Health Insurance Status Research Articles

HIV status and substance use disorder treatment need and utilization among adults in the United States, 2015–2019: Implications for healthcare service provision and integration

IntroductionSubstance use disorders (SUD) are associated with HIV acquisition and care disruptions. Most research focuses on clinical samples; however, we used a nationally representative, community-based sample to estimate SUD treatment need and utilization by HIV status. MethodsWe included participants from the 2015–2019 National Survey on Drug Use and Health aged 18 and older who met past-year DSM-IV SUD criteria (n = 22,166). Participants self-reported whether a healthcare professional ever told them they had HIV or AIDS [i.e., people with HIV (PWH), non-PWH, HIV status unknown]. Outcomes included past-year: 1) any SUD treatment use; 2) any specialty SUD treatment use; and 3) perceived SUD treatment need. Survey weighted multivariable logistic regression models estimated the likelihood of each outcome by HIV status, adjusting for age, sex, race/ethnicity, education, survey year, health insurance status, and household income. ResultsOverall, 0.5 % were PWH and 0.8 % had an HIV unknown status. Any past-year SUD treatment utilization was low across all groups (10.3 % non-PWH, 24.2 % PWH, and 17.3 % HIV status unknown respondents). Specialty SUD treatment utilization was reported by 7.2 % of non-PWH, 17.8 % PWH, and 10.9 % HIV status unknown respondents. Perceived treatment need was reported by 4.9 % of non-PWH, 12.4 % of PWH, and 3.7 % of HIV status unknown respondents. In adjusted models, PWH were more likely than non-PWH to report any past-year SUD treatment utilization (aOR = 2.06; 95 % CI = 1.08–3.94) or past-year specialty SUD treatment utilization (aOR = 2.07; 95 % CI = 1.07–4.01). Among those with a drug use disorder other than cannabis, respondents with HIV-unknown status were less likely than HIV-negative individuals to report past-year perceived treatment need (aOR = 0.39; 95 % CI = 0.20–0.77). ConclusionsDespite high SUD treatment need among PWH, more than three quarters of PWH with SUD reported no past-year treatment. Compared to non-PWH, PWH had higher treatment utilization and higher specialty treatment utilization, but SUD treatment was low across all groups. As SUD is associated with adverse HIV outcomes, our findings highlight the need for the integration of SUD treatment with HIV testing and care. Increasing access to SUD treatment could help reduce negative SUD-related outcomes along the HIV care continuum.

The Prevalence of Duplicate Prescription of Oral Antibiotic Drugs in Outpatient Care among People Insured by Corporate Health Insurance Societies in Japan.

Inappropriate antimicrobial use is a global problem, especially because the use of antimicrobials in excess of appropriate doses is associated with increased antimicrobial resistance. Duplicate prescriptions are an issue contributing to inappropriate antimicrobial use. This study aimed to analyse antibiotic prescriptions during a specific month to examine the frequency of outpatients receiving duplicate antibiotic prescriptions and the associated determinants. Utilizing the Japan Medical Data Centre health insurance claim database, we retrospectively identified 527,110 insured individuals with at least one medicine prescription in October 2014. Data regarding age, gender, antibiotic drug usage, and health insurance status were extracted. Duplicate prescriptions entailed a patient receiving two or more prescriptions of systemic antibiotics from multiple facilities within one month. The risk factors for duplicate antibiotic prescriptions were evaluated using logistic regression analysis. Of the total sample, 131,709 individuals (25.0%) received antibiotics, and 24,529 of these individuals (18.6%) had duplicate prescriptions. Third-generation cephalosporins accounted for the largest proportion of prescriptions (37.4%). Duplicate prescriptions were significantly associated with sex, age, medical facilities, and health insurance status. These findings could help to identify patients at risk of duplicate antibiotic prescriptions, highlighting the need to promote proper antimicrobial use in both patients and medical professionals.

Association of immune checkpoint inhibitor introduction and changes in survival disparities by health insurance coverage among individuals newly diagnosed with advanced cancers in the US.

