Healthcare Utilization In Adults Research Articles

When the smoke gets in your lungs: short-term effects of Indonesia’s 2015 forest fires on health care use

BackgroundThe forest fires that ravaged parts of Indonesia in 2015 were the most severely polluting of this century but little is known about their effects on health care utilization of the affected population. We estimate their short-term impact on visit rates to primary and hospital care with particular focus on visits for specific smoke-related conditions (respiratory disease, acute respiratory tract infection (ARTI) and common cold).MethodWe estimate the short-term impact of the 2015 forest fire on visit rates to primary and hospital care by combining satellite data on Aerosol Optical Depth (AOD) with administrative records from Indonesian National Health Insurance Agency (BPJS Kesehatan) from January 2015–April 2016. The 16 months of panel data cover 203 districts in the islands of Sumatra and Kalimantan before, during and after the forest fires. We use the (more efficient) ANCOVA version adaptation of a fixed effects model to compare the trends in healthcare use of affected districts (with AOD value above 0.75) with control districts (AOD value below 0.75). Considering the higher vulnerability of children’s lungs, we do this separately for children under 5 and the rest of the population adults (> 5), and for both urban and rural areas, and for both the period during and after the forest fires.ResultsWe find little effects for adults. For young children we estimate positive effects for care related to respiratory problems in primary health care facilities in urban areas. Hospital care visits in general, on the other hand, are negatively affected in rural areas. We argue that these patterns arise because accessibility of care during fires is more restricted for rural than for urban areas.ConclusionThe severity of the fires and the absence of positive impact on health care utilization for adults and children in rural areas indicate large missed opportunities for receiving necessary care. This is particularly worrisome for children, whose lungs are most vulnerable to the effects. Our findings underscore the need to ensure ongoing access to medical services during forest fires and emphasize the necessity of catching up with essential care for children after the fires, particularly in rural areas.

Impact of landscape fire smoke exposure on patients with Asthma with or without laryngeal hypersensitivity.

Individuals with asthma experienced severe and prolonged symptoms following the Australian 2019-2020 landscape fire period. Many of these symptoms, such as throat irritation, are referrable to the upper airway suggesting that laryngeal hypersensitivity contributes to persistent symptoms following smoke exposure. The study examined the relationship between laryngeal hypersensitivity and symptoms, asthma control and health impact in individuals exposed to landscape fire smoke. The study was a cross sectional survey of 240 participants in asthma registries who were exposed to smoke during the 2019-2020 Australian fire period. The survey, completed between March and May 2020, included questions about symptoms, asthma control and healthcare utilisation, as well as the Laryngeal Hypersensitivity Questionnaire. Daily PM2.5 concentration levels were measured over the 152 day study period. The 49 (20%) participants with laryngeal hypersensitivity had significantly more asthma symptoms (96% versus 79%, p=0.003), cough (78% versus 22%, p<0.001) and throat irritation (71% versus 38%, p<0.001), during the fire period than those without laryngeal hypersensitivity. Participants with laryngeal hypersensitivity had greater healthcare utilisation (p=<0.02), more time off work (p=0.004), and reduced capacity to participate in usual activities, (p<0.001) during the fire period, and poorer asthma control during the follow up period, (p=0.001). Laryngeal hypersensitivity is associated with persistent symptoms, reports of lower asthma control and increased healthcare utilisation in adults with asthma who were exposed to landscape fire smoke. Management of laryngeal hypersensitivity before, during or immediately after landscape fire smoke exposure might reduce symptom burden and health impact.

Access and Utilization of Health Care by Adults with Spina Bifida

To contextualize the challenges that persons with congenital genitourinary conditions (CGC) may encounter in adulthood, we examined health care access, readiness for self-management, and health care utilization of adults with spina bifida (SB). Through surveys distributed via social media, persons with SB were asked about access and barriers to care, readiness for self-management, and health care utilization (ie, medical visits, missed visits, emergency room [ER] visits, hospital admissions) within the past year. Multivariable models were fitted to examine determinants of utilization. Of the 270 eligible respondents (mean age 39), 24.5% had not received care from a urologist in the past year. The odds of missing any medical visits were increased among those with more prior urologic surgeries (odds ratio (OR) 1.35, 95%confidence interval (CI) 1.05-1.78) and those with ER visits for urologic condition within the past year (OR 2.65, 95%CI 1.22-6.01). Those with private insurance had lower odds of having ER visits for urologic condition (OR 0.46, 95%CI 0.22-0.84). The odds of hospital admission related to urologic condition were increased among female (OR 2.35, 95%CI 1.01-6.64), those with more prior urologic surgeries (OR 1.18, 95%CI 1.09-1.51), and those with a urologist (OR 2.98, 95%CI 1.15-14.47). A substantial proportion of adults with CGC lack routine urologic care. Considering the significant barriers to care and lapses in care, efforts to improve access and optimize health care services utilization for this population with high medical complexity are warranted.

