Higher Health Care Expenditures Research Articles

Sex-specific guideline target value attainment and prognostic value of low-density lipoprotein cholesterol in tertiary care

Abstract Background Factors contributing to guideline-target-level-attainment of low-density lipoprotein cholesterol (LDL-C) in countries with high healthcare expenditure are incompletely understood. Purpose the primary aim of this study was to test two hypotheses: 1) LDL-C control may be inferior in women versus men; 2) within the secondary prevention group, presence of a previous acute atherothrombotic event (acute myocardial infarction and stroke) may result in superior LDL-C control. Methods LDL-C levels and guideline target level attainment were determined in 4090 consecutive patients referred for myocardial perfusion single photon emission tomography (MPI-SPECT) between 2010 and 2016. Findings were validated in an independent cohort (n=1228) of consecutively enrolled patients in an outpatient cardiac rehabilitation program, between 2016 and 2023. Results About one third of patients (33%) were women, median age was 68 years, 1439 patients had a history of atherothrombosis, 759 patients a history of atherosclerosis without atherothrombosis, and 1892 were in primary prevention. LDL-C levels were higher and guideline target level attainment worse in women than in men in all three strata: age-adjusted difference in atherothrombosis 0.19 mmol/L (95%CI 0.03,0.35 mmol), guideline-target-value-attainment 39.5 % versus 49.4%, p<0.01; in atherosclerosis 0.33 mmol/L (95%CI 0.10-0.57), guideline-target-value-attainment 27.3 % versus 42.2 %, p<0.01; and in primary prevention 0.24 mmol/L (95% CI 0.13-0.38). This was confirmed in the validation cohort. LDL-C levels were higher and guideline-target-value-attainment worse in women versus men: age-adjusted difference age-adjusted difference 0.17 mmol/L (95%CI 0.02-0.33) guideline-target-value-attainment 43.8% versus 49.5%, After multivariate adjustment, female sex remained an independent predictor for higher LDL-C levels. LDL-C concentrations with atherothrombosis was 1.93 mmol/L (IQR 1.48-2.47) versus 2.07 mmol/L (IQR 1.40-2.72, p=0.003) with atherosclerosis and guideline target value attainment 47.5% vs 38.6%, p<0.001, respectively. Conclusion Concerning age-adjusted sex-inequalities with higher LDL-C levels and lower guideline-target-value-attainment in women were found in both primary and secondary prevention. Within secondary prevention, a previous atherothrombotic event was associated with lower LDL-C levels and higher guideline-target-value-attainment.

Are post-communist countries paying increased healthcare costs because of risky behaviour?

Abstract Background Based on the annual Country Health Profiles, we can see the difference in population behaviour across EU countries and the associated health risks. At first glance, the so-called post-communist countries are characterised by above-average per-capita harmful consumption of sin goods, alcohol and tobacco. Is this harmful consumption associated with increased healthcare costs? Methods The idea of the study is based on balanced panel-data published in Country Health Profiles. The member countries were divided into groups based on their health risk scores - high risk (above average), and low risk (below average). The group of countries with high risk is mostly composed of post-communist countries. The detailed per-capita annual data for the period 2013-2021 was collected, such as GDP, consumption of sin goods, alcohol, and tobacco. The analysis is based on fixed-effects linear regression models, following recent recommendations on suppressing the excessive role of statistical-inference tools. Results We built various models for different groups of countries, and in this abstract, we present results for the group of post-communist countries - a simple model of harmful consumption (sin goods, GDP) and a more complex model (alcohol, tobacco, GDP). The results show that in the case of the post-communist countries group, for a fixed level of GDP per capita, higher consumption of sin goods by EUR 1 per capita corresponds with total healthcare expenditures higher by EUR 0.244 per capita. For a fixed level of GDP per capita and tobacco consumption per capita, higher consumption of alcohol by EUR 1 per capita corresponds with total healthcare expenditures higher by EUR 1.367 per capita. Conclusions Harmful consumption has a multiplier effect in the health sector; besides direct impact, it influences an increase in healthcare expenditures. More emphasis should be placed on prevention and awareness of consumers to reduce harmful consumption. Key messages • For fixed GDP per capita, higher harmful consumption corresponds with higher healthcare costs in post-communist countries. • For fixed GDP per capita and tobacco consumption per capita, a €1 higher alcohol consumption corresponds with more than €1 higher healthcare expenditure in the post-communist countries.