1580 Background: First approved by the US Food and Drug Administration (FDA) in 2011, immune checkpoint inhibitors (ICIs) have transformed treatment options for many cancers. Unfortunately, due to their high cost, individuals without health insurance coverage may not be able to afford them. Therefore, the introduction of ICIs may lead to greater disparities in cancer survival between patients with and without health insurance. This study examined the association of health insurance with changes in survival disparities associated with the introduction of ICIs. Methods: We identified individuals newly diagnosed at age 18-64 years at stage IV with any one of the following cancers with FDA approval for ICI treatment, including melanoma (first approved 03/25/2011, n=9992); HR+ HER- female breast cancer (02/03/2015, n=13632); non-small cell lung cancer (NSCLC; 03/04/2015, n=113866); and renal cell carcinoma (RCC; 11/23/2015, n=15403) from the National Cancer Database. Individuals with private health insurance or who were uninsured at the time of the cancer diagnosis were included. For each cancer, we applied a difference-in-differences (DD) approach to examine the changes in two-year overall survival before and after the ICI FDA approval date among individuals without health insurance compared to those with private health insurance, using flexible parametric survival models and controlling for key sociodemographic factors. Results: As shown (Table), among patients diagnosed with melanoma, 2-year survival rate increased from 16.33% pre-ICI approval to 27.04% after ICI approval among patients who were uninsured and increased from 28.22% to 45.45% among patients with private health insurance, with the disparity by health insurance status widened by 4.58 (95% confidence interval [CI] = 0.02 to 9.14) percentage points (ppt) after adjusting for sociodemographic factors. For patients diagnosed with stage IV NSCLC, the disparity by health insurance widened by 1.58 (95% CI = 0.52 to 2.64) ppt. Conclusions: The introduction of ICIs increased disparities in survival by health insurance status. Policies to improve health insurance coverage options or make new treatments more affordable to uninsured patients are needed. [Table: see text]

Number of comorbidities and the risk of delay in seeking treatment for coronary heart disease: a longitudinal study in Bogor City, Indonesia.

The aim of this study was to investigate the relationship between the number of patient comorbidities and the delays in seeking treatment for coronary heart disease (CHD). This longitudinal study utilized secondary data from the Non-Communicable Disease Risk Factor (NCDRF) cohort study conducted in Bogor City. Individuals who participated in the NCDRF cohort study and were diagnosed with CHD within the 6-year study period met the inclusion criteria. Respondents who were not continuously monitored up to the 6th year were excluded. The final sample included data from respondents with CHD who participated in the NCDRF cohort study and were monitored for the full 6-year duration. The final logistic regression analysis was conducted on data collected from 812 participants. Among the participants with CHD, 702 out of 812 exhibited a delay in seeking treatment. The risk of a delay in seeking treatment was significantly higher among individuals without comorbidities, with an odds ratio (OR) of 3.5 (95% confidence interval [CI], 1.735-7.036; p<0.001). Among those with a single comorbidity, the risk of delay in seeking treatment was still notable (OR, 2.6; 95% CI, 1.259-5.418; p=0.010) when compared to those with 2 or more comorbidities. These odds were adjusted for age, sex, education level, and health insurance status. The proportion of patients with CHD who delayed seeking treatment was high, particularly among individuals with no comorbidities. Low levels of comorbidity also appeared to correlate with a greater tendency to delay in seeking treatment.

Elevated C-reactive protein and mortality risk among COPD patients

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive disease associated with autoimmune systemic inflammation. The evidence on the role of C-reactive protein (-CRP) in predicting mortality among people with COPD remains mixed.MethodsData from the National Health and Nutrition Examination Survey (1999–2010) were linked with mortality files up to December 31st, 2019, from the National Death Index. Adults ages 20 years or older were included in the analytic sample to assess the relationship between physician-diagnosed self-reported COPD and mortality based on blood CRP levels. Multivariate complex samples Cox regression analyses were conducted to determine the hazards ratios (with 95% CI).ResultsA total of 30,669 individuals comprised of the final sample with 2215 deaths observed upon follow-up for an average of 10.2 years. Compared to individuals without COPD or elevated CRP, individuals with COPD but without elevated CRP (HR = 1.25, 95% CI = 0.97–1.61) did not have a significantly higher risk of mortality. However, those with both COPD and elevated CRP had a significantly higher risk of mortality (HR = 2.70, 95% CI = 1.08–6.81). Age, health insurance status, and a history of comorbidities modified these relationships.ConclusionsBiomarkers such as CRP continue to show promise for long-term COPD-related outcomes. Additional prospective assessments of individuals with airway obstruction are warranted to understand if CRP levels predict the occurrence or worsening of COPD and if those relate to long-term health outcomes.