Exploring the Effect of Anti-immigration Rhetoric on Emergency Department Use by Undocumented Adults.

An unwelcoming policy climate can create barriers to health care access and produce a 'Chilling Effect' among immigrant communities. For undocumented immigrants, barriers may be unique and have a greater impact. We used administrative emergency department (ED) data from 2015 to 2019 for a Midwestern state provided under a data use agreement with the state hospital association. General linear modelling was used to estimate the impact of anti-immigrant rhetoric on ED visit intensity among non-elderly adults who were likely Hispanic/Latino with undocumented status. Compared to 2015, the average ED visit intensity among adults who were likely Hispanic/Latino with undocumented status was significantly higher during 2016-2019 when anti-immigrant rhetoric was heightened. The magnitude of this change increased over time (0.013, 0.014, 0.021, and 0.020, respectively). Additionally, this change over time was not observed in the comparison groups. Our findings suggest that anti-immigrant rhetoric may alter health care utilization for adults who are likely Hispanic/Latino with undocumented status. Limitations to our findings include the use of only those likely to be Hispanic/Latino, data from only one Midwestern state and the loss of data due to non-classification using the NYU ED algorithm. Further research should focus on validating these findings and investigating these identification methods and anti-immigrant rhetoric effects among other undocumented groups including children and adults of different race or ethnicity such as black, both those that identify as Hispanic/Latino and those that do not. Developing strategies to improve health care access for undocumented Hispanic/Latino adults also warrants future research.

The Economic Burden of Bronchiectasis: A Systematic Review

Bronchiectasis, a previously neglected condition, now has renewed research interest. There are a few systematic reviews that have reported on the economic and societal burden of bronchiectasis in adults, but none have reported on children. We undertook this systematic review to estimate the economic burden of bronchiectasis in children and adults. What is the health care resource utilization and economic burden of bronchiectasis in adults and children? We performed a systematic review identifying publications from Embase, PubMed, Web of Science, Cochrane (trials, reviews, and editorials), and EconLit about the economic burden and health care utilization in adults and children with bronchiectasis between January 1, 2001, and October 10, 2022. We used a narrative synthesis approach and estimated aggregate costs for several countries. We identified 53 publications reporting on the economic burden and/or health care utilization of people with bronchiectasis. Total annual health care costs per adult patient ranged from 2021 $3,579 to $82,545 USD and were predominantly driven by hospitalization costs. Annual indirect costs including lost income because of illness (reported in only five studies) ranged from $1,311 to $2,898 USD. Total health care costs in children with bronchiectasis were $23,687 USD annually in the one study that estimated them. Additionally, one publication found that children with bronchiectasis missed 12 school days per year. We estimated aggregate annual health care costs for nine countries, ranging from $101.6 million per year in Singapore to $14.68 billion per year in the United States. We also estimated the aggregate cost of bronchiectasis in Australian children to be $17.77 million per year. This review highlights the substantial economic burden of bronchiectasis for patients and health systems. To our knowledge, it is the first systematic review to include the costs for children with bronchiectasis and their families. Future research to examine the economic impact of bronchiectasis in children and economically disadvantaged communities, and to further understand the indirect burden of bronchiectasis on individuals and the community, is needed.

67-OR: Examining the Association between Health Care Utilization and Race/Ethnicity in U.S. Adults with Diabetic Kidney Disease—2000–2020