Empowering health literacy: Turkiye’s Health Literacy Action Plan 2022-2026

Abstract Issue/Problem The ‘Health Literacy Action Plan 2022-2026’ of the Turkish Ministry of Health addresses the critical public health issue of limited health literacy, leading to increased hospital admissions, inappropriate emergency department use, and poor health outcomes. This underscores a significant challenge in individual health self-management and higher healthcare expenditure within the country. Description of the Problem The Health Literacy Action Plan aims to tackle disparities in health literacy levels among people. It employs customized teaching schemes, digital communication, and inclusive healthcare practices to reach every demographic group. The plan seeks to enhance health knowledge and empowerment among Turkish people by increasing access to medical information, simplifying clinician instructions, and promoting closer communication between patients and healthcare professionals. Results Comparative evaluation of nationwide surveys conducted in 2017 and 2023 with 15,000 participants shows remarkable improvements. Despite delays due to the pandemic, the action plan led to a notable increase in adequate health literacy levels from 31.9% in 2017 to 46.1% in 2023. Additionally, significant improvements were observed in ailment prevention and health promotion, with health literacy levels in disease prevention increasing from 28.4% to 45.7%. Lessons The Health Literacy Action Plan plays a crucial role in developing and implementing multifaceted public health strategies based on data and stakeholder participation. These interventions, requiring continuous monitoring and adjustment, are essential steps toward achieving high-level health literacy. Key messages • Strategic health literacy interventions are essential for improving health outcomes and optimizing the use of public resources. • Evidence-based interventions and ongoing evaluation are key to promoting health literacy.

Healthcare expenditures among older immigrants in the US with Alzheimer's disease and related dementias: Population-based study between 2007 and 2020.

Using nationally representative datasets, this study examined differences in healthcare expenditures between US-born and foreign-born individuals aged 65 and above by the presence of Alzheimer's disease and related dementias (ADRD) and cognitive limitations (CL). This study further examined whether healthcare expenditures among foreign-born individuals vary by their duration of residence in the US. The study used the 2007-2020 Medical Expenditure Panel Survey (MEPS) and employed generalized linear regression models to estimate differences in healthcare expenditures between US-born and foreign-born older adults with ADRD, CL, and without ADRD or CL. Survey weights were applied to all estimates. Our study identified significant differences in healthcare expenditures among older adults by the presence of ADRD/CL and immigrant status. Having ADRD/CL had a more pronounced impact on high healthcare expenditures among foreign-born older adults than US-born adults with ADRD/CL, thereby diminishing the difference in healthcare expenditures by US nativity status for the older adults with ADRD or CL. In the analysis further distinguishing immigrants by their duration of residence, lower healthcare expenditures were primarily observed among foreign-born individuals with ADRD or CL who had lived in the US for less than ten years. Our results suggest potential shifts in costs resulting from delayed access to, and diagnosis or treatment of ADRD at a younger age, leading to increased healthcare needs and expenses among US foreign-born older adults.

Real-world treatment patterns, health care resource utilization, and costs in a US Medicare population with bronchiectasis.

Bronchiectasis carries a significant economic burden with high health care expenditures associated with frequent hospitalizations, physician visits, and treatments, including oral and intravenous antibiotics for repeated lung infections, airway-clearance therapy, and oxygen administration. Bronchiectasis exacerbations can contribute to this burden. To estimate US health care resource utilization (HCRU) and costs associated with bronchiectasis and with bronchiectasis exacerbations. This retrospective study used the 100% Medicare Fee-for-Service database (January 2014 to December 2020) to compare HCRU and costs among patients with bronchiectasis with those of patients without bronchiectasis (controls). For patients with bronchiectasis, the index date was a randomly selected bronchiectasis claim after more than 1 year of disease history and, for controls, a claim closest to their matched bronchiectasis patient's index date. All patients had continuous enrollment for at least 12 months pre-index (baseline) and at least 12 months post-index. Primary outcomes were all-cause, respiratory-related, and bronchiectasis-related HCRU and health care costs, which were presented by the overall sample and by segmented patient cohorts based on the number of exacerbations during baseline (0, 1, or ≥2). 92,529 patients with bronchiectasis (mean [SD] age, 76.7 [8.8] years; 72.3% female) and 92,529 matched controls qualified for the study. Compared with controls, patients with bronchiectasis presented greater mean (SD) all-cause physician visits (15.4 [10.0] vs 13.2 [9.7]; P < 0.001) and respiratory-related physician visits (5.2 [4.3] vs 1.9 [3.1]), pulmonologist visits (1.9 [2.2] vs 0.3 [1.0]), hospitalizations (0.4 [0.9] vs 0.3 [0.8]), emergency department visits (0.33 [1.0] vs 0.26 [1.0]), and total health care costs ($10,224 [$23,263] vs $6,704 [$19,593]). Respiratory-related HCRU was also greater in patients with more baseline exacerbations, with total health care costs of $8,506, $10,365, and $14,790 for patients with 0, 1, and at least 2 exacerbations, respectively (P < 0.01). This real-world study demonstrates the high disease burden associated with bronchiectasis and with exacerbations, highlighting the need to improve management and reduce exacerbations.

