Government Insurance Research Articles

Disparities Associated with Discharge Patterns in Firearm-Associated Ocular Trauma

Firearm injuries are associated with devastating visual outcomes. Several studies have demonstrated disparities in trauma care and discharge to rehabilitation and other advanced care facilities (ACFs) due to race and ethnicity and insurance status. The identification of possible disparities in disposition of patients admitted with firearms-associated ocular injuries (FAOIs) is a crucial step in moving toward health equity. To describe disposition patterns following admission for FAOI trauma. This retrospective analysis of National Trauma Data Bank (NTDB) from 2008 through 2014 used hospitalized trauma cases from over 900 US facilities detailed in the NTDB. Participants included patients admitted with ocular injuries. Statistical analysis was conducted between April 16, 2017, and December 15, 2021. Firearm injuries. Patients admitted with FAOIs were identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes and E-codes. Demographic data, location, injury type and severity, and insurance status were documented. The primary outcome was the odds of discharge to ACFs. A total of 8715 of 235 254 firearms injuries involved the eye (3.7%). Of the 8715 included patients, 7469 were male (85.7%), 3050 were African American (35.0%), and 4065 White (46.6%), with a mean (SD) age of 33.8 (16.9) years. Common payments were government insurance (31.5%), self-paid insurance (29.4%), and commercial insurance plans (22.8%). Frequent dispositions were home (48.8%) and ACF (20.5%). Multivariate analysis demonstrated that the following factors were associated with the highest odds of discharge to an ACF: hospital stays 6 days or longer (odds ratio [OR], 3.05; 95% CI, 2.56-3.63; P < .001), age 65 years or older (OR, 2.94; 95% CI, 1.94-4.48; P < .001), associated traumatic brain injury (OR, 2.32; 95% CI, 1.94-2.78; P < .001), severe traumatic brain injury (OR, 2.10; 95% CI, 1.79-2.46; P < .001), and very severe Injury Severity Score (OR, 2.22; 95% CI, 1.88-2.62; P < .001). White race (OR, 2.00; 95% CI, 1.71-2.33; P < .001) was associated with higher odds than Medicare insurance (OR, 1.64; 95% CI, 1.16-2.31; P = .01). These findings suggest that older, more severely injured, Medicare-insured, or White patients have higher odds of ACF placement than younger, less severely injured, otherwise insured, and Black and Hispanic patients. This study is limited by its retrospective nature and the study team was unable to explore the basis for these disposition differences. Nevertheless, this work highlights that disparities may exist in disposition after FAOIs that may limit the rehabilitation potential of specific populations.

Optimal Long-Term Health Insurance Contracts: Characterization, Computation, and Welfare Effects

Abstract Reclassification risk is a major concern in health insurance where contracts are typically 1 year in length but health shocks often persist for much longer. While most health systems with private insurers pair short-run contracts with substantial pricing regulations to reduce reclassification risk, long-term contracts with one-sided insurer commitment have significant potential to reduce reclassification risk without the negative side effects of price regulation, such as adverse selection. We theoretically characterize optimal long-term insurance contracts with one-sided commitment, extending the literature in directions necessary for studying health insurance markets. We leverage this characterization to provide a simple algorithm for computing optimal contracts from primitives. We estimate key market fundamentals using data on all under-65 privately insured consumers in Utah. We find that dynamic contracts are very effective at reducing reclassification risk for consumers who arrive at the market in good health, but they are ineffective for consumers who come to the market in bad health, demonstrating that there is a role for the government insurance of pre-market health risks. Individuals with steeply rising income profiles find front-loading costly, and thus relatively prefer ACA-type exchanges. Switching costs enhance, while myopia moderately compromises, the performance of dynamic contracts.