Associations of social determinants of health with avoidance of information, treatment receipt, and physician mistrust for women with breast cancer.

1507 Background: Social determinants of health (SDoH) are key factors contributing to breast cancer disparities but are difficult to measure. We surveyed a diverse population of women with breast cancer to identify SDoH and demographic measures associated with avoiding information, treatment receipt, and physician mistrust. Methods: During 2018-2020, we interviewed 297 women (60% White, 25% Black, 15% Hispanic) with a history of breast cancer treated at three academic institutions. We used multivariable regression to assess the associations of SDoH, demographics, and related factors (social support, discrimination in daily life and within healthcare, education, financial strain, faith, age, birth country, race and ethnicity, marital status) with three outcomes: (1) avoiding information about cancer, (2) lack of initiation of recommended treatments, and (3) physician mistrust. For each model, we included factors statistically significant (p&lt;0.05) in unadjusted analyses. Results: Overall, 79 participants (26.6%) reported avoiding information about cancer. Age &lt;40, discrimination (treated with less courtesy or as if dishonest), and financial strain (worry about medical bills, uninsured status) were all significantly associated with avoiding information (p&lt;0.05 for all). In multivariable analyses, discrimination in daily life (OR 3.37, 95% CI 1.40-8.10 for being treated as if dishonest) and age (OR 3.36 for age &lt;40 compared to &gt;60) were associated with avoiding information. Twenty-two participants (7.4%) reported not initiating at least one recommended treatment. Discrimination in daily life and in healthcare were both significantly associated with treatment receipt, as was financial strain (all p&lt;0.01). In multivariable analyses, discrimination (OR 3.51, 95% CI 1.05-11.76 for being treated as if dishonest) and worrying about medical bills (OR 3.53, 95% CI 1.40-8.93) were associated with lack of treatment initiation. Twelve participants (4.0%) reported not trusting physician’s judgements about medical care. Discrimination in daily life and in health care and insurance status were significantly associated with physician mistrust (both p&lt;0.05). Multivariable analysis found that discrimination in both daily life and in health care (OR 5.95, 95% CI 1.40-25.3 for being treated with less courtesy in daily life, and OR 12.79, 95% CI 2.49-65.6 for reporting being treated as dishonest in health care setting) were associated with mistrust. Race and ethnicity were not significantly associated with any of the outcome measures in unadjusted or adjusted analyses (all p&gt;0.05). Conclusions: SDoH measures and not race were associated with lack of engagement and trust within the health care system, with experiences of discrimination and financial strain associated with avoiding information, not initiating treatments, and physician mistrust.

Factors Influencing Insulin Adherence among Outpatients with Type 2 Diabetes Mellitus and the Impact of Pharmaceutical Intervention: A Randomized Clinical Trial

Aims. This study aimed to identify and analyze the factors significantly influencing long-term insulin medication adherence among outpatients and to evaluate whether pharmaceutical interventions targeting these factors can improve patient medication adherence and glycemic control. Methods. A cohort of 180 patients was recruited from a tertiary hospital in Nanjing, China. Factors potentially influencing insulin adherence were scrutinized employing the KAP (knowledge, attitude/belief, and practice) health behavior model. Baseline characteristics were extracted from the hospital information system, while patient knowledge of the disease and medication, medication adherence, medication beliefs, and management self-efficacy were assessed, respectively, using self-developed questionnaires, MMAS-8, C-DMSES, and BMQ scales. Univariate and multivariate analyses were conducted to determine the impact of these factors on insulin adherence. Following this, participants were randomly allocated to either the intervention or control group. The intervention group received three months of weekly telephone sessions and educational interventions targeting facets such as medication knowledge and beliefs, while the control group received standard care. After the intervention, insulin adherence and glycemic control conditions of both groups were collected and re-evaluated. Results. After excluding lost-to-follow-up patients, 152 individuals were analyzed (intervention: 75 and control: 77). Multivariate analyses revealed factors influencing insulin adherence, including age, diabetes duration, health insurance status, HbA1c level, disease and medication knowledge, diabetes management self-efficacy, and medication beliefs (P&lt;0.05). Before targeted pharmaceutical care, no significant differences existed in insulin adherence, HbA1c levels, management self-efficacy, knowledge, or medication beliefs between intervention and control groups (P&gt;0.05). However, subsequent pharmaceutical intervention notably improved adherence, HbA1c levels, self-efficacy, knowledge, and medication beliefs (P&lt;0.05). Conclusion. This study examines the impact of glycemic control, health insurance status, management self-efficacy, level of knowledge, and medication beliefs on improving insulin medication adherence in patients with type 2 diabetes mellitus. Targeted pharmaceutical intervention can enhance medication adherence, improve glucose control, and promote rational insulin use. This trial is registered with ChiCTR2300074444.