Epidemiological characteristics and outcomes of special-cause burns: analysis of 33,619 burn patients in a major regional burn center in China from 2004 to 2021

Special-cause burn injuries are usually more severe and difficult to manage, and often contribute to a high mortality in severely injured patients. The aim of this study was to present the epidemiological characteristics of special-cause burn in a major regional burn center in China between 2004 and 2021 and determine the risk factors associated with the mortality of burn patients. A total of 33,619 burn patients were included the study, among which 4,452 (13.2%) were special-cause burn patients. Compared to the thermal burn group, the special-cause burn patients were usually male, elder, married and III-IV degree of burn with onset of upper extremity in summer and autumn. Moreover, a greater proportion of patients in the special-cause burn group underwent surgical treatment and amputation and had a higher median hospital stay and treatment costs. During the multivariate logistic regression, older age, male, unmarried, winter, III-IV degree of burn, ≥ 3 burn sites, and larger total body surface area (TBSA) of burn were significantly associated with higher burn mortality (all P < 0.05), however, patients with special-cause burn injuries have not increased odds for mortality (P > 0.05). These results suggested that special cause-burn patients suffer more severe injuries, resulting in longer hospital stays and higher health care expenditures, but it did not significantly increase the mortality risk. Therefore, burn clinicians should not only have the responsibility to cure burns, but also need to know and popularize burn epidemiological characteristic and precaution.

Post-COVID-19 Pandemic Effect on University Students’ Fitness Level

Background and Study Purpose: Through the present paper, we aimed to determine to what extent physical capacity was affected by the restrictions during the pandemic. This confirmatory study hypothesises that university students’ fitness level and effort capacity decreased after the pandemic compared to the results obtained before sanitary restrictions. Material and Methods: Fifty female students at the economic faculties, part of two groups of 25 each, in the age range between 19 and 21, passed six physical tests. The applied physical tests targeted strength (sit-ups and squads in 30 s), power (standing long jump), flexibility (sit and reach), coordination (Matorin test), and cardio-respiratory fitness level (Ruffier test). Results: All test results, except one, demonstrate a statistically significant difference, confirming the hypothesis that the two samples differ in strength, power, flexibility, coordination, and cardio-respiratory fitness. By calculating Cohen d effect size, the standardized mean difference of the pandemic effect demonstrates how substantially different are the two samples. Conclusions: This study compares objective results of standardised fitness tests in two successive samples of young women that can contribute to a better understanding of the long-term impact of the pandemic breakdown on the fitness level. The physical abilities decrease between 10 and 28 per cent, with the most worrying level recorded at flexibility and abdominal strength tests. Remedial measures are needed to reverse the physical potential decrease of young adults after the sanitary crisis. A diminished physical potential of the future educated workforce would have lasting effects on their physical and mental health with higher healthcare expenditure and economic consequences due to a resilience and productivity decrease.

Economic and Humanistic Burden of Rheumatoid Arthritis: Results From the US National Survey Data 2018-2020.

