Access To Insurance Research Articles

Epidemiology, treatment and outcomes of gastroenteropancreatic neuroendocrine neoplasms

To investigate incidence, treatment patterns and outcomes of gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN) in the United States. The 2019 National Cancer Database was searched for adult GEP-NEN patients. Main outcomes included overall and site-specific incidence, treatment patterns, and overall survival (OS). Overall survival was evaluated using averaged Cox regression. 86,324 GEP-NEN patients were included (6.33% of all GEP malignancies). From 2004 to 2016, annual GEP-NEN cases increased (n = 4,010 to n = 9,379), largely driven by low-stage, low-grade disease. Most patients received surgery, either alone (72.9%) or in combination with systemic therapy (4.9%). Longest overall survival (OS) was evident in patients with low stage and low grade GEP-NEN of the small intestine and rectum (p < 0.001). Patients undergoing surgical resection demonstrated longest OS. The addition of systemic therapy was most effective in high stage G3 NEN. Having higher income (≥$63,333) and private insurance or Medicare, but not Medicaid, was associated with improved survival. GEP-NEN incidence increases, likely due to improved detection and diagnosis. Treatment patterns have evolved to follow the latest international guidelines and site-specific improvement in survival is noted. In addition to disease specific factors, insurance access and socioeconomic factors emerged as potential targets for improving outcomes.

Insurtech\'s Role in Enhancing Healthcare Insurance Accessibility and Efficiency in India

Abstract: Insurance Technology (Insurtech) is transforming healthcare this paper explores how innovative technologies such as digital on boarding, automated claims processing, wearable health trackers, and predictive analytics are reshaping the industry. These advancements have not only streamlined processes but also brought insurance services to underserved areas, offering personalized solutions that significantly enhance customer satisfaction. Technologies like telemedicine, block chain for secure transactions, and AI-driven risk analysis are playing a transformative role in improving transparency, speeding up claims processing, and delivering tailored insurance products. These developments are creating a more inclusive and efficient insurance system. However, challenges such as data privacy concerns, regulatory hurdles, and low levels of digital literacy remain obstacles to fully realizing the sector's potential. This study also highlights trends in InsurTech funding in India, the increasing demand for health-focused insurance products, and the role of technology in improving policyholder engagement. InsurTech is poised to redefine healthcare insurance in India, driving operational excellence, expanding coverage, and enhancing service quality. The study offers insights into Insurtech and how to reshape healthcare insurance in India.

Insurability and government-funded mitigation: safer but costlier

AbstractHurricanes significantly harm homeowners through physical damage and long-term financial strain due to rising insurance costs, property value loss, and repair expenses. This paper focuses on the interrelated decisions of the government mitigation funding of residential acquisitions and retrofit subsidies and of price restrictions on the insurance market in eastern North Carolina to determine the financial effects on stakeholders. The introduction of these policy interventions have impacts that propagate through the system due to risk adjustments, homeowner take-up behaviour, and insurer profit-maximising behaviour. This study uses an integrated game theoretic model to demonstrate that there are cost-effective government spending levels that reduce residential loss from hurricane damage. When insurance prices are capped at preintervention levels, the number of households and their distribution of losses, which has been altered through mitigation, leads to increased insurer insolvency. When insurance prices are allowed to adjust after mitigation, some homeowners find insurance is no longer affordable. This highlights the tradeoff between ensuring insurer stability and expanding homeowner insurance accessibility.

Facilitators of medication adherence in patients with hypertension: a qualitative study.

Hypertension has been identified as the most important risk factor for disability and premature death worldwide. This study aimed to explain the factors that facilitate medication adherence from the perspective of patients with hypertension in southeastern Iran. This qualitative study used conventional content analysis and purposive sampling methods to achieve data saturation, involving 25 participants. Facilitating factors were categorized into two main categories: individual and family factors and organizational support. Individual factors included motivational fears, disease acceptance, healthy lifestyle, disease monitoring, and follow-up. Family factors included family support, while organizational support included governmental support to provide inexpensive medicines, comprehensive healthcare team support, health insurance access, and media training. These factors were identified as essential facilitators that significantly influence appropriate adherence to hypertensive drugs. This study revealed that various factors affected medication adherence in these patients, and efforts should be made to improve hypertension treatment and increase medication adherence. Measures taken to control hypertension are cost-effective to reduce the burden associated with this disease. The findings of this study can be valuable in formulating policies for the treatment and care of hypertension.