Multidimensional Poverty and Risk of Atherosclerotic Cardiovascular Disease: A U.S. National Study

BackgroundPoverty is associated with atherosclerotic cardiovascular disease (ASCVD). While poverty can be evaluated using income, a unidimensional poverty metric inadequately captures socioeconomic adversity. ObjectivesThe aim of the study was to examine the association between a multidimensional poverty measure and ASCVD. MethodsSurvey data from the National Health Interview Survey was analyzed. Four poverty dimensions were used: income, education, self-reported health, and health insurance status. A weighted deprivation score (ci) was calculated for each person. The multidimensional poverty index was computed for various cutoffs, k, for total population, and by ASCVD status. The association between multidimensional poverty and ASCVD was examined using Poisson regression. Area under receiver operator characteristics curve analysis was performed to compare the multidimensional poverty measure with the income poverty measure as a classification tool for ASCVD. ResultsAmong the 328,164 participants, 55.0% were females, the mean age was 46.3 years, 63.1% were non-Hispanic Whites, and 14.1% were non-Hispanic Blacks. Participants with ASCVD (7.95%) experienced greater deprivation at each multidimensional poverty cutoff, k, compared to those without ASCVD. In adjusted models, higher burden of multidimensional poverty was associated with up to 2.4-fold increased prevalence of ASCVD (ci = 0.25, adjusted prevalence ratio [aPR] = 1.66, P < 0.001; ci = 0.50, aPR = 1.99; ci = 0.75, aPR = 2.29; P < 0.001; ci = 1.00, aPR = 2.38, P < 0.001). Multidimensional poverty exhibited modestly higher discriminant validity, compared to income poverty (area under receiver operator characteristics = 0.62 vs 0.58). ConclusionsThere is an association between the multidimensional poverty and ASCVD. Multidimensional poverty index demonstrates slightly better discriminatory power than income alone. Future validation studies are warranted to redefine poverty's role in health outcomes.

Health insurance coverage and experiences of intimate partner violence and postpartum abuse screening among rural US residents who gave birth 2016-2020.

Intimate partner violence (IPV) is elevated among rural residents and contributes to maternal morbidity and mortality. Postpartum health insurance expansion efforts could address multiple causes of maternal morbidity and mortality, including IPV. The objective of this study was to describe the relationship between perinatal health insurance, IPV, and postpartum abuse screening among rural US residents. Using 2016-2020 data on rural residents from the Pregnancy Risk Assessment Monitoring System, we assessed self-report of experiencing physical violence by an intimate partner and rates of abuse screening at postpartum visits. Health insurance at childbirth and postpartum was categorized as private, Medicaid, or uninsured. We also measured insurance transitions from childbirth to postpartum (continuous private, continuous Medicaid, Medicaid to private, and Medicaid to uninsured). IPV rates varied by health insurance status at childbirth, with the highest rates among Medicaid beneficiaries (7.7%), compared to those who were uninsured (1.6%) or privately insured (1.6%). When measured by insurance transitions, the highest IPV rates were reported by those with continuous Medicaid coverage (8.6%), followed by those who transitioned from Medicaid at childbirth to private insurance (5.3%) or no insurance (5.9%) postpartum. Nearly half (48.1%) of rural residents lacked postpartum abuse screening, with the highest proportion among rural residents who were uninsured at childbirth (66.1%) or postpartum (52.1%). Rural residents who are insured by Medicaid before or after childbirth are at elevated risk for IPV. Medicaid policy efforts to improve maternal health should focus on improving detection and screening for IPV among rural residents.