Disparities and Patterns of Pain Management, Pharmacologic Therapies, and Surgical Treatments for Leiomyomas in the 2017–2019 National Survey of Family Growth [ID: 1380252

INTRODUCTION: Leiomyomas affect most women throughout their lifetime with an incidence of roughly 80%. Approximately 30% of these women develop symptomology that warrants intervention. With such a large prevalence, it is important to highlight patterns in treatment modalities to guide effective management for all women with this condition. METHODS: We utilized weighted survey results from the Centers for Disease Control and Prevention’s 2017–2019 National Survey of Family Growth. After isolating data to those who reported a leiomyoma diagnosis, we performed a test of equal proportions (P&lt;.05) among the nine listed therapies compared to the following socioeconomic factors: race, age, education, and insurance status. RESULTS: The incidence of leiomyomas was 7.3% (449/6,141). Hispanic women and those with state-sponsored or uninsured status were more likely to report receiving none of the listed treatments (P=.05 and .02). Women who marked “Other” were most likely to seek alternative medicine (P=.03). Hysterectomy was most likely for Black, White, and 40- to 49-year-old women (P=.02 and P&lt;.001). Nonhysterectomy procedures were most seen with government-sponsored health care, private insurance, and women with graduate degrees (P&lt;.001 and P=.02). Pharmacologically, White women were more likely to receive progesterone-releasing intrauterine devices (P=.02), women 19–29 were more likely to use hormonal medicine (P&lt;.001), and those with government insurance were more likely to receive narcotics (P=.006). CONCLUSION: All socioeconomic factors held significant inconsistencies in the utilization of various leiomyoma treatments. As this condition will affect most women, this analysis highlights the need for future standardization to ensure optimal treatment implementation and patient outcomes.

Coping up mechanism and financial aid scheme for cancer treatment at a tertiary care hospital in Lucknow

Background: Cancer treatment has one of most expensive disease treatment due to its chronicity and expertise. In a region where per capita income of persons/ annual income of household is low, they have to depend on some coping up mechanism or financial aid schemes for successful completion of treatment. But awareness and proportion of utilization of the financial benefit for cancer patient is doubtful. The present study aims to study coping up mechanism and financial benefits availed by cancer patients at a tertiary care hospital in Lucknow. Methods: The study was done in a tertiary care hospital in Lucknow. 120 cancer patients who had undergone treatment and come for follow-up were taken from surgical oncology OPD. Data was collected using an interview-based pre-tested, self-administered questionnaire and analyzed using MS excel 2017 and SPSS v 23. Results: About 64 % of participants borrowed money from social net, 3% took loans, 10% mortgage assets, and 20% sold their assets to cope up with high expenditure on cancer treatment. Financial benefit of schemes was availed by about 1/3rd of participants and 20% availed concessions in rail/road travel fare and 16% availed concessions in income tax. Conclusions: Large number of people had to use some of the coping up mechanism for treatment of cancer this further pushes them into viscous cycle of poverty And at same time they are unable to avail benefits of financial aid schemes by government and others for cancer patients. Thus, an increase in utilization and coverage of government financial aids or insurance is needed.

The Impact of the COVID-19 Pandemic on Hepatocellular Carcinoma Time to Treatment Initiation: A National Cancer Database Study.

The COVID-19 pandemic strained oncologic care access and delivery, yet little is known about how it impacted hepatocellular carcinoma (HCC) management. Our study sought to evaluate the annual effect of the COVID-19 pandemic on time to treatment initiation (TTI) for HCC. The National Cancer Database was queried for patients diagnosed with clinical stages I-IV HCC (2017-2020). Patients were categorized based on their year of diagnosis as "Pre-COVID" (2017-2019) and "COVID" (2020). TTI based on stage and type of treatment first received was compared by the Mann-Whitney U test. A logistic regression model was used to evaluate factors of increased TTI and treatment delay (> 90 days). In total, 18,673 patients were diagnosed during Pre-COVID, whereas 5249 were diagnosed during COVID. Median TTI for any first-line treatment modality was slightly shorter during the COVID year compared with Pre-COVID (49 vs. 51 days; p < 0.0001), notably in time to ablation (52 vs. 55 days; p = 0.0238), systemic therapy (42 vs. 47 days; p < 0.0001), and radiation (60 vs. 62 days; p = 0.0177), but not surgery (41 vs. 41 days; p = 0.6887). In a multivariate analysis, patients of Black race, Hispanic ethnicity, and uninsured/Medicaid/Other Government insurance status were associated with increased TTI by factors of 1.057 (95% CI: 1.022-1.093; p = 0.0013), 1.045 (95% CI: 1.010-1.081; p = 0.0104), and 1.088 (95% CI: 1.053-1.123; p < 0.0001), respectively. Similarly, these patient populations were associated with delayed treatment times. For patients diagnosed during COVID, TTI for HCC, while statistically significant, had no clinically significant differences. However, vulnerable patients were more likely to have increased TTI.