Association Between Social Determinants of Health and Patient Portal Utilization in the United States

(1) Background: Differences in health outcomes across populations are due to disparities in access to the social determinants of health (SDoH), such as educational level, household income, and internet access. With several positive outcomes reported with patient portal use, examining the associated social determinants of health is imperative. Objective: This study analyzed the association between social determinants of health—education, health insurance, household income, rurality, and internet access—and patient portal use among adults in the United States before and after the COVID-19 pandemic. (2) Methods: The research used a quantitative, retrospective study design and secondary data from the combined cycles 1 to 4 of the Health Information National Trends Survey 5 (N = 14,103) and 6 (N = 5958). Descriptive statistics and logistic regression were conducted to examine the association between the variables operationalizing SDoH and the use of patient portals. (3) Results: Forty-percent (40%) of respondents reported using a patient portal before the pandemic, and this increased to 61% in 2022. The multivariable logistic regression showed higher odds of patient portal utilization by women compared to men (AOR = 1.56; CI, 1.32–1.83), those with at least a college degree compared to less than high school education (AOR = 2.23; CI, 1.29–3.83), and annual family income of USD 75,000 and above compared to those &lt;USD 20,000 (AOR = 1.59; CI, 1.18–2.15). Those with access to the internet and health insurance also had significantly higher odds of using their patient portals. However, those who identified as Hispanic and non-Hispanic Black and residing in a rural area rather than urban (AOR = 0.72; CI, 0.54–0.95) had significantly lower odds of using their patient portals even after the pandemic. (4) Conclusions: The social determinants of health included in this study showed significant influence on patient portal utilization, which has implications for policymakers and public health stakeholders tasked with promoting patient portal utilization and its benefits.

Abstract 4134272: Association of depression symptoms with cardiovascular health stratified by military status: Insights from 2013-2020 National Health and Nutrition Examination Survey

Introduction: Emerging evidence supports the mind-heart-body connection, yet less attention has been given to examining the relationship in specific populations. Veterans have a higher risk for mental and cardiovascular problems and have unique social determinants of health (SDoH), such as healthcare access, than civilians. This study aims to examine how depression and SDoH are associated with cardiovascular health (CVH) and if associations differ by military status. Hypotheses: 1) Depression symptoms and SDoH will be associated with CVH. 2) The associations will differ between people who served in the US military and those who did not. Methods: A cross-sectional analysis was conducted using data from the 2013 to 2020 National Health and Nutrition Examination Survey. Individuals were aged ≥ 20 years without cardiovascular disease and current pregnancy. Patient Health Questionnaire-9 was used to assess depression symptoms and dichotomized into no symptoms (&lt;5) and mild-to-severe symptoms (≥5). The Life's Essential 8 quantified CVH, with scores from 0-100. SDoH included age, gender, race/ethnicity, marital status, education, employment, financial status, health insurance, and healthcare access. Sample weights were applied in multiple linear regression analyses. Results: Among 6498 participants, 92% were civilians (mean age: 45 years; 51% female), and 8% were veterans (mean age: 56 years; 10% female). In both groups, 23% had depression symptoms. The mean CVH was 72 in civilians and 69 in veterans. In adjusted models, individuals with depression symptoms had 4 points lower CVH scores than those without (95% CI: -5.11, -2.84). This trend was similar in civilians but insignificant in veterans. Lower CVH was significantly associated with age, being non-Hispanic Black and other races people, lower education, and lower financial status. The associations were preserved after being stratified by military status. Conclusions: Depression symptoms and SDoH were associated with lower CVH. However, there was no significant evidence that military status moderated the associations of depression and SDoH with CVH. Examining the intersection between depressive symptoms and SDoH may be useful when assessing CVH.

Availability Of Adult Dental Plans In The Affordable Care Act Marketplaces, 2016-23.

The Affordable Care Act Marketplaces may improve access to dental insurance, but little is known about the availability of such coverage. We used data from state and federal Marketplace sources to describe the availability of adult dental plans, including Stand-alone Dental Plans and those embedded in medical plans. We also examined the characteristics of counties with limited dental insurer participation and those that experienced a net loss of Stand-alone Dental Plan insurers between 2016 and 2023. We found that in 2023, at least one Stand-alone Dental Plan was offered in every state, and thirty-six states offered embedded dental plans. Most counties (63.6percent) had access to more than five insurers offering adult dental plans, whereas approximately 4percent had only one insurer offering adult dental plans. Counties in state-based Marketplaces, rural areas, and dentist shortage areas were more likely to be counties with limited dental insurer participation. The net loss of Stand-alone Dental Plans between 2016 and 2023 was more common in state-based Marketplaces and disadvantaged counties. Our findings can inform future policies to improve the dental insurance Marketplace and access to affordable dental care.

Lung Cancer Screening Health Belief Model: Psychometric Properties of the Arabic Version and Factors Influencing Screening and Prevention Among Jordanians.