Background: No recent national estimates have examined overall trends in health care utilization in adults with diabetic kidney disease (DKD) or the association between DKD health care utilization and race/ethnicity. This study sought to fill this current gap in knowledge. Methods: Medical Expenditure Panel Survey data (2000-2020) for adults with DKD was used for this analysis. The dependent variable was total health care utilization for the calendar year for each individual including office-based medical provider, hospital outpatient, emergency room, inpatient hospital, pharmacy, dental, and home health care visits. The primary independent variable was race/ethnicity. Mean health care utilization by DKD status was estimated and negative binominal regression was used to estimate Incident Rate Ratios (IRR) for health care utilization while adjusting for demographics, comorbidities, and time. Stata version 17 was used with a significant p-value set at &amp;lt;0.05. Results: After full adjustments, African American (IRR 1.20 95% CI 1.09 - 1.31) and Hispanic (IRR 1.15 95% CI 1.04 - 1.28) adults with DKD had significantly higher rates of total health care utilization compared with Whites. In addition, African American adults with DKD had significantly higher rates of office visits (IRR 1.10 95% CI 1.01 - 1.20) and outpatient visits (IRR 1.41 95% CI 1.14 - 1.75) compared with Whites and lower rates of dental care visits (IRR 0.74 95% CI 0.61 - 0.89) and prescription utilization (IRR 0.83 95% CI 0.78 - 0.88) compared with Whites with DKD. Further, over time adults with DKD had higher mean total health care visits (17.0 - 23.6) compared with 8.8-10.4 visits in adults without DKD. Conclusions: Our findings show that compared with individuals without DKD, individuals with DKD had significantly higher health care utilization from 2000 to 2020 and racial differences in health care utilization exists and persists over this period. Disclosure M.N.Ozieh: None. A.Z.Dawson: None. J.S.Williams: None. L.E.Egede: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R21DK131356 to M.N.O.), (R01DK118038, R01DK120861 to L.E.E.); National Institute on Minority Health and Health Disparities (K23MD016448 to M.N.O), (R01MD013826 to L.E.E.)

1001-P: Adherence and Persistence to Basal Insulin Therapy Is Associated with Decreased Health Care Utilization in Adults with Type 2 Diabetes

Objectives: Lack of adherence and persistence to prescribed therapy impact achievement of glycemic goals. This study aimed to assess the association between adherence and persistence to basal insulin therapy with healthcare resource utilization (HCRU) among adults with type 2 diabetes (T2D). Methods: This was an observational, retrospective cohort study of commercially insured US patients using IQVIA PharMetrics® Plus claims data. We identified adults with T2D initiating basal insulin therapy between January 1, 2016 and December 31, 2018. Adherence/non-adherence and persistence/non-persistence were assessed per established definitions. Demographic and clinical characteristics were assessed over the one-year baseline period (prior to initiation). Inverse probability of treatment weighting (IPTW) was used to adjust for confounding by adherence and persistence status. Post-IPTW, all-cause medical HCRU and costs in the one-year follow-up period were compared across cohorts. Results: The final sample consisted of 64,953 patients: 42% and 58% met criteria for adherence and non-adherence, respectively; 57% and 43% met criteria for persistence and non-persistence, respectively. The proportion of patients with ≥1 hospitalization was lower for the adherence and persistence cohorts compared to their reference groups (adherence: 12.2% vs. 13.8%; persistence: 12.5% vs. 14.2%, both P&amp;lt;0.0001); for these patients, mean hospitalization days were lower among adherence and persistence cohorts (adherence: 10.1 vs. 13.2; persistence: 10.4 vs. 13.8, both P&amp;lt;0.0001). Total mean medical costs were also lower (adherence: $16,118 vs. $17,991; persistence: $16,459 vs. $18,399, both P&amp;lt;0.0001), driven by lower acute care costs (adherence: $6,210 vs. $7,775; persistence: $6,385 vs. $8,171, both P&amp;lt;0.0001). Conclusions: In this study, adherence and persistence to basal insulin therapy was associated with lower HCRU and costs, particularly for acute care. Disclosure N.F.Nielsen: Employee; Novo Nordisk A/S, Coloplast A/S. V.R.Aroda: Consultant; Applied Therapeutics Inc., Fractyl Health, Inc., Novo Nordisk, Pfizer Inc., Sanofi, Other Relationship; Janssen Pharmaceuticals, Inc., Research Support; Applied Therapeutics Inc., Eli Lilly and Company, Fractyl Health, Inc., Novo Nordisk, Sanofi. K.K.Mangla: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. V.Divino: Employee; IQVIA Inc. T.Namvar: None. J.R.Rajpura: Employee; Novo Nordisk.