Our objective was to estimate the economic and humanistic burden among US adults with rheumatoid arthritis (RA). This study analyzed results from the Medical Expenditure Panel Survey from 2018 to 2020. Adults (aged ≥18 years) self-reporting with RA or with the presence of the International Classification of Disease, 10th Revision clinical modification codes were identified. Healthcare expenditures (inpatient care, outpatient care, emergency department, office visits, prescription medications, home health, and others) were measured. The Short Form 12 Health Survey physical component summary (PCS), mental component summary (MCS), activities of daily living (ADL), and instrumental ADL (IADL) were measured. Two-part models assessed the incremental increase in the health care expenditures for the RA group compared to the non-RA group. In addition, the multivariable linear regression was used to evaluate the marginal difference in PCS and MCS between those with RA and those without RA, whereas the multivariable logistic regression models were used to evaluate the association between ADL and IADL by RA status. Annually, 4.27 million adults with RA were identified. The two-part model showed significantly higher total annual healthcare expenditures in the RA group than non-RA group (mean $3,382.971 [95% confidence interval (CI) $1,816.50-$4,949.44]). Compared to the non-RA group, the RA group was associated with lower PCS scores (mean4.78 [95% CI 3.47-6.09]) and similarly lower MCS scores (mean -0.84 [95% CI -2.18 to 0.50]), as well as increased odds of requesting ADL (adjusted odds ratio [aOR] 2.02 [95% CI 1.59-2.56]) and IADL assistance (aOR 2.11 [95% CI 1.57-2.84]). RA was associated with higher health care expenditures, particularly prescription medication costs, and was associated with suboptimal quality of life.

Cross‐sectional analysis of pharmaceutical industry payments to board‐certified breast cancer specialists in Japan

AbstractFinancial interactions between pharmaceutical companies and physicians introduce conflicts of interest among physicians, and can unduly influence physicians' clinical decision‐making, such as increased use of non‐recommended cancer treatments and higher healthcare expenditures. Breast cancer is the most common cancer for which there is a growing number of novel treatments. Nevertheless, the financial relationships between pharmaceutical companies and physicians treating patients with breast cancer remain unknown. Using payment data disclosed by major pharmaceutical companies in Japan between 2016 and 2020, this study examined size and trends in non‐research payments from the pharmaceutical companies to breast cancer specialists who were board‐certified by the Japanese Breast Cancer Society. A total of $17.2 million were made to 1349 or 77.8% of all board‐certified breast cancer specialists over the five years. Of all specialists, 41.9% to 55.5% received the payments each year. The median payments per specialist were $1,149–$1,371 annually. Only 5op 1% and 10% of all specialists received 24.7% and 70.3% of all payments to the specialists. The payments per specialist significantly increased by 9.9% (95% confidence interval: 6.713.1, p &lt; 0.001) from 2016 to 2019, but decreased by 29.6% (95% CI: −34.4 to −24.5, p &lt; 0.001) in 2020 when the COVID‐19 pandemic occurred. Given that even a small payment to physicians is associated with their clinical practice, it is imperative that these breast cancer specialists are more aware of the potential influence of payments on their decision‐making.

The Burden of Inpatient Hospitalizations with Cardiac and Cerebrovascular Diseases in Patients with Type 1 Diabetes: Insights from the National Inpatient Sample in the US.

This study aimed to evaluate the burden and impact of cardiac and cerebrovascular disease (CCD) on hospital inpatients with type 1 diabetes mellitus (T1DM). This is a retrospective nationwide cohort study of people with T1DM with or without CCD in the US National Inpatient Sample between 2016 and 2019. The in-hospital mortality rates, length of stay (LoS), and healthcare costs were determined. A total of 59,860 T1DM patients had a primary diagnosis of CCD and 1,382,934 did not. The median LoS was longer for patients with CCD compared to no CCD (4.6 vs. 3 days). Patients with T1DM and CCD had greater in-hospital mortality compared to those without CCD (4.1% vs. 1.1%, p < 0.001). The estimated total care cost for all patients with T1DM with CCD was approximately USD 326 million. The adjusted odds of mortality compared to patients with non-CCD admission was greatest for intracranial hemorrhage (OR 17.37, 95%CI 12.68-23.79), pulmonary embolism (OR 4.39, 95%CI 2.70-7.13), endocarditis (OR 3.46, 95%CI 1.22-9.84), acute myocardial infarction (OR 2.31, 95%CI 1.92-2.77), and stroke (OR 1.47, 95%CI 1.04-2.09). The burden of CCD in patients with T1DM is substantial and significantly associated with increased hospital mortality and high healthcare expenditures.