The Association Between Sociodemographic Factors, Social Determinants of Health, and Spine Surgical Patient Portal Utilization.

Retrospective cohort study. To examine patient portal use among the surgical spine patient population across different sociodemographic groups and assess the impact of patient portal use on clinical outcomes. Patient portals (PP) have been shown to improve outcomes and quality of care. Engaging them requires internet access, technological literacy, and dexterity, which may serve as access barriers. After exclusion criteria were applied, the study included data for 9211 encounters from 7955 patients. PP utilization was defined as having activated and used the Duke University Medical Center patient portal system, MyChart, at least once. Sociodemographic characteristics included urbanicity, age, race, ethnicity, language, employment, and primary insurer. Clinical outcomes included the length of hospital stay during the procedure, 30-day return to the emergency department, 30-day readmission, and being discharged somewhere other than home. Being older than 65, non-White, unemployed, non-English-speaking, male, not-partnered, uninsured or publicly insured (Medicaid, Medicare and under 65 years of age, or other government insurance), and living in a rural environment were all risk factors for decreased PP utilization among surgical spine patients. A one-risk factor decrease in the number of social risk factors was associated with a 78% increase in the odds of PP utilization [odds ratio (OR): 1.78; 95% Confidence interval (CI): 1.69-1.87; P <0.001]. Patients not utilizing the portal at the time of their procedure had higher odds of 30-day readmission (OR: 1.59; 95% CI: 1.26-2.00), discharge somewhere other than home (OR: 2.41, 95% CI: 1.95-2.99), and an increased length of hospital stay (geometric mean ratio: 1.21; 95% CI: 1.12-1.30) compared with those who utilized it. In patients undergoing spine procedures, PPs are not equally utilized among different sociodemographic groups. PP utilization is also associated with better outcomes. Interventions aimed at increasing PP uptake may improve care for certain patients.

Abstract 746: Disparities in factors affecting access to palliative care in patients with stage IV breast cancer

Abstract Background: Palliative care is an essential component of cancer care; however, factors hindering its reach to the target population remain understudied. We aim to explore whether an association exists between socioeconomic and geographic factors and access to palliative care (PC) in patients with Stage IV breast cancer in the US. Methods: This 2004-2017 National Cancer Database analysis includes patients with Stage IV breast cancer who received palliative care. Access to PC is defined as being either at the patient’s primary healthcare facility or at a referral site. Chi-square tests and a multivariate logistic regression were performed to determine the independent factors predicting access to PC. SAS version 9.4 was used to analyze the data. Results: A total of 18,903 patients were included in the analysis: 15,111 received palliative care services at the same facility and 3,792 were referred elsewhere. Patient age, race, insurance status, Charlson-Deyo score, setting, high school diploma status, median income, facility type, facility location, and distance from healthcare centers were all significantly different between the two groups. On logistic regression, better odds for access to PC were predicted by urban settings (OR: 1.47; 95% CI: 1.30 - 1.67) and being in the Middle Atlantic region (OR: 1.27; 95% CI: 1.07 - 1.52). Distance from the healthcare facility of 4 miles or greater predicted worse odds for access to PC. Comprehensive cancer programs (OR: 1.60; 95% CI: 1.43 - 1.80) and academic/research programs (OR: 2.40; 95% CI: 2.11 - 2.73) held higher odds for access to PC. Having Medicaid/other government insurance (OR: 1.43; 95% CI: 1.24 - 1.65) predicted better odds for access to PC. However, having no insurance was also found to increase access to PC (OR: 1.30; 95% CI: 1.08 - 1.55). Median income and high school diploma status were not significantly associated with the outcome. Conclusion: PC was positively affected by having access to urban settings, nearby healthcare centers, non-community care centers, Medicaid/other governmental insurance, and by being in the Middle Atlantic region of the US. Having no insurance appears to increase palliative care use, which was unexpected but could be explained if patients with no insurance did not receive standard treatment and were instead offered palliative care. This needs to be investigated in future research. Citation Format: Mira Itani, Saad Sabbagh, Mohamed Mohanna, Barbara Dominguez, Hong Liang, Zeina Nahleh. Disparities in factors affecting access to palliative care in patients with stage IV breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 746.