Influence of Socioeconomic Status on Functional Outcomes After Stroke: A Systematic Review and Meta-Analysis.

This review aimed to quantify the impact of socioeconomic status on functional outcomes from stroke and identify the socioeconomic status indicators that exhibit the highest magnitude of association. We performed a systematic literature search across Medline and Embase from inception to May 2022, to identify observational studies (n≥100, and in English). Risk of bias was assessed using the modified Newcastle Ottawa Scale. Random effects meta-analysis was used to pool data. We included 19 studies (157 715 patients, 47.7% women) reporting functional outcomes measured with modified Rankin Scale or Barthel index, with 10 assessed as low risk of bias. Measures of socioeconomic status reported were education (11 studies), income (8), occupation (4), health insurance status (3), and neighborhood socioeconomic deprivation (3). Pooled data suggested that low socioeconomic status was significantly associated with poor functional outcomes, including incomplete education or below high school level versus high school attainment and above (odds ratio [OR], 1.66 [95% CI, 1.40-1.95]), lowest income versus highest income (OR, 1.36 [95% CI, 1.02-1.83]), a manual job/being unemployed versus a nonmanual job/working (OR, 1.62 [95% CI, 1.29-2.02]), and living in the most disadvantaged socioeconomic neighborhood versus the least disadvantaged (OR, 1.55 [95% CI, 1.25-1.92]). Low health insurance status was also associated with an increased risk of poor functional outcomes (OR, 1.32 [95% CI, 0.95-1.84]), although this was association was not statistically significant. Despite great strides in stroke treatment in the past decades, social disadvantage remains a risk factor for poor functional outcome after an acute stroke. Further research is needed to better understand causal mechanisms and disparities.

Middle-Aged and Older Adult Employment and the Perceived Risk of Running Out of Money During COVID-19: A Dynamic Panel Data Analysis.

The coronavirus disease of 2019 (COVID-19) adversely affected the health of middle-aged and older adults and altered their economic outlook. Several national polls revealed older adults felt stress about money and many reported difficulties in paying expenses during 2021. Although such descriptive reports have raised awareness, peer-reviewed studies utilizing panel data can offer additional insight. As such, the purpose of this study was to contribute to this growing literature by examining the demographic, economic, and health factors associated with employment and the perceived risk of running out of money for middle-aged and older adults during the pandemic. This study utilized the April-May 2020, April-May 2021, and March 2022 waves of the Understanding America Study. Next, a dynamic panel data model was formulated to account for reverse causality and unobserved heterogeneity with a sample of 2,302 adults between the ages of 50 and 74. Employment (-2.77, p < .05) was negatively associated with the perceived risk of running out of money. Male, higher education levels, currently married, and health insurance status also exhibited a negative association. Meanwhile, a positive association was found for non-White (6.79, p < .01). Financial well-being is an important consideration in later life and what role employment played during the COVID-19 pandemic is a worthwhile examination. A better understanding of which factors may be associated with the perceived risk of running out of money during the pandemic can be useful when devising policies which address financial security for middle-aged and older adults.

Abstract PO4-10-03: Relationship Between Insurance Status and Breast Cancer Care in Young Mexican Women