Healthcare spending for non-fatal falls among older adults, USA

BackgroundThe older adult (65+) population in the USA is increasing and with it the number of medically treated falls. In 2015, healthcare spending attributable to older adult falls was approximately...

Money matters: The association between blood donation rates and healthcare system quality across 171 countries.

Worldwide, insufficient blood donations cause blood shortages that jeopardize vital medical treatments for patients. Blood donation rates vary widely across countries, yet the determinants of this variation remain poorly understood. This study aims to illuminate the role of the institutional context in which blood donation is embedded by examining the link between country-level blood donation rates and healthcare system quality. The study employed a cross-sectional design using data on blood donation rates from 171 countries from the 2021 WHO Global Status Report on Blood Safety and Availability and three healthcare quality indicators (i.e., Healthcare Access and Quality [HAQ] Index, life expectancy, and health expenditures). The pre-registered hypotheses are tested using multiple linear regression. Robustness checks control for confounding factors. HAQ Index and health expenditures are positively associated with blood donation rates, whereas life expectancy is not related to blood donation when controlling for confounds. Health expenditures display the most robust association with blood donations, even when controlling for confounding factors, and when comparing countries within the same continent. Higher healthcare system quality in terms of HAQ Index and higher healthcare expenditures are related to higher blood donation rates. The finding that healthcare expenditures are most consistently related to blood donation rates indicates that policymakers should consider prioritizing financial support for the healthcare system, including blood-collecting institutions. More broadly, a better understanding of the role of contextual factors for blood donation may be needed to increase blood availability worldwide.

Effective health systems facing pandemic crisis: lessons from COVID-19 in Europe for next emergencies

PurposeThe investigation goal is the analysis of the relation between healthcare expenditures and other resources, and COVID-19 fatality rates among European countries to design effective health policies for crisis management.Design/methodology/approachResearch methodology is based on descriptive statistics and various parametric methods, also including a linear model of regression to analyze basic relationships of variables under study.FindingsResults show that a lower COVID-19 fatality rate is associated with higher levels of health expenditure (% GDP), of healthcare expenditure per capita, health expenditure in preventive care (% GDP), hospitals per million inhabitants, physicians, nurses, hospital beds and curative acute care beds per 1,000 inhabitants. Regression analysis shows that a 1% increase in healthcare expenditures per capita of countries, it reduces the level of COVID-19 fatality rate by 0.74%. In fact, many countries in Eastern Europe with low healthcare expenditures per capita in 2019 (e.g., Bulgaria, Romania, Hungary, Poland, Latvia, Slovakia, Lithuania, etc.), they have experienced high COVID-19 fatality rates. Instead, a lot of countries in Western Europe, with high healthcare expenditures per capita, such as Germany, Denmark, Austria, and the Netherlands, they had resilient health systems to face pandemic crisis and lower COVID-19 fatality rates.Practical implicationsThese findings suggest strategies of systematic and continuous investments in healthcare, medical technologies, and ICT infrastructures to support effective health policy of crisis management in countries to face future pandemic crisis and other emergencies in society.Originality/valueThe explanation of critical role of high health expenditure (% GDP) and healthcare expenditure per capita to support robust health systems that bolster the resilience in nations to face health emergencies and worldwide crises.

Abstract P381: Geographic Variation in Financial Strain and Food Insecurity After the COVID-19 Pandemic: Implications for Cardiovascular Health Equity