Relationship between oral health service quality and patient satisfaction at community health centers in Kupang city during COVID-19 pandemic

ABSTRACTIntroduction: Oral health service quality has been severely impacted by the COVID-19 pandemic, including in Kupang, one of the cities in the east part of Indonesia. Like in other cities, community health centers (Puskesmas) are the frontline to provide dental healthcare, including avoiding the spread of COVID-19. The objective of this study therefore is to analyze the correlation between oral health service quality (patient safety, effectiveness, patient centeredness, waiting time, efficiency, and equity) and patients’ satisfaction during COVID-19 pandemic. Methods: Cross sectional design was used to investigate the correlation of oral health services quality and patients’ satisfaction. Structured questionnaire was used to measure patients’ satisfaction. The number of samples involved in this study were fifty people. This study employed a non-probability sampling technique known as incidental sampling. The results of this research were obtained using multivariate multiple logistic regression analysis. Results: Patients involved in this study consist of women (60%), teenager (50%), adult (40%), educational background is senior high school (56%), junior high school (20%), employment statuses are farmer (30%) and student (28%), monthly average income is &lt; 2 million rupiahs (and government insurance user accounting for 70%). Based on statistical analysis, there is a significant relationship between oral health service quality and patients’ satisfaction (p = 0,002). Conclusion: Patients are satisfied with oral health service quality in Kupang city during COVID-19 pandemic particularly on an equity aspect.Keywords: oral health service quality, patient satisfaction, community health center, COVID-19 pandemic

Factors Associated With Triage Decisions in Older Adult Trauma Patients: Impact on Mortality and Morbidity

IntroductionAs medical advances have significantly increased the life expectancy among older adults, the number of older patients requiring trauma care has risen proportionately. Nevertheless, it is unclear among this growing population which sociodemographic and economic factors are associated with decisions to triage and transfer to level I/II centers. This study aims to assess for any association between patient sociodemographic characteristics, triage decisions, and outcomes during acute trauma care presentations. MethodsThe National Trauma Data Bank was queried for patients aged 65 and older with an injury severity score > 15 between the years 2007 to 2017. Factors associated with subsequent levels of triage on presentation were assessed using multivariate logistic regression, and associations of levels of triage with outcomes of mortality, morbidity, and hospital length of stay are examined using logistic and linear regression models. ResultsTriage of 210,310 older adult trauma patients showed significant findings. American Indian patients had higher odds of being transferred to level I/II centers, while Asian, Black, and Native Hawaiian patients had lower odds of being transferred to level I/II centers when compared to Caucasian patients (P < 0.001). Regarding insurance, self-pay (uninsured) patients were less likely to be transferred to a higher level of care; however, this was also demonstrated in private insurance holders (P < 0.001). Caucasian patients had significantly higher odds of mortality, with Black patients (odds ratio [OR] 0.80 [0.75, 0.85]) and American Indian patients (OR 0.87 [0.72, 1.04]) having significantly lower odds (P < 0.001). Compared to government insurance, private insurance holders (OR 0.82 [0.80, 0.85]) also had significantly lower odds of mortality, while higher odds among self-pay were observed (OR 1.75 [1.62, 1.90]), (P < 0.001). ConclusionsAccess to insurance is associated with triage decisions involving older adults sustaining trauma, with lower access increasing mortality risk. Factors such as race and gender were less likely to be associated with triage decisions. However, due to this study's retrospective design, further prospective analysis is necessary to fully assess the decisions that influence trauma triage decisions in this patient population.

Disparities in the Receipt of Recommended Curative Treatment for Patients with Early-Stage Hepatocellular Carcinoma.