Suboptimally controlled asthma in patients treated with inhaled ICS/LABA: prevalence, risk factors, and outcomes

This observational claims-linked survey study assessed the prevalence of and risk factors for suboptimal asthma control and healthcare utilization in adults with asthma receiving fixed-dose combination (FDC) inhaled corticosteroid/long-acting β2-agonist (ICS/LABA). Commercially insured adults from the Optum Research Database were invited to complete the Asthma Control Test (ACT) and Asthma Control Questionnaire-6 (ACQ-6). Among participants (N = 428), 36.4% (ACT-assessed) and 55.6% (ACQ-6-assessed) had inadequately controlled asthma. Asthma-related quality of life was worse and asthma-related healthcare resource utilization was higher in poorly controlled asthma. Factors associated with ACT-defined suboptimal asthma control in multivariate analysis included: frequent short-acting β2-agonist (SABA) use, asthma-related outpatient visits, lower treatment adherence, and lower education levels. During follow-up, factors associated with asthma exacerbations and/or high SABA use included: inadequately controlled asthma (ACT-assessed), body mass index ≥30 kg/m2, and high-dose ICS/LABA. Approximately 35–55% of adults with asthma were inadequately controlled despite FDC ICS/LABA; poor control was associated with worse disease outcomes.

Food Insecurity, Neighborhood, and Health Care Utilization in Health System Adults

To (1) explore relationships among food insecurity, neighborhood disadvantage, and health care utilization in adults from a single health system and (2) determine whether food insecurity and neighborhood disadvantage predict acute health care utilization within 90 days of hospital discharge. A retrospective, correlational design with a single cohort. Data were analyzed from health system administrative billing databases, electronic health records, and publicly available population databases. Multivariable negative binomial regression was performed to assess the association between factors of interest and acute health care utilization within 90 days of index hospital discharge. In 41,566 records, 1.45% (n = 601) of patients reported food insecurity. The mean (SD) Area Deprivation Index score was 54.4 (26), indicating that the majority of patients lived in disadvantaged neighborhoods. Patients with food insecurity were less likely to have a provider office visit (P < .001) but were expected to have 2.1 times greater acute health care utilization within 90 days (incidence rate ratio [IRR], 2.12; 95% CI, 1.90-2.37; P < .001) compared with those without food insecurity. Living in a disadvantaged neighborhood had a small effect on acute health care utilization (IRR, 1.12; 95% CI, 1.08-1.17; P < .001). When considering social determinants of health for health system patients, food insecurity was a stronger predictor of acute health care utilization than was neighborhood disadvantage. Identifying patients with food insecurity and targeting appropriate interventions to high-risk populations may improve provider follow-up and acute health care utilization.

Relationship between criminal legal system exposure and health care utilization in US adults with diabetes: A cross-sectional study

BackgroundBlack Americans have a higher prevalence of diabetes compared to White Americans and have higher rates of complications and death. Exposure to the criminal legal system (CLS) is a social risk factor for chronic disease morbidity and mortality with significant overlap with populations most likely to experience poor diabetes outcomes. However, little is known about the association between CLS exposure and healthcare utilization patterns among U.S. adults with diabetes. MethodsUsing data from the National Survey of Drug Use and Health (2015-2018) a cross-sectional, nationally representative sample of U.S. adults with diabetes was created. Negative binomial regression was used to test the association between lifetime CLS exposure and three utilization types (emergency department (ED), inpatient, and outpatient) controlling for relevant socio-demographic and clinical covariates. ResultsOf 11,562 (weighted to represent 25,742,034 individuals) adults with diabetes, 17.1% reported lifetime CLS exposure. In unadjusted analyses, exposure was associated with increased ED (IRR 1.30 95% CI 1.17-1.46) and inpatient utilization (IRR 1.23, 95% CI 1.01-1.50), but not outpatient visits (IRR 0.99 95% CI 0.94-1.04). The association between CLS exposure and ED (IRR 1.02, p=0.70) and inpatient utilization (IRR 1.18, p=0.12) was attenuated in adjusted analyses. Low socioeconomic status, comorbid substance use disorder, and comorbid mental illness were independently associated with health care utilization in this population. ConclusionsAmong those with diabetes, lifetime CLS exposure is associated with higher ED and inpatient visits in unadjusted analyses. Adjusting for socioeconomic status and clinical confounders attenuated these relationships, thus more research is needed to understand how CLS exposure interacts with poverty, structural racism, addiction and mental illness to influence health care utilization for adults with diabetes.