Abstract BACKGROUND In Mexico, 71% of the population is covered by public health insurance, while 2% are privately insured and 27% are uninsured. Previous studies have demonstrated differences in breast cancer (BC) care according to type of healthcare coverage in the United States and Latin America. Most studies have observed that privately insured patients are diagnosed at earlier stages, have less symptom-to-diagnosis and treatment delays, and have better overall outcomes. The aim of this analysis was to evaluate whether differences in BC care exist among young women with breast cancer (YWBC), ≤40 years at diagnosis, depending on their insurance status in Mexico. METHODS Data was collected from the Mexican prospective cohort of YWBC Joven &amp; Fuerte. Patient surveys and researcher follow-ups were used to collect data related to clinicopathologic features, time from symptom onset to seeking medical assistance and treatment, and perceived quality of information received and medical staff support. Results were analyzed using SPSS. RESULTS Information about health insurance status was available for 608 patients: 565 (93%) had public coverage and 43 (7%) had private coverage. Table 1 describes the clinicopathologic characteristics of both groups. Patients with private insurance were diagnosed at earlier stages, 0-II vs. III-IV (81% vs. 16%), than those with public insurance (50% vs. 45%) (p&amp;lt; 0.001). No difference was found on the distribution of BC subtypes among both groups. A total of 573 (94%) patients had registered information regarding the time from symptom onset to contacting a medical professional. Only 18 (3%) were diagnosed with imaging studies (5% and 3% with private and public coverage, respectively). More privately insured patients (95%) contacted a healthcare professional during the first 3 months since symptom onset than publicly insured patients (74%) (p=0.003). Information regarding the time from contacting a healthcare professional to treatment start was available for 472 (78%) patients. There was no difference in the proportion of patients who started treatment ≤3 months after arriving with a healthcare professional according to type of health insurance (76% private vs. 67% public coverage; p=0.2). The majority of patients (96%) considered having adequate support from the medical staff (100% private vs. 94% public). Compared to those with public coverage, more privately insured patients perceived receiving adequate information about their treatment (79% private vs. 50% public; p&amp;lt; 0.001). There were no differences between groups regarding the perceived quality of information regarding their diagnosis (p=0.06) and continuous BC care (p=0.6). CONCLUSION Patients with private coverage were diagnosed at earlier stages, reported contacting a healthcare professional earlier, and perceived receiving adequate information regarding their treatment more often than patients with public coverage. These results coincide with previously reported differences between patients with private and public health insurance. Interestingly, there were no differences between the delays from the first visit to treatment initiation and perceived support from the medical staff depending on type of healthcare coverage. Given the observed differences between privately and publicly insured patients, population-based interventions to increase awareness of alarm signs for BC and widespread access to quality patient education resources could help decrease the disparities between these groups. Table 1. Clinicopathologic features of BC depending on insurance status Citation Format: David G Gonzalez-Sanchez, Arantxa Ramirez-Cisneros, Alejandra Platas, Alejandra Platas, Daniela Vazquez-Juarez, Fernanda Mesa-Chavez, Ana Ferrigno, Alejandro Mohar, Alan Fonseca, Cynthia Villarreal-Garza. Relationship Between Insurance Status and Breast Cancer Care in Young Mexican Women [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-10-03.

The effect of fine particulate matter (PM2.5) pollution on health inequality: an intergenerational perspective.

Air pollution poses a serious challenge to public health and simultaneously exacerbating regional & intergenerational health inequality. This research introduces PM2.5 pollution into the intergenerational health transmission model, and estimates its impact on health inequality in China using Ordered Logit Regression (OLR) and Multi-scale Geographically Weighted Regression (MGWR) model. The results indicate that PM2.5 pollution exacerbate the intergenerational health inequality, and its impacts show inconsistency across family income levels, parental health insurance status, and area of residence. Specifically, it is more difficult for offspring in low-income families to escape from the influence of unhealthy family to become upwardly mobile. Additionally, this health inequality is more significant in households in which at least one parent does not have health insurance. Moreover, the intergenerational solidification caused by PM2.5 pollution is higher in the east and lower in the west. Both the PM2.5 level and solidification effect are high in Beijing-Tianjin-Hebei region, Yangtze River Delta region and central areas of China, which is the focus of air pollution management. These findings suggest that more emphasis should be placed on family-based health promotion. In areas with high PM2.5 pollution levels, resources, subsidies and air pollution protection should be provided for less healthy families with lower incomes and no health insurance.

Gestational Diabetes Significantly Associated With Food Insecurity and Insurance Status in the United States [ID 2683536

INTRODUCTION: Gestational diabetes (GD) is on the rise in the United States, posing risks to women's cardiovascular health, pregnancy, and their offspring's well-being. We sought to characterize the association between food insecurity and health care access and GD prevalence. METHODS: We analyzed data from 29,732 females aged 18+ in the 2021–2022 National Health Interview Survey to determine the prevalence of self-reported GD and its relationship with food security and health insurance status. We used χ2 tests to compare GD rates across different food security classifications and insurance statuses. Additionally, we cross-examined GD rates within food security groups based on insurance coverage. RESULTS: The overall GD prevalence among females was 5.70%. Stratified by food security, significant differences emerged (P&lt;.05): 5.23% for high security, 7.99% for marginal security, 7.72% for low security, and 11.85% for very low security. We observed significant differences in GD rates by insurance coverage (P&lt;.05): 5.57% for insured and 7.72% for uninsured respondents. Notably, when individuals were not highly food secure, there was no significant difference in the prevalence of GD between those who were insured or uninsured. CONCLUSION: This study highlights the significant associations between food insecurity, insurance coverage, and GD prevalence, although our cross-sectional analysis indicated that food insecurity may be the more salient factor. To combat GD's rise, policies should prioritize providing nutritious food access to pregnant women, potentially through mobile food units. Further research should explore whether food insecurity causally affects GD.