In early-stage hepatocellular carcinoma (HCC), the receipt of recommended care is critical for long-term survival. Unfortunately, not all patients decide to undergo therapy. We sought to identify factors associated with the decision to decline recommended intervention among patients with early-stage HCC. The National Cancer Database was queried for patients diagnosed with clinical stages I and II HCC (2004-2017). Cohorts were created based on the receipt or decline of recommended interventions-hepatectomy, liver transplantation, and ablation. Multivariable logistic regression identified predictors for declining intervention, and propensity score analysis was used to calculate the respective odds. Survival analysis was performed using the Kaplan-Meier method. Of 20,863 patients, 856 (4.1%) declined intervention. Patients who were documented as having declined intervention were more often Black (vs. other: OR, 1.3; 95% CI, 1.1-1.6; p = 0.0038), had Medicaid or no insurance (vs. Private, Medicare, or other government insurance): OR, 1.9; 95% CI, 1.6-2.3; p < 0.0001), lived in a low-income area (vs. other: OR, 1.4; 95% CI, 1.2-1.7; p < 0.0001), and received treatment at a non-academic center (vs. academic: OR, 2.1; 95% CI, 1.9-2.5; p < 0.0001). Patients who declined recommended interventions had worse survival compared to those who received treatment (22.9 vs. 59.2months; p < 0.0001, respectively). Racial and socioeconomic disparities persist in the decision to undergo recommended treatment. Underutilization of treatment acts as a barrier to addressing racial and socioeconomic disparities in early-stage HCC outcomes.

NEW INDIA ASSURANCE CO. LTD: GROWTH STORY AND ITS COMPETITIVE STATUS IN NON-LIFE GENERAL INSURANCE SECTOR IN THE GLOBALISED WORLD

New India Assurance a Market leader in the Indian general insurance sector, with 100 years of operations. There were a total of 4 non-life insurance companies in India, but only one of them, New India Assurance, turned a profit and rose to the top of the non-life market. The main goal of the study is to understand how New India Assurance Company managed to outperform other government insurance companies in the face of setbacks. In 2000, the Indian government liberalised the insurance industry, increasing competition by allowing many foreign and private insurance companies to operate there. The research focuses on the factors that have kept New India Assurance Company at the top of the market even after the liberalisation and privatization of the insurance sector. For the purpose of the research, secondary data were gathered from a number of annual reports and the websites of the New India Assurance Company.

Challenges in the management of hereditary angioedema in urban and rural settings: Results of a United States survey

BackgroundCaring for patients with hereditary angioedema (HAE), especially rural patients, has challenges. ObjectiveTo confirm experiences of allergy and immunology health professionals in diagnosing and treating patients with HAE, including those living in rural settings. MethodsAn online survey of 2996 members of the American College of Allergy, Asthma, and Immunology was conducted in April 13 to May 3, 2022. Eligible participants were association members (physician, fellow, or allied health professional members) currently practicing allergy or immunology, in the United States, seeing or treating at least 1 patient with HAE yearly. ResultsA total of 138 responders saw an average of 9 patients with HAE yearly; 12% of the patients resided in a rural area. They reported that 66% of their patients with HAE had type I, 15% type II, and 19% HAE C1nl-INH. Misdiagnosis was the top diagnostic challenge reported (82%). Inability to afford treatment was the top treatment challenge (76%). Other observations include the sentiment that patients with HAE with government insurance are at a disadvantage because it is not accepted by many specialists who treat HAE (64%) and that better payments for drugs from Medicaid and Medicare (57%) and better payments to providers from Medicaid and Medicare (49%) could better support the treatment of patients in rural settings. Responders expressed a preference for therapies administered at home (72%). Since the coronavirus disease 2019 pandemic, 86% of the respondents used telehealth for appointments occasionally. ConclusionOur findings illustrate the challenge of diagnosing HAE, especially HAE C1nl-INH, and the economic challenges of treatment, which can be compounded for those living in rural areas. We provide a call to action for addressing several of these real challenges.

Lifecycle Earnings Risk and Insurance: New Evidence from Australia*

This paper studies the nature of earnings dynamics in Australia, using the Household, Income and Labour Dynamics in Australia (HILDA) Survey 2001–2020. Our results indicate that the distribution of earnings shocks displays negative skewness and excess kurtosis, deviating from the conventional linearity and normality assumptions. Wage changes are strongly associated with earnings changes and account more for the dispersion of earnings shocks; meanwhile, the contribution of hour changes is largely absent in upward movement and relatively small in downward movement of earnings changes. Furthermore, family and government insurance plays distinct roles in reducing exposure to earnings risk. Government insurance embedded in the targeted transfer system is important in mitigating the dispersion of shocks, whereas family insurance via income pooling and adjustment of secondary earners' labour market activities is dominant in reducing the magnitude and likelihood of extreme and rare shocks. The magnitude and persistence of earnings risk as well as the insurance role of family and government vary significantly across gender, marital and parental status. Accounting for these non‐Gaussian and non‐linearity features is important for evaluating the insurance role of government transfer programmes.