Socioeconomic Disparities Associated With Healthcare Utilization Among Adults With Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic and debilitating disease associated with negative health outcomes and high healthcare utilization. Little is known about the role of demographic and socioeconomic factors associated with healthcare utilization in RA. The purpose of this study was to explore the relationships between demographic and socioeconomic characteristics, insurance status, general health perception, and healthcare utilization among adults with RA. In this cross-sectional analysis of data from 537 participants with a self-reported diagnosis of RA from the 2017-2020 National Health and Nutrition Examination Survey, multivariate logistic regression analyses were used to explore the relationships between demographic and socioeconomic factors, insurance status, general health perception, and healthcare utilization (i.e., whether an individual saw a provider, had a routine place to go for healthcare, and stayed overnight in the hospital). The mean age of participants was 57 years; 50% were female, 57.9% were non-Hispanic White, 17.9% were Black, and 15.2% were Mexican or other Hispanic. Individuals without health insurance were less likely than insured individuals with RA to have seen a provider, have a routine place to go for healthcare, and have stayed overnight in the hospital. Adults with RA who rated their health as very good or excellent were more likely to have a routine place for healthcare and less likely to stay overnight in the hospital than those who rated their health as fair or poor. Lack of health insurance significantly correlates with decreased healthcare utilization in adults with RA in the United States. Our findings underscore the need for more frequent assessment of insurance status in adults with RA to identify individuals at an increased risk for reduced healthcare utilization and who are more likely to experience poorly perceived general health.

Health Care and Behavioral Service Use by Medicaid-Enrolled Adults After Release From Incarceration.

This study explored the characteristics and health care utilization of adults released from state prisons and enrolled in Medicaid in Indiana, which has policies to facilitate timely enrollment. Medicaid claims and Department of Corrections data were used to examine demographic and incarceration characteristics and health care utilization patterns of adults (N=15,929) released from state prisons and enrolled in Medicaid within 120 days of release, between 2015 and 2018. More than 80% of participants had at least one health encounter within 120 days of initiating coverage, and nearly 50% used the emergency department. Those enrolled in Medicaid within 30 days of release were more likely to have behavioral health needs and to utilize subacute behavioral health care than those who enrolled later. Understanding these patterns of health care utilization is essential to operationalizing procedures and interventions to support the health care needs of adults involved in the criminal legal system.

Adults with concomitant atopic dermatitis and asthma have more frequent urgent healthcare utilization and less frequent scheduled follow-up visits than adults with atopic dermatitis or asthma only: a nationwide cohort study.

Atopic dermatitis (AD) and asthma often co-occur in the same patient, and healthcare utilization is related to disease severity of these diseases. The objective of the study was to investigate differences in healthcare utilization in adults with concomitant AD and asthma compared to patients with asthma or AD only. All Danish adults with a hospital diagnosis of AD, asthma or concomitant AD, and asthma recorded in national registries were included. Healthcare utilization data were obtained in 3-month intervals from 2 years prior to index date (the date of the first hospital diagnosis) and to 5 years after. A total of 12 409 patients with AD were included (11 590 with AD only and 819 with concomitant AD and asthma), and 65 539 with asthma only. Adults with concomitant AD and asthma had higher risk of hospitalization for AD (OR 1.38, 95% CI (1.15-1.67), P = 0.001) and asthma (OR 1.16, 95% CI (1.00-1.35), P = 0.047) compared to patients with only AD and asthma, respectively. These patients also had fewer visits in outpatient clinics for AD (OR 0.10, 95% CI (0.08-0.12), P < 0.001) and asthma (OR 0.34, 95% CI (0.29-0.39), P < 0.001) compared to patients with only AD or asthma. Outpatient clinic visits for rhinitis were more frequent among patients with concomitant AD and asthma compared to patients with only AD or asthma. Adults with concomitant AD and asthma had different patterns of healthcare utilization compared to adults with AD or asthma alone, suggesting that improvements in management and monitoring may reduce unscheduled healthcare visits and lower healthcare costs.

Impact of Comorbid Psychiatric Disorders on Healthcare Utilization in Patients with Inflammatory Bowel Disease: A Nationally Representative Cohort Study.