Health Insurance Utilization and Financial Behaviour: A Study of Rashtriya Swasthya Bima Yojana (RSBY) in Kerala

This paper examines the health behaviour and health insurance landscape in Kerala, India, with a focus on the impact of the Rashtriya Swasthya Bima Yojana (RSBY) on healthcare utilization and financial behaviour. Using primary data collected from Mukkam municipality in Kozhikode district, Kerala, the study analyses the demographic profile of respondents, their health insurance status, and satisfaction levels with the RSBY scheme. The findings indicate a fairly balanced preference between government and private insurance schemes among households, with a significant majority possessing an insurance card. The RSBY scheme has been successful in enrolling a large proportion of households and providing satisfactory coverage at both government and private hospitals. However, there are variations in insurance coverage and satisfaction levels among different demographic subgroups, highlighting the need for targeted interventions and policy measures to improve access to healthcare and financial security among vulnerable populations.

Exploring the Patient Experience and Perspective in Virtual-First Primary Care: A Cross-Sectional Study from an Integrated Health System.

Background: Little is known about the implication of launching virtual-first primary care (VPC) in a health system. Our experience and survey can guide others to establish their virtual-first programs. This study examines implementation, patient perspectives, and satisfaction with VPC at University of Pittsburgh Medical Center (UPMC). Methods: We conducted a Web-based survey to examine factors associated with the likelihood of early adoption and continued use of VPC. We used bivariate comparisons and cluster analysis to evaluate the results. The survey was sent to 1,420 patients seen between August 2022 and January 2023. Responses related to demographics, doctor-patient relations, savings, experience, and future preferences of use were aggregated. To evaluate the relationship between demographics and survey responses, we conducted univariate analysis. Results: Females and patients between 40 and 50 years of age were the primary users and indicated the most interest in continued use. Health insurance status seems not to be a significant predictor in the selection and use of VPC. Most (78%) felt that the physician-patient relationship was unimpaired. The survey showed that 90% of patients saved time by using VPC, and 66% reported saving money on tolls, childcare, or gasoline. Only 13% reported not wanting to continue VPC. Discussion: A majority of surveyed patients felt the doctor-patient relationship was not negatively affected in VPC. VPC programs can be implemented with high patient satisfaction in an integrated health system. VPC is acceptable to most patients, and further expansion of the model is warranted.

An exploratory study of community violence and HIV care engagement among Black gay and bisexual men

ABSTRACT This study examined the relationship between exposure to community violence and HIV care engagement among 107 Black gay or bisexual men living with HIV in Chicago. Measures assessed the importance of demographic covariates (age, annual income, health insurance status, and years living with HIV), community violence exposures, mental health, social support, in explaining variations in missed doses of antiretroviral therapy (ART) medication and missed HIV care appointments. Results showed that participants who reported higher rates of exposure to community violence were two times more likely to have missed ART doses and HIV care appointments. Participants who reported depression scores were two times more likely to have greater non-ART adherence. Finally, older participants were more likely to report fewer missed ART doses. More research is needed to clarify the mechanisms between age or depression and ART adherence given community violence exposure. Health care providers should screen for depression when attempting to promote better ART adherence and keeping HIV care appointments for Black gay and bisexual men living with HIV. Younger Black gay and bisexual men living with HIV may be more vulnerable than older men for missed ART doses and may require additional screening and follow-up.