Impact of insurance status on healthcare resource utilization and outcomes in adolescent patients presenting with spinal cord injuries.

Insurance disparities have been suggested to influence the medical and surgical outcomes of adult patients with spinal cord injury (SCI), with a paucity of studies demonstrating their impact on the outcomes of pediatric and adolescent SCI patients. The aim of this study was to assess the impact of insurance status on healthcare utilization and outcomes in adolescent patients presenting with SCI. An administrative database study was performed using the 2017 admission year from 753 facilities using the National Trauma Data Bank. Adolescent patients (11-17 years old) with cervical/thoracic SCIs were identified using International Classification of Diseases, Tenth Revision, Clinical Modification coding. Patients were categorized by governmental insurance versus private insurance/self-pay. Patient demographics, comorbidities, imaging, procedures, hospital adverse events (AEs), and length of stay (LOS) data were collected. Multivariate regression analyses were used to determine the effect of insurance status on LOS, any imaging or procedure, or any AE. Of the 488 patients identified, 220 (45.1%) held governmental insurance while 268 (54.9%) were privately insured. Age was similar between the cohorts (p = 0.616), with the governmental insurance cohort (GI cohort) having a significantly lower proportion of non-Hispanic White patients than the private insurance cohort (PI cohort) (GI: 43.2% vs PI: 72.4%, p < 0.001). While transportation accident was the most common mechanism of injury for both cohorts, assault was significantly greater in the GI cohort (GI: 21.8% vs PI: 3.0%, p < 0.001). A significantly greater proportion of patients in the PI cohort received any imaging (GI: 65.9% vs PI: 75.0%, p = 0.028), while there were no significant differences in procedures performed (p = 0.069) or hospital AEs (p = 0.386) between the cohorts. The median (IQR) LOS (p = 0.186) and discharge disposition (p = 0.302) were similar between the cohorts. On multivariate analysis, with respect to governmental insurance, private insurance was not independently associated with obtaining any imaging (OR 1.38, p = 0.139), undergoing any procedure (OR 1.09, p = 0.721), hospital AEs (OR 1.11, p = 0.709), or LOS (adjusted risk ratio -2.56, p = 0.203). This study suggests that insurance status may not independently influence healthcare resource utilization and outcomes in adolescent patients presenting with SCIs. Further studies are needed to corroborate these findings.

Using the Social Vulnerability Index to Examine Disparities in Surgical Pediatric Trauma Patients

IntroductionThe Social Vulnerability Index (SVI) is a composite measure geocoded at the census tract level that has the potential to identify target populations at risk for postoperative surgical morbidity. We applied the SVI to examine demographics and disparities in surgical outcomes in pediatric trauma patients. MethodsSurgical pediatric trauma patients (≤18-year-old) at our institution from 2010 to 2020 were included. Patients were geocoded to identify their census tract of residence and estimated SVI and were stratified into high (≥70th percentile) and low (<70th percentile) SVI groups. Demographics, clinical data, and outcomes were compared using Kruskal–Wallis and Fisher's exact tests. ResultsOf 355 patients included, 21.4% had high SVI percentiles while 78.6% had low SVI percentiles. Patients with high SVI were more likely to have government insurance (73.7% versus 37.2%, P < 0.001), be of minority race (49.8% versus 19.1%, P < 0.001), present with penetrating injuries (32.9% versus 19.7%, P = 0.007), and develop surgical site infections (3.9% versus 0.4%, P = 0.03) compared to the low SVI group. ConclusionsThe SVI has the potential to examine health care disparities in pediatric trauma patients and identify discrete at-risk target populations for preventative resources allocation and intervention. Future studies are necessary to determine the utility of this tool in additional pediatric cohorts.

