 1000 beneficiaries was 2.3 for the White population compared with 0.8, 0.6, and 0.3 for the Black, Hispanic, and Asian population, respectively. A higher percentage of outpatient TSAs were in White patients (25.6%) compared with Black patients (20.4%) (P<.001). The Black TSA patients were also younger, more likely to be female, more likely to be dually eligible for Medicaid, and had higher HCC risk scores. After controlling for patient sociodemographic characteristics and hospital characteristics, the odds of receiving outpatient TSAs were 30% less for Black than the White group (odds ratio 0.70). Variations were observed across different census divisions, with South Atlantic (0.67, P<.01), East North Central (0.56, P<.001), and Middle Atlantic (0.36, P<.01) being the 4 regions observed with significant racial disparities. Statistically significant gender disparities were also found nationally and across regions, with an overall odds ratio of 0.75 (P<.001). Statistically significant racial and gender disparities were found nationally in outpatient TSAs, with Black patients having 30% (P<.001) fewer odds of receiving outpatient TSAs than White patients, and female patients with 25% (P<.001) fewer odds than male patients. Racial and gender disparities continue to be an issue for shoulder arthroplasties after the adoption of outpatient TSAs.

State mandatory paid medical leave policies and cancer stage at diagnosis in US adults.

11008 Background: Since 2012, several states implemented mandatory paid medical leave policies. Mandatory paid medical leave may alleviate time and financial burdens, enabling patients to undergo screening and/or timely diagnostic workup for new cancer-related symptoms. These policies have been associated with increased cancer screening. We investigated whether state mandatory paid medical leave policies were associated with stage at cancer diagnosis. Methods: Adults ages 18-64 years diagnosed with cancer from 2010-2019 were identified from the Surveillance, Epidemiology, and End Results program. Differences-in-differences (DID) analyses using the updated method of accounting for heterogeneity in policy enactment compared proportions of stage I and IV cancer diagnoses from pre- to post-policy implementation in states with vs. without paid medical leave policies. Analyses adjusted for age, sex, race, ethnicity, rurality, cancer site, county-level income, and time-varying state Medicaid eligibility levels. Since some cities enacted city-wide policies prior to state-wide implementation, cases from affected states between the time of city and state policy enactment were excluded. Sensitivity analyses were conducted excluding counties with cities that enacted paid leave policies. The plausibility of the parallel trends assumption was assessed by comparing stage at diagnosis between state groups in the pre-policy period and was satisfied for all reported results. Results: A total of 1,052,307 adults with cancer were identified. 39.8% and 19.7% of patients were diagnosed with stage I and IV cancers, respectively. In adjusted DID analyses, there was a 1.34 percentage point (PP) increase in stage I diagnoses and a 2.05 PP decrease in stage IV diagnoses associated with mandatory paid medical leave policy implementation (Table). Results were similar in sensitivity analyses. In subgroup analyses, policy-associated stage shifts were seen in males, Hodgkin lymphoma, and liver and lung cancers, with less clear patterns for cervix and pancreas cancers. Conclusions: State mandatory paid medical leave was associated with increased early-stage cancer diagnoses and decreased late-stage diagnoses. Paid leave policies may promote earlier detection of non-screenable cancers by enabling employees to promptly seek care for new cancer-related symptoms. Policies that improve opportunities to seek medical care may facilitate earlier cancer detection and ultimately contribute to better patient outcomes. [Table: see text]

Retirement Makes You Old? Causal Effect of Retirement on Biological Age

Retirement is a critical life event for older people. Health scholars have scrutinized the health effects of retirement, but its consequences on age-related diseases and mortality are unclear. We extend this body of research by integrating measurements of biological age, representing the physiological decline preceding disease onset. Using data from the UK Biobank and a fuzzy regression discontinuity design, we estimated the effects of retirement on two biomarker-based biological age measures. Results showed that retirement significantly increases biological age for those induced to retire by the State Pension eligibility by 0.871–2.503 years, depending on sex and specific biological age measurement. Given the emerging scientific discussion about direct interventions to biological age to achieve additional improvements in population health, the positive effect of retirement on biological age has important implications for an increase in the State Pension eligibility age and its potential consequences on population health, public health care policy, and older people's labor force participation. Overall, this study provides novel empirical evidence contributing to the question of what social factors make people old.

Effect of Sleep Restriction on Adolescent Cognition by Adiposity

Pediatric obesity is associated with impaired cognitive function; however, the mechanisms underlying this association demand assessment. Sleep may be a relevant moderator, as poor sleep predicts both increased adiposity and impaired cognitive function. To determine the effects of adiposity and sleep on adolescent cognitive function. This single-blind randomized crossover trial was conducted from September 2020 to October 2022. Parents or caregivers provided demographic information for adolescent participants. Body mass index percentile and bioelectrical impedance analysis assessed adiposity. Adolescents completed 2 actigraphy-confirmed sleep conditions, adequate and restricted, followed by in-person cognitive assessment. No additional follow-up was provided. Data collection for this population-based study took place in a behavioral medicine clinic in Birmingham, Alabama. A total of 323 participants were assessed for eligibility (ages 14-19 years and healthy). Of the 244 eligible adolescents, 157 declined participation. Eighty-seven were randomized and 26 dropped out postenrollment. The final sample included 61 adolescents, 31 with healthy weight and 30 with overweight or obesity. Data were analyzed from April to October 2023. Following a 2-day washout period of adequate sleep, adolescents completed 2 sleep conditions: adequate (mean [SD] duration, 8 hours, 54 minutes [58.0 minutes]) and restricted (mean [SD] duration, 4 hours, 12 minutes [50.7 minutes]). The National Institutes of Health Cognitive Toolbox assessed global and fluid cognition, cognitive flexibility, working and episodic memory, attention, and processing speed. The Stroop Task assessed inhibition. The final sample included 61 adolescents (mean [SD] age, 16.3 [1.6] years; 35 [57.4%] female). Restricted sleep predicted poorer global cognition scores (restricted mean [SD], 98.0 [2.8]; adequate mean [SD], 103.2 [2.9]), fluid cognition scores (restricted mean [SD], 94.5 [3.2]; adequate mean [SD], 102.0 [3.6]), and cognitive flexibility scores (restricted mean [SD], 84.8 [3.0]; adequate mean [SD], 92.8 [3.0]) for adolescents with overweight or obesity. No differences emerged for adolescents with healthy weight. Adolescents with overweight or obesity also had poorer attention scores (mean [SD], 80.0 [2.3]) compared to adolescents with healthy weight (mean [SD], 88.4 [SD, 2.3]) following restricted sleep. No differences emerged following adequate sleep. Findings were similar for total body fat percentage (TBF%); however, for adolescents with TBF% above 42, restricted sleep also predicted poorer processing speed, and the association between sleep and attention did not vary based on TBF%. Adolescents with overweight or obesity may be more vulnerable to negative cognitive effects following sleep restriction. Improved sleep hygiene and duration in this group may positively impact their cognitive health. ClinicalTrials.gov Identifier: NCT04346433.