Patients with inflammatory bowel disease (IBD) frequently experience comorbid psychiatric disorders, which negatively impact quality of life. We characterized the longitudinal burden of hospitalization-related healthcare utilization in adults with IBD with and without comorbid anxiety, depression, or bipolar disorder. In the 2017 Nationwide Readmissions Database (NRD), we identified 40,177 patients with IBD who were hospitalized between January 1, 2017 and June 30, 2017 and who were followed until December 31, 2017. In this cohort, we compared the annual burden (i.e., total days spent in hospital), costs, risk of readmission, inpatient mortality, and IBD-related surgery in patients with and without comorbid psychiatric disorders (anxiety, depression, or bipolar disorder). Of the 40,177 adults who were hospitalized for IBD, 25.7% had comorbid psychiatric disorders. Over a 10month-long period of follow-up, patients with comorbid psychiatric disorders spent more days in the hospital (median, 7days vs. 5days, p < 0.01), experienced higher 30-day (31.3 vs. 25.4%; p < 0.01) and 90-day (42.6 vs. 35.3%, p < 0.01) readmission rates, and had higher hospitalization-related costs (median, $41,418 vs. $39,242, p < 0.01). However, they were less likely to undergo IBD-related procedures or surgeries. There were no differences in risk of mortality. On Cox proportional hazard analysis, the presence of comorbid psychiatric disorders was associated with a 16% higher risk of readmission (HR, 1.16; 95% CI, 1.13-1.20) and a 13% higher risk of severe IBD-related hospitalization (HR, 1.13; 95% CI, 1.08-1.16). In adults with IBD, comorbid psychiatric disorders were independently associated with a higher burden and cost of hospitalization, without an increase in the risk of IBD-related surgery or procedures. Population-based interventions aimed at treating psychiatric comorbidities may decrease the risk of unplanned healthcare utilization.

Sociodemographic Differences in Pain Medication Usage and Healthcare Provider Utilization Among Adults With Chronic Low Back Pain.

Chronic low back pain (cLBP) is the most common reason for individual suffering and health care utilization in adults. Ample evidence suggests sociodemographic variables and socioeconomic status (SES) influence pain. However, a framework informing associations on race, SES, and the utilization of pharmacologic therapies and provider type are limited—particularly in cLBP. Thus, this study examined the extent to which sociodemographic (i.e., age, race, and gender) and socioeconomic factors (i.e., national area deprivation index, NADI) influence pain treatment (i.e., NSAIDs, opioids, antidepressants, and non-NSAIDs) and provider utilization for cLBP (i.e., no provider care, primary care, or tertiary care). Eligible participants with cLBP completed a series of questionnaires. Of the 174 participants, 58% were women, 59% were non-Hispanic Black (NHB), and the mean age was 46.10 (SD 13.58). Based on NADI distributions by race, NHB participants lived in more socioeconomically disadvantaged neighborhoods (p < 0.001) than non-Hispanic White (NHW) adults. Results suggested that the use of one or more pharmacologic therapies was associated with race (p = 0.021). Specifically, NHW adults were two times more likely to take one or more pharmacologic therapies than NHBs (p = 0.009). NHWs were also more likely to use NSAIDs (p = 0.041) and antidepressants (p < 0.001) than NHBs. Furthermore, provider utilization was significantly associated with gender (p = 0.037) and age (p = 0.018); which suggests older women were more likely to use primary or tertiary care. Findings from this study expand on the existing literature as it relates to associations between disparities in access to healthcare providers and access to medications. Future research should seek to understand differences in age and utilization of primary or tertiary care providers and continue to examine the influence of sociodemographic and SES factors to cLBP and compare with other types of chronic pain.

Medical manifestations and health care utilization among adult MyCode participants with neurodevelopmental psychiatric copy number variants

PurposeRecurrent pathogenic copy number variants (pCNVs) have large-effect impacts on brain function and represent important etiologies of neurodevelopmental psychiatric disorders (NPDs), including autism and schizophrenia. Patterns of health care utilization in adults with pCNVs have gone largely unstudied and are likely to differ in significant ways from those of children. MethodsWe compared the prevalence of NPDs and electronic health record–based medical conditions in 928 adults with 26 pCNVs to a demographically-matched cohort of pCNV-negative controls from >135,000 patient-participants in Geisinger’s MyCode Community Health Initiative. We also evaluated 3 quantitative health care utilization measures (outpatient, inpatient, and emergency department visits) in both groups. ResultsAdults with pCNVs (24.9%) were more likely than controls (16.0%) to have a documented NPD. They had significantly higher rates of several chronic diseases, including diabetes (29.3% in participants with pCNVs vs 20.4% in participants without pCNVs) and dementia (2.2% in participants with pCNVs vs 1.0% participants without pCNVs), and twice as many annual emergency department visits. ConclusionThese findings highlight the potential for genetic information—specifically, pCNVs—to inform the study of health care outcomes and utilization in adults. If, as our findings suggest, adults with pCNVs have poorer health and require disproportionate health care resources, early genetic diagnosis paired with patient-centered interventions may help to anticipate problems, improve outcomes, and reduce the associated economic burden.