Reduced food security is associated with higher healthcare expenditures and increased risk of coronary heart disease, angina, heart attacks, and hypertension. State-level responses to the COVID-19 pandemic and support policies may contribute to regional differences in financial strain and food insecurity, which could have implications for cardiovascular outcomes. Hypothesis: We assessed the hypothesis that there is geographic variation in financial strain and food insecurity in the United States three years after the start of the pandemic. Methods: This study utilizes weighted data from the U. S. Census Bureau’s Household Pulse Survey Phase 3.10 conducted from August 23 - September 4, 2023. We organized data responses according to the Department of Health and Human Services regions - Boston, New York, Philadelphia, Atlanta, Chicago, Dallas, Kansas City, Denver, San Francisco, and Seattle. Food insecurity was measured using a single survey item about having sufficient food to eat in the last 7 days. Financial strain was defined as difficulty paying expenses in the last seven days. Results: There were 254,966,752 adults in the total sample population, (59%) reported difficulty with expenses due to the COVID-19 pandemic. The Atlanta region reported the most financial strain (13%), while the Denver region reported the least (2%), p-value=0.000. The rate of food insecurity was highest in the Atlanta region at 8% compared with 5% or less in other regions, p-value=0.000. Among the 8 states in the Atlanta region, Black individuals were disproportionately more likely to be food insecure, with the greatest difference for Kentucky, Florida, Tennessee, and South Carolina. All states in the Atlanta region had similar odds of food insecurity, but Mississippi residents were nearly twice as likely to experience food insecurity than residents of other states (OR 1.87, p =0.016). Conclusions: The Atlanta region (i.e., the “Deep South”) consists of the most populous states for non-Hispanic Black people and is experiencing the worst food insecurity and financial strain post-pandemic. The economic toll of the pandemic and post-pandemic inflation may contribute to worsening food insecurity and cardiovascular outcomes in a region that is already burdened by poor cardiovascular health. Multilevel intervention is needed to support full pandemic recovery and avoid exacerbating inequities in cardiovascular disease.

Clinical aspects of reimbursement policies for orphan drugs in Central and Eastern European countries.

Objectives: The aim of this study was to characterize the reimbursement policy for orphan drugs (ODs) in Central and Eastern European (CEE) countries in relation to the availability and impact of clinical evidence, health technology assessment (HTA) procedure, selected economic indicators, and the drug type according to indications. Materials and methods: A list of authorized medicines with orphan designation and information about active substance, Anatomical Therapeutic Chemical (ATC) classification, and therapeutic area was extracted from the web-based register of the European Medicines Agency (EMA). A country-based questionnaire survey was performed between September 2021 and January 2022 in a group of selected experts from nine CEE countries (an invitation was sent to 11 countries). A descriptive and statistical analysis was conducted to determine statistical significance, correlations, between the drug or country characteristic and the positive recommendation or reimbursement of ODs. Results: The proportion of reimbursed orphan drugs differed between countries, ranging from 17.7% in Estonia to 49.6% in Hungary (p < 0.001). The odds that ODs were reimbursed were reduced in countries with a "strong" level of impact of drug safety and efficacy on reimbursement decisions (p=0.018), the presence of other additional specific clinical aspects (e.g., genomic data) considered in the reimbursement decision (p < 0.001) and mandatory (without exception) safety assessments (p=0.004). The probability that ODs were reimbursed was increased in countries with a "moderate" level of impact of drug safety and efficacy on reimbursement decisions (p=0.018), when reimbursement decisions are dependent on the EMA registration status and orphan drug designation (p < 0.001), the presence of the "positive HTA recommendation guarantees reimbursement" policy (p < 0.001), higher GDP per inhabitant (p=0.003), and higher healthcare expenditure (p < 0.001). Conclusion: We found that there are differences among CEE countries in the reimbursement of orphan drugs, and we identified aspects that may influence these differences. Safety, efficacy, and specific clinical aspect issues significantly influenced reimbursement decisions. Antineoplastic and immunomodulating agents drugs were the largest group of ODs and increased the chance of getting a positive recommendation. The higher GDP per inhabitant and healthcare expenditures per inhabitant were positively linked to the chance that an OD receives reimbursement.

Surgical outcomes and healthcare expenditures among patients with dementia undergoing major surgery.