Does health insurance status influence healthcare-seeking behavior in rural communities? evidence from rural Ghana

IntroductionNational health insurance programs are considered important mechanisms for ensuring equity in access to and utilization of healthcare services by removing financial barriers associated with seeking treatment in healthcare facilities. Although studies on health insurance schemes in many low-and-middle-income countries (LMICs) have demonstrated a significant relationship between health insurance status and healthcare-seeking behavior, data on the influence of this health financing policy on the decision to seek formal healthcare among rural inhabitants remains limited. Underpinned by the Andersen-Newman behavioral model of healthcare use, this study examined the influence of health insurance status on healthcare-seeking behavior among rural dwellers in Ghana. MethodsA community-based cross-sectional study was conducted among 460 rural residents in Ghana from 8th September to 5th December 2022. Chi-square tests were used to study the significance level and association between healthcare-seeking behavior and selected independent variables. A multiple logistic regression model was fitted to test the association between health insurance status and healthcare-seeking behavior, introducing other selected explanatory variables as controls. ResultsThe mean age of the respondents was 29.6 ± 6.8 years. A little above half (53.1 %) disclosed having insurance, whereas 46.1 % stated they were without coverage. Regarding healthcare-seeking behavior, the most commonly chosen treatment source was traditional healers (37.2 %), followed by the public healthcare system (28.3 %) and self-treatment (18.2 %). The private healthcare system was the least preferred, with only 16.3 % opting for it. While the bivariate analysis demonstrated a significant relationship between health insurance status and healthcare-seeking behavior (p-0.001), the logistic regression model results showed that health insurance status was not an independent predictor of healthcare-seeking behavior (p = 0.069). ConclusionIt could, therefore, not be concluded that the respondents with health insurance coverage were more likely than the uninsured to use formal healthcare providers as their most frequent source of treatment during illness. This study provides vital information for policymakers aiming at increasing access to and utilization of facility-based formal care in rural and remote settings.

The trend of dental check-up and prevalence of dental complications following the use of bone modifying agents in patients with metastatic breast and prostate cancer: analysis of data from the Korean National Health Insurance Service

BackgroundBone-modifying agents (BMA) are key components in the management of cancer patients with bone metastasis. Despite their clinical benefits, the use of BMA is associated with dental adverse events (AEs) including medication-related osteonecrosis of the jaw (MRONJ). This study investigated the frequency of dental surveillance before BMA treatment and the prevalence of dental AEs including MRONJ, after BMA treatment in patients with bone metastasis from breast and prostate cancer using data from the national health insurance system.MethodsData, including age, cancer diagnosis, administered BMA, and dental AEs during cancer treatment, of patients with bone metastasis from breast and prostate cancer who received at least one infusion of BMA between 2007 and 2019 were extracted from the Korean National Health Insurance Service (KNHIS) dataset.ResultsOf the 15,357 patients who received BMA, 1,706 patients (11.1%) underwent dental check-ups before BMA treatment. The proportion of patients receiving dental check-up increased from 4.4% in 2007 to 16.7% in 2019. Referral to dentists for a dental check-up was more active in clinics/primary hospitals than general/tertiary hospitals, and medical doctors and urologists actively consulted to dentists than general surgeons, regardless of the patient’s health insurance status. After BMA treatment, 508 patients (3.8%) developed dental AEs, including abscess (42.9%), acute periodontitis (29.7%), acute pericoronitis (14.9%), and MRONJ (12.5% of dental AEs cases, 0.5% of total BMA treated patients).ConclusionsConsidering the long treatment period in patients with metastatic cancer, coordination between dentists and oncologists is necessary to ensure appropriate dental management before the initiation of BMA.

Social and demographic determinants of health insurance status in India: Evidence from a nationally representative cross-sectional survey.

Out-of-pocket medical expenses are a crucial metric for assessing how well the healthcare system is working toward obtaining universal health coverage in any country. In India, out-of-pocket expenses for health are relatively high compared to other developed countries due to a lack of alternative finance arrangements. The disparity in out-of-pocket medical expenses largely depends upon the public health expenditure, government policies, and level of health insurance coverage. The study used a logit regression model to examine the association of the status of health insurance with socio and demographic variables using National Sample Survey 2018 data. The objective of the study is to analyze the impact of demographic variables on the status of health insurance in India. This research found that education and occupation have a significant impact on the status of health insurance, among other demographic factors. These findings underscore the importance of targeted policies and interventions aimed at improving access to health insurance among specific demographic groups. Addressing disparities in health insurance coverage based on educational and occupational factors is essential for achieving equitable healthcare access and improved health outcomes in the country. Increasing awareness of health insurance reduces out-of-pocket medical expenses and subsequently brings down economic poverty.