Demographic variations and time to initiation of adjunct treatment following surgical resection of anaplastic astrocytoma in the United States: a National Cancer Database analysis

The aim of this study was to analyze the trends, demographic differences in the type and time to initiation (TTI) of adjunct treatment AT following surgery for anaplastic astrocytoma (AA). The National Cancer Database (NCDB) was queried for patients diagnosed with AA from 2004 to 2016. Cox proportional hazards and modeling was used to determine factors influencing survival, including the impact of time to initiation (TTI) of adjuvant therapy. Overall, 5890 patients were identified from the database. The use of combined RT + CT temporally increased from 66.3% (2004-2007) to 79% (2014-2016), p < 0001. Patients more likely to receive no treatment following surgical resection included elderly (> 60years old), hispanic patients, those with either no or government insurance, those living > 20 miles from the cancer facility, those treated at low volume centers (< 2 cases/year). AT was received following surgical resection within 0-4weeks, 4.1-8weeks, and > 8weeks in 41%, 48%, and 3%, respectively. Compared to patients who received RT + CT, patients were likely to receive RT only as AT either at 4-8weeks or > 8weeks after the surgical procedure. Patients who received AT within 0-4weeks had the 3-year OS of 46% compared to 56.7% for patients who received treatment at 4.1-8weeks. We found significant variation in the type and timing of adjunct treatment following surgical resection of AA in the United States. A considerable number of patients (15%) received no AT following surgery.

An assessment of good agriculture practices for safe and sustainable vegetable production in mid-hills of Nepal

The vegetable sector provides immediate income, nutrition, and food security and contributes significantly to the economy of Nepal. In recent decades, the sustainability of the vegetable sector has been challenged due to the unsystematic use of agrochemicals for commercializing production. Adopting Good Agriculture Practices (GAP) could reduce the use of agrochemicals in commercial vegetable production. This study conducted the assessment of GAP in Kathmandu Valley. A mixed-method approach, combining quantitative and qualitative methods, was adopted for the study, which included farmers' surveys, key informant interviews, and in-depth interviews. The results showed that farmers were adopting different GAP, such as cropping practices, livestock integration, soil fertility management practices, and integrated pest management practices. Upon adopting these practices, farmers reduced agrochemicals' use by more than 40%. The critical incentives for surveyed farmers to adopt GAP were soil health improvement, farmers' safety, and reduction in the use of agrochemicals while improving the farm's image. Further, the study revealed that farmers faced several challenges in adopting GAP. Management difficulty (I = 0.9) was identified as the most critical problem, followed by no premium price (I = 0.8), knowledge (I = 0.6), access to GAP inputs (I = 0.5), and other risks (I = 0.04). The study's findings imply that adopting GAP helps reduce the use of agrochemicals, consequently motivating farmers toward safe and sustainable vegetable production. The study recommends market-based solutions such as creating mass consumer awareness, ensuring premium prices with quality assurance mechanisms for making the GAP-based production profitable, and promoting its wider adoption. This is supported by facilitating farmers' access to government subsidies, price incentives, and insurance services and increasing access to GAP inputs. This study aims to generate evidence on a safe and sustainable vegetable production model that will be key to institutionalizing GAP in Nepal.

A multivariate frequency-severity framework for healthcare data breaches

Data breaches in healthcare have become a substantial concern in recent years and cause millions of dollars in financial losses each year. It is fundamental for government regulators, insurance companies, and stakeholders to understand the breach frequency and the number of affected individuals in each state, as these are directly related to the federal Health Insurance Portability and Accountability Act (HIPAA) and state data breach laws. However, an obstacle to studying data breaches in healthcare is the lack of suitable statistical approaches. We develop a novel multivariate frequency-severity framework to analyze breach frequency and the number of affected individuals at the state level. A mixed effects model is developed to model the square root transformed frequency, and the log-gamma distribution is proposed to capture the skewness and heavy tail exhibited by the distribution of numbers of affected individuals. We further discover a positive nonlinear dependence between the transformed frequency and the log-transformed numbers of affected individuals (i.e., severity). In particular, we propose to use a D-vine copula to capture the multivariate dependence among conditional severities, given frequencies due to its inherent temporal structure and rich bivariate copula families. The rejection sampling technique is developed to simulate the predictive distributions. Both the in-sample and out-of-sample studies show that the proposed multivariate frequency-severity model that accommodates nonlinear dependence has satisfactory fitting and prediction performances.