We sought to define surgical outcomes among elderly patients with Alzheimer's disease and related dementias (ADRD) following major thoracic and gastrointestinal surgery. A retrospective cohort study was used to identify patients who underwent coronary artery bypass grafting (CABG), abdominal aortic aneurysm (AAA) repair, pneumonectomy, pancreatectomy, and colectomy. Individuals were identified from the Medicare Standard Analytic Files and multivariable regression was utilized to assess the association of ADRD with textbook outcome (TO), expenditures, and discharge disposition. Among 1,175,010 Medicare beneficiaries, 19,406 (1.7%) patients had a preoperative diagnosis of ADRD (CABG: n=1,643, 8.5%; AAA repair: n=5,926, 30.5%; pneumonectomy: n=590, 3.0%; pancreatectomy: n=181, 0.9%; and colectomy: n=11,066, 57.0%). After propensity score matching, patients with ADRD were less likely to achieve a TO (ADRD: 31.2% vs. no ADRD: 40.1%) or be discharged to home (ADRD: 26.7% vs. no ADRD: 46.2%) versus patients who did not have ADRD (both p<0.001). Median index surgery expenditures were higher among patients with ADRD (ADRD: $28,815 [IQR $14,333-$39,273] vs. no ADRD: $27,101 [IQR $13,433-$38,578]; p<0.001) (p<0.001). On multivariable analysis, patients with ADRD had higher odds of postoperative complications (OR 1.32, 95% CI 1.25-1.40), extended length-of-stay (OR 1.26, 95% CI 1.21-1.32), 90-day readmission (OR 1.37, 95% CI 1.31-1.43), and 90-day mortality (OR 1.76, 95% CI 1.66-1.86) (all p<0.001). Preoperative diagnosis of ADRD was an independent risk factor for poor postoperative outcomes, discharge to non-home settings, as well as higher healthcare expenditures. These data should serve to inform discussions and decision-making about surgery among the growing number of older patients with cognitive deficits.

Overview of Community Knowledge about The Use of Antibotic in Blungkan Hamlet, Sendangrejo Village, Lamongan Sub-district, Lamongan District

Antibiotics are medications that combat bacterial illnesses. There are several negative health outcomes associated with the current epidemic of antibiotic resistance, including higher rates of illness and death, higher healthcare expenditures, and treatment failures. In 2015, there were an increase of 50 million unnecessary antibiotic prescriptions (Unnescecery prescribing) from 150 million, and this number continues to increase every year. Thus, the number of bacteria that are resistant to antibiotics is increasing. This study aims to determine the extent of public awareness on the utilization of antibiotics in Dusun Blungkan, Sendangrejo village, Lamongan district. The design of this research is descriptive research and data collection using questionnaires with Cronbach's alpha value of 0.83 (&gt;0.60) then the questionnaire is declared reliable that covers 7 domains of knowledge namely understanding antibiotics, antibiotic examples, antibiotics use, dosage, contraindications, side effects, and antibiotic resistance. The results showed that in Dusun Blungkan, Sendangrejo Village, Lamongan District, and Lamongan Province there are 21 (70%) people who are aware of the use of antibiotics. Out of 30 respondents, 21 people (70%) have sufficient knowledge, 7 people (23.3%) have less knowledge, and 2 people (6.7%) have good knowledge. Controlled use of antibiotics can prevent resistance. Therefore, accurate information about the importance of antibiotics and how to use antibiotics properly and correctly is needed, as well as more wisdom in using them to avoid unexpected side effects.

Obstetric Medicine: the protocol for a prospective three-dimensional cohort study to assess maternity care for women with pre-existing conditions (ForMaT).

Pregnancies in women with pre-existing medical conditions are on the rise. These pregnancies are characterized by an increased rate of maternal and perinatal complications, which can result in higher health care expenditures and altered pregnancy experiences. The purpose of this study is to integrally analyze maternity care for women with pre-existing conditions in the framework of a risk-adapted, interdisciplinary care by recording three substantial parts of maternity care: (1) maternal and perinatal outcome; (2) hospital costs and reimbursements covering the period from preconception counseling or initial antenatal visit to discharge after birth; and (3) women's experience of reproductive choice and becoming a mother in the presence of a pre-existing condition. In this observational, prospective, longitudinal, and monocentric cohort study, we aim to include a total of 1,500 women over a recruitment period of 15 months. Women registering for care at the Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Germany, are allocated to three groups based on their health and risk status: women with pre-existing conditions, as well as healthy women with obstetric risk factor and healthy women with a low-risk pregnancy. Participants are observed from time of initial consultation until discharge after birth. Analysis focuses on (1) maternal and perinatal outcome, especially rate of severe maternal and neonatal morbidity; (2) costs and reimbursements; and (3) surveys to capture of women's experience and health-related quality of life during the time of reproductive choice, pregnancy, and childbirth in the presence of pre-existing medical conditions. With its complex three-dimensional design, the ForMaT-Trial is aiming to provide a comprehensive analysis of pregnancy and childbirth in women with pre-existing conditions. The results may serve as a basis for counseling and care of these women. By analyzing costs of specialized care, data for discussing reimbursement are generated. Lastly, our results may increase awareness for the perception of reproductive choice, pregnancy and motherhood in this continuously rising population.Clinical trial registration: German Clinical Trials Register, DRKS00030061, October 28, 2022.