Improved Clinical Outcomes in Adults with Sickle Cell Disease and Diabetes Treated with Metformin

▪BackgroundComplications of sickle cell disease (SCD) include pain episodes, chronic anemia, cardiopulmonary disease, and long-term end-organ damage. Hydroxyurea is efficacious in preventing these complications by increasing fetal hemoglobin levels (HbF); however, adherence is limited. Metformin, a Food and Drug Administration-approved drug used for type-2 diabetes mellitus (DM), was recently found to induce HbF through upregulation of FOXO3 and gamma-globin expression. However, the relation of metformin utilization to clinical outcomes and healthcare utilization in adults with SCD and DM has not been studied.ObjectivesOur specific aims were to 1) estimate the prevalence of DM in a cohort of adult patients with SCD and 2) assess the association of metformin with clinical outcomes and healthcare utilization in this population. We hypothesized that adults with SCD and DM on metformin have less frequent SCD-related complication and lower utilization of hospital care for those complications.MethodsWe analyzed subjects with SCD and DM ≥18 years of age from the Truven Health MarketScan® Multi-State Medicaid Database from 2009-2015 with continuous enrollment of ≥365 days. Subjects with SCD and DM were identified through the presence of ≥1 inpatient or ≥2 outpatient disease-specific billing codes or ≥1 outpatient DM code and ≥1 DM-related drug claim. Subjects with drug claims for insulin, hydroxyurea, or iron chelation were excluded. Metformin use was defined as having ≥1 metformin-related drug claim in the study period. Outcomes included annual rates of all-cause inpatient hospitalizations, SCD-related hospitalizations, all-cause emergency department (ED) visits, SCD-related ED visits, vaso-occlusive episodes (VOE), strokes, acute chest syndrome (ACS) episodes, avascular necrosis (AVN) events, and gallstone events. Outcomes were identified based on claims records after the subject's first DM diagnosis record in the dataset. Clinical events among metformin users and non-users were compared using chi square tests. Rate ratios (RR) comparing annual rates of clinical events among metformin users to non-users were estimated using negative binomial regression, controlling for age, sex, and claims-data-defined Charlson Comorbidity Index (CCI) score.ResultsWe identified 7,617 subjects with SCD and 1,296 (17%) of them also had a diagnosis of DM. Our final cohort included a total of 375 subjects who met all our pre-defined criteria; of them, 126 (34%) were treated with metformin. Subjects were 72% female and 82% Black, and had a median age of 44 years (interquartile range (IQR) 33-52) and CCI score of 2 (IQR 0-4). All clinical events were less frequent in metformin users when compared to non-users, summarized in Table 1a, and subjects in both groups were similar in age, sex, race and CCI score. Using negative binomial regression, adjusted for age, sex and CCI score, metformin users had significantly lower all-cause inpatient stays (rate ratio (RR) 0.55; 95% confidence interval (CI) 0.42-0.72), SCD-related inpatient stays (RR 0.36; 95% CI 0.24-0.54), all-cause ED visits (RR 0.65; 95% CI 0.50-0.86), SCD-related ED visits (RR 0.43; 95% CI 0.27-0.68), VOE (RR 0.15; 95% CI 0.08-0.27), ACS (RR 0.14; 95% CI 0.03-0.59) and AVN (RR 0.29; 95% CI 0.09-0.91), compared to metformin non-users (Table 1b). Similar trends were also seen when patients were stratified by age as young adults (<40 years) vs. adults (≥40 years), as shown in Table 1b.ConclusionsThis study is the first to examine clinical associations of metformin use with SDC-related complications in adults with SCD and DM. These findings strongly suggest that metformin has important protective effects on all-cause and SCD-related hospital-treated clinical events. Among adults with SCD and DM, metformin users had 45% fewer SCD-related inpatient stays and roughly 85% fewer VOE or ACS episodes after controlling for confounding variables. These benefits are consistent with the effects of metformin on HbF induction observed in earlier laboratory data. An analysis of the effects of adherence to metformin on clinical outcomes and healthcare utilization in our cohort is ongoing. Given our findings and the known safety profile of metformin, future prospective studies are warranted to evaluate its efficacy and cost-effectiveness in relation to clinical outcomes, quality of life, mortality and healthcare utilization in adults with SCD. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Impact of the COVID-19 pandemic and lockdown restrictions on psychosocial and behavioural outcomes among Australian adults with type 2 diabetes: Findings from the PREDICT cohort study.