Effects of Mobi’s equity initiatives on public bike share access and use

Since its launch, Vancouver’s public bike share system has implemented changes to reduce barriers, enhance uptake, and make bike sharing more equitable. These include hiring an equity coordinator, expanding the service area, adding e-bikes to the fleet, reducing the age eligibility, reducing financial barriers through their Community Pass, and partnering with community organizations. We used a mixed methods study design to assess the impact of these initiatives on access to and use of public bike share. We found that the service area expansion reduced inequities in spatial access by socioeconomic status, age, and race, but higher socioeconomic status and white populations continue to have better access. Our analysis of system and survey data, and interviews with community organizations, revealed how the Community Pass is enhancing transport justice by expanding the benefits of bike share and improving access to opportunities for more diverse populations.

Differences in Reimbursements, Procedural Volumes, and Patient Characteristics Based on Surgeon Gender in Total Hip Arthroplasty

BackgroundPrior studies have suggested there may be differences in reimbursement and practice patterns by gender. The purpose of this study was to comprehensively evaluate differences in reimbursement, procedural volume, and patient characteristics in total hip arthroplasty (THA) between men and women surgeons from 2013 to 2021. MethodsThe Medicare Physician and Other Practitioners database from 2013 to 2021 was queried. Inflation-adjusted reimbursement, procedural volume, surgeon information, and patient demographics were extracted for surgeons performing over 10 primary THAs each year. Wilcoxon, t-tests, and multivariate linear regressions were utilized to compare men and women surgeons. ResultsOnly 1.4% of THAs billed to Medicare between 2013 and 2021 were billed by women surgeons. Men surgeons earned significantly greater reimbursement nationally in 2021 compared to women surgeons per THA ($1,018.56 versus $954.17, P = .03), but no difference was found when assessing each region separately. Reimbursement declined at similar rates for both men and women surgeons (−18.3 versus −19.8%, P = .38). An increase in the proportion of women surgeons performing THA between 2013 and 2021 was seen in all regions except the South. In 2021, the proportion of all THAs performed by women surgeons was highest in the West (3.5%) and lowest in the South (1.0%). Women surgeons had comparable patient populations in terms of age, race, comorbidity status, and Medicaid eligibility to their men counterparts, but performed significantly fewer services per beneficiary (5.6 versus 8.1, P < .001) and fewer unique services (51.1 versus 69.6, P < .001). ConclusionsAverage reimbursement per THA has declined at a similar rate for men and women physicians between 2013 and 2021. Women’s representation in THA surgery nationwide has nearly doubled between 2013 and 2021, with the greatest increase in the West. However, there are notable differences in billing practices between genders.

Public Pensions and Private Savings

How does the provision of public pension benefits impact private savings? We answer this question in the context of a Danish reform that increased social security eligibility ages. Using administrative data and a regression discontinuity design, we identify the causal effects of the policy on savings throughout the financial portfolio. We find increases in contributions to personal and employer-sponsored retirement accounts when delayed benefit eligibility induces extended employment. We argue that inertia—the continuation of previous savings behaviors—is a key mechanism, and we highlight how firm default contribution rate policies can mediate savings responses to social security reform. (JEL G51, H55, J22, J26, J32)

Household Labor Supply and the Value of Social Security Survivors Benefits

We combine quasi-experimental variation in spousal death and age eligibility for survivors benefits using US tax records to study the effects on American households’ labor supply and the design of social security’s survivors insurance. Benefit eligibility at the exact age of 60 induces sharp reductions in the labor supply of newly widowed households, highlighting the value of survivors benefits and the liquidity they provide following the shock. Among eligible widows, the spousal death event induces no increases in labor supply, suggesting little residual need to self-insure. Using theory, we underscore the program’s protective insurance role and its high valuation among survivors. (JEL D12, D91, G22, G51, H55, J16, J22)

Synergistic Impacts of Expansions in Pre-K Access and School Funding on Student Achievement: Evidence from California’s Transitional Kindergarten Rollout

This paper investigates the extent to which expansions in public pre-K and increases in K12 funding improve student learning trajectories and narrow achievement gaps. I link school-and student-level information on public preschool participation with longitudinal student data for all public school students in California. The research design exploits Transitional Kindergarten's (TK's) age eligibility cutoffs and the 2013-2019 staggered implementation of California's school funding reform. This quasi-experimental variation is combined to investigate interactive effects between TK attendance and school resources in elementary school. I find positive synergistic effects of TK and elementary school spending on math and reading achievement.