The association between dual sensory loss and healthcare expenditure: Mediating effect of depression

BackgroundPrevious studies have suggested the dual sensory loss (DSL) is linked to depression, and that they are associated with higher healthcare expenditures, respectively. However, the association between DSL, depression and healthcare expenditures remains ambiguous. ObjectivesThe current study aims to examine the association between DSL, depression and healthcare expenditures as well as catastrophic health expenditures (CHE) among Chinese people aged 45 and above. MethodsWe first utilized the China Health and Retirement Longitudinal Survey (CHARLS) 2018 to obtain data from a total of 13,412 Chinese individuals aged 45 and above to conduct a cross-sectional study. DSL was defined as a combined variable of self-reported vision loss and hearing loss. Depression was measured using The Center for Epidemiologic Studies Depression Scale (CESD-10). The healthcare expenditures, including outpatient out-of-pocket cost and inpatient out-of-pocket cost, were obtained from the Harmonized CHARLS section. CHE were defined as out-of-pocket (OOP) health spending equal to or higher than 40 % of a household's capacity to pay. A Tobit linear regression with three models and a path analysis were conducted to estimate the association between DSL, depression and healthcare expenditures and CHE. Then we utilized 2011CHARLS and 2018CHARLS to present a longitudinal analysis. A path analysis was conducted to estimate the association between 2011DSL, 2018depression and 2018healthcare expenditures and CHE. ResultsDepression has a significant mediating effect between DSL and healthcare expenditures. (For outpatient OOP cost: a = 0.453, b = 23.559, c = 25.257, the proportion of mediating effect in total effect = 29.71 %; for inpatient OOP cost: a = 0.453, b = 13.606, c = 15.463, the proportion of mediating effect in total effect = 28.50 %; all P < 0.05). The mediating effect of depression also exists in the association between DSL and CHE (a = 0.453, b = 0.018, c = 0.043, the proportion of mediating effect in total effect = 15.90 %; P < 0.05). The mediation effect of depression on healthcare expenditures and CHE also exists in the longitudinal analysis using CHARLS 2011 and CHARLS 2018 (all P < 0.05). LimitationsThe DSL status were based on self-report and we used 2018CHARLS to conduct the study, which may cause some bias. ConclusionSignificant mediating effect of depression exists between DSL and higher healthcare expenditures and CHE. The mental health of elder people with DSL should be focused on, and we should have an overall viewpoint on the topic of healthcare expenditures and CHE.

Determinants of out-of-Pocket Healthcare Expenditure by Households in Sierra Leone

The study sought to identify the determinants that influence Sierra Leonean households’ out-of-pocket healthcare expenditure. The research explicitly examined the demographic and socioeconomic determinants that impact out-of-pocket healthcare expenditure by households in Sierra Leone. The study was based on the positivism philosophy and used secondary data from the 2018 Siera Leone Household Integrated Survey to address the study objectives. Logistic regression analysis was conducted to see whether there were any relationships between the dependent and independent variables. The analysis revealed that Sierra Leone’s out-of-pocket healthcare expenditure is influenced by several demographic and socio-economic determinants which should be monitored by the policymakers. Sierra Leone households’ out-of-pocket healthcare expenditure is influenced by the household size (p &lt; 0.001), place of residence (p=0.03), employment status of the head of household (p=0.008), health provider consultation (p &lt;0.001) and wealth quintile (p&lt;0.001). The government should continue to identify and address the main causes of high OOP healthcare expenditure. A concerted effort is necessary to reduce high out-of-pocket health expenditures by improving prepaid health payment arrangements. The study provides information that governments may use to establish policies that reduce the financial burden that families endure when seeking medical care. To address structural determinants of access to healthcare, such as availability, distribution, accessibility, and quality, regardless of an individual’s location or socioeconomic status, the government could implement policies and activities aimed at increasing the availability, accessibility, and quality of healthcare services without the households suffering financial burden. The study encountered limitations inherent in the use of secondary data; however, these constraints do not undermine the validity of the findings. Such estimations remain crucial in advancing research on healthcare financing, providing valuable insights despite the methodological challenges associated with secondary data sources.