AimTo examine psychosocial and behavioural impacts of the novel coronavirus disease 2019 (COVID‐19) pandemic and lockdown restrictions among adults with type 2 diabetes.MethodsParticipants enrolled in the PRogrEssion of DIabetic ComplicaTions (PREDICT) cohort study in Melbourne, Australia (n = 489 with a baseline assessment pre‐2020) were invited to complete a phone/online follow‐up assessment in mid‐2020 (i.e., amidst COVID‐19 lockdown restrictions). Repeated assessments that were compared with pre‐COVID‐19 baseline levels included anxiety symptoms (7‐item Generalised Anxiety Disorder scale [GAD‐7]), depressive symptoms (8‐item Patient Health Questionnaire [PHQ‐8]), diabetes distress (Problem Areas in Diabetes scale [PAID]), physical activity/sedentary behaviour, alcohol consumption and diabetes self‐management behaviours. Additional once‐off measures at follow‐up included COVID‐19‐specific worry, quality of life (QoL), and healthcare appointment changes (telehealth engagement and appointment cancellations/avoidance).ResultsAmong 470 respondents (96%; aged 66 ± 9 years, 69% men), at least ‘moderate’ worry about COVID‐19 infection was reported by 31%, and 29%–73% reported negative impacts on QoL dimensions (greatest for: leisure activities, feelings about the future, emotional well‐being). Younger participants reported more negative impacts (p < 0.05). Overall, anxiety/depressive symptoms were similar at follow‐up compared with pre‐COVID‐19, but diabetes distress reduced (p < 0.001). Worse trajectories of anxiety/depressive symptoms were observed among those who reported COVID‐19‐specific worry or negative QoL impacts (p < 0.05). Physical activity trended lower (~10%), but sitting time, alcohol consumption and glucose‐monitoring frequency remained unchanged. 73% of participants used telehealth, but 43% cancelled a healthcare appointment and 39% avoided new appointments despite perceived need.ConclusionsCOVID‐19 lockdown restrictions negatively impacted QoL, some behavioural risk factors and healthcare utilisation in adults with type 2 diabetes. However, generalised anxiety and depressive symptoms remained relatively stable.

Clinical and utilization outcomes associated with tumor mutational burden in a real-world pan-tumor population.

Aim & methods: This real-world study examined the association of tumor mutational burden (TMB) with clinical and healthcare utilization in adults diagnosed with advanced solid tumor 1 January2015- 31 January2019. Results: There were 170 patients in low-TMB group (TMB<10mut/Mb) and 32 in high-TMB group (TMB ≥10mut/Mb). Median overall survival was 18.8 (95% CI: 17.3-28.8) and 15.9months (95% CI: 11.3-18.0) whereas median progression-free survival was 9.9 (95% CI: 8.6-11.4) and 7.8months (95% CI: 3.8-12.5) for the low- and high-TMB groups, respectively. Hospitalization (49.4 vs 37.5%), emergency visit (25.3 vs 21.9%), and median overall cost of care (US$135,403 vs 87,570) were all lower in low-TMB group. Conclusion: Despite the limited sample, these data provide a historical perspective for examining real-world outcomes associated with TMB.

National Estimates of Financial Hardship From Medical Bills and Cost-related Medication Nonadherence in Patients With Inflammatory Bowel Diseases in the United States

Inflammatory bowel diseases (IBDs) are associated with substantial health care needs. We estimated the national burden and patterns of financial toxicity and its association with unplanned health care utilization in adults with IBD in the United States. Using the National Health Interview survey (2015), we identified individuals with self-reported IBD and assessed national estimates of financial toxicity across domains of financial hardship due to medical bills, cost-related medication nonadherence (CRN) and adoption of cost-reducing strategies, personal and health-related financial distress (worry about expenses), and health care affordability. We also evaluated the association of financial toxicity with emergency department (ED) utilization. Of the estimated 3.1 million adults with IBD in the United States, 23% reported financial hardships due to medical bills, 16% of patients reported CRN, and 31% reported cost-reducing behaviors. Approximately 62% of patients reported personal and/or health-related financial distress, and 10% of patients deemed health care unaffordable. Prevalence of financial toxicity was substantial even in participants with higher education, with private insurance, and belonging to middle/high-income families, highlighting underinsurance. Inflammatory bowel disease was associated with 1.6 to 2.6 times higher odds of financial toxicity across domains compared with patients without IBD. Presence of any marker of financial toxicity was associated with higher ED utilization. One in 4 adults with IBD experiences financial hardship due to medical bills, and 1 in 6 adults reports cost-related medication nonadherence. These financial determinates of health-especially underinsurance-have important implications in the context of value-based care.