Abstract P4-03-27: The impact of Sociodemographic Disparities on Overall Survival of Adolescent and Young Adults (AYA) with Invasive Breast Cancer

Abstract Background: Women of racial/ethnic minorities more often receive a diagnosis of advanced breast cancer (BC) at a younger age, and have higher morbidity, risk of recurrence and mortality. In addition to clinicopathologic and biological differences, sociodemographic factors may influence overall survival (OS) in these patients. BC care in AYA is particularly challenging and requires a multidisciplinary approach. In this National Cancer Database (NCDB) analysis, we aim to investigate various socioeconomic variables and their impact on survival in AYA patients with invasive BC. Methods: Using de-identified data accessed from the NCDB, we conducted a retrospective cohort analysis. Patients diagnosed with invasive BC between 2004-2019 and belonging to the age group of 15-39 years, defined as AYA, were included in the study. We performed an exploratory analysis and divided patients based on race/ethnicity, primary payer (government, private or uninsured), community median income (≤$40K, $40-50K, $50-63K, ≥$63K), residence area (metropolitan, rural or suburban) and high school degree achievement. Step-wise univariate regression models were used to analyse the impact of the relevant factors on overall survival. Survival estimates were calculated using the Kaplan Meier method. Results: We identified 18,018 AYA patients with invasive BC. Median age was 36 years, the median time from diagnosis to treatment was 25 days and the median follow-up was 82.9 months (range 0.1 - 207.1 months). The majority of patients were Caucasian (66%), followed by Black (14%), Hispanic (10%) and Asian (6%). 61% of Asian and 47% of Caucasians had an income of ≥$63,000, whereas only 31% of Hispanic patients and 26% of Black patients were in this income bracket. While Black patients constituted the majority of the lower income community (median income ≤$40K), Hispanics had the largest amount of patients without a high school degree (44%). Considering all patients, the 5-year OS was 92% (95% CI 0.91-0.92) for this study period. However, improved survival was observed in patients with private insurance versus government insurance (93% vs 84%, p &amp;lt; 0.0001); patients with median income ≥$63,000 compared to &amp;lt;$40,000 (94% vs 88%, p &amp;lt; 0.0001); a lower percentage of no high school degree quartile &amp;lt; 6.3% in contrast to ≥ 17.6% (95% vs 88%, p &amp;lt; 0.0001); and lastly, patients living in a metropolitan area as opposed to suburban area (92% vs 89%, p &amp;lt; 0.0001). Additional details are noted in Table 1. Conclusions: In our analysis we have found that AYA patients with invasive BC included in the NCDB have a variable OS that is impacted by demographic factors and socioeconomic status. Patients with private insurance, higher income, higher level of education and living in a metropolitan area had improved OS at 2 and 5 years. Understanding and narrowing the disparities in the care provided to AYA patients with invasive BC, particularly to those with sociodemographic disadvantages, could lead to improve outcomes. Citation Format: Nerea Lopetegui-Lia, Thejus Thayyil Jayakrishnan, Shimoli Barot, Wei Wei, Megan L. Kruse. The impact of Sociodemographic Disparities on Overall Survival of Adolescent and Young Adults (AYA) with Invasive Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-27.

Dental patients’ perceptions of and desired content from patient health portals

BackgroundPatient health portals (PHPs) encourage patient engagement to achieve the quadruple aim of health care: to improve the patient’s experience of care, improve population health, reduce health care costs, and improve the work life of health care providers. The purpose of this study was to capture dental patients’ perspectives on PHPs and their desired content. Specifically, the authors examined the important features for dental patients to have as well as the barriers and facilitators of PHPs. MethodsThe authors conducted a cross-sectional study of adult patients attending the predoctoral, faculty, and resident clinics at an academic dental center from July through October 2020. Patients were invited to complete an 18-item self-administered survey. The survey captured patient demographics, preferences, desired content, and facilitators and barriers of PHPs. The authors performed descriptive statistical analysis and bivariate analysis. ResultsA total of 325 people participated. Most participants had a bachelor’s degree, internet access, government insurance, and a combined household income of more than $50,000 per year. Completed procedures, past visit summaries, and date of last visit were the top 3 types of information patients desired in dental health PHPs. The top 3 desired oral health topics in PHPs included signs of gingival disease and proper management, caries prevention, and proper toothbrushing and flossing techniques. Highest perceived barriers included high cost and privacy and security concerns. Highest perceived facilitators included user-friendly portals and monitoring personal health. ConclusionsThis study highlights dental patients’ preferences for a PHP and can inform the development of dental PHPs. Dentists must overcome identified barriers to increase patient engagement in using dental PHPs. Practical ImplicationsImplementing the patient-identified features in a dental PHP will help improve the quality of oral health care delivery by increasing patient engagement and improving the patient’s experience.