Several screening models have recently been applied to study awareness and help people make informed decisions regarding cancer screening. This study aimed to explore the knowledge, attitudes, and lung cancer screening health beliefs (LCSHBs) among Jordanians. Moreover, we intended to translate the LCSHBs scale into the Arabic language and test its validity and reliability. An online survey (Google Forms) was completed by 916 participants in Jordan via snowball sampling technique from February 10, 2024, to March 2, 2024, assessing lung cancer screening knowledge, lung cancer preventive attitudes, screening-related health beliefs, and stages of screening adoption. Linear regression analysis, correlations, and non-parametric statistics were utilized for statistical inference. Participants had high mean percentage scores of 86.56% and 85.75% for knowledge and preventive attitudes towards lung cancer screening, respectively. The Arabic version of the LCSHBs model was found to be a valid and reliable tool, as indicated by principal component analysis extraction and Cronbach's alpha values. Lung cancer screening knowledge was positively associated with perceived benefits and negatively associated with perceived barriers to screening. Knowledge, perceived barriers, perceived risk of lung cancer, self-efficacy (SE) to screen, and lung cancer preventive attitudes were significantly associated with the perceived benefits of lung cancer screening (p<0.05). We also found that the higher the SE, the higher the physical activity and the lower the perceived barriers. The Arabic version of the LCSHBs model is valid and reliable for assessing health beliefs toward lung cancer screening. We recommend enhancing targeted interventions, educational outreach, and improving health insurance access to reduce lung cancer incidence in Jordan and promote screening behaviors.

Insurance and Structural Access Quality and Effects on AAA Mortality: A National Healthcare Quality and Disparities Report Analysis.

The National Health care Quality and Disparities Report (NHDQR) presents trends for measures related to access to care, affordable care, care coordination, effective treatment, healthy living, patient safety, and person-centered care. This study aims to determine the significance of insurance quality and access to care on AAA repair outcomes. Data was obtained through the Agency for Health care Research and Quality database from 2016-2020. AAA repair mortality rates per 1000 persons, insurance quality, and structural access were compared between the 31 reportable U.S. states in which data was analyzed using linear regression models and ANOVA. Insurance quality and structural access groups were categorized as weak, average, and strong, based on NHDQR Reports measures. No association was found between access to care and AAA mortality at specific time points (2016 and 2020; P-value = .90 and .29 respectively) and when comparing states that showed improvement from 2016 to 2020 (weak categorization to strong; P value = .27). An association was found between private insurance quality and AAA repair mortality at baseline (2016; P-value = .022) and in those that showed improvement or worsening in private insurance quality over the study period (P-value = .042). Our findings suggest that there is no association between structural access quality and AAA mortality although an association exists between AAA mortality and private insurance quality.

Joint effect of tobacco and meat on cardiovascular disease and treatment adherence in Indian Women

Abstract Background Cardiovascular disease (CVD) is a leading cause of death for both men and women in India. But it is often overlooked in women. Tobacco and meat consumption are common risk factors for CVD. While individual studies have explored the link between tobacco or meat consumption and CVD, their joint effect remained understudied. Methods The study analyzed data from the National Family Health Survey 2019-21, of 711431 women aged 15 to 49 in India. Univariate and multivariate logistic regression were used to assess the risk of individual and joint effects of tobacco and meat consumptions on self-reported CVD prevalence. Age, BMI, education, wealth index, residency, region, religion, and alcohol were used as covariates. Additionally, interactions model was assessed. Lastly, treatment adherence for CVD was studied, considering treatment behavior, insurance, and healthcare access barriers. Results Cardiovascular disease prevalence was 0.72%. The risk of CVD was higher among the smokers [aOR: 2.26(1.83-2.73)] than smokeless tobacco [aOR: 1.34(1.21-1.49)] consumers. In contrast daily meat consumers showed higher risk [aOR: 1.23(1.03-1.47)] than meat non-consumers. Women who were consumers of both tobacco and meat had risk of [aOR: 1.15 (1.02 - 1.30)] CVD compared to who did not consume both tobacco and meat. Interaction was not detected between tobacco and meat consumption. CVD treatment adherence was higher among the women who possess an insurance [OR: 1.11(1.04-1.19)]. The risk of treatment non-adherence was higher among women who were aged below 40 with no education and from the poorest section of the society. Barriers for accessing health care facilities were solo attendance, provider availability, and drug access. Conclusions Tobacco and meat both need to be addressed to control CVD among women. Empowering women and bringing them under government insurance with an improve health care system are crucial. Key messages • The joint effect of tobacco and meat consumption increased the risk of cardiovascular diseases among women. However, there was no interaction effects observed between tobacco and meat consumption. • Healthcare facilities needs to be improved and awareness among young adults are extremely crucial for better CVD treatment management among women in India.

Age and sex differences in the association of dental visits with inadequate oral health and multimorbidity: Findings from the Canadian Longitudinal Study on Aging (CLSA)

BackgroundDental attendance is important for the prevention, diagnosis, and treatment of oral diseases. In this study, we aimed to assess the extent of the association between dental visits, inadequate oral health, and multimorbidity (MM), and whether this association differs by age and sex.MethodsWe conducted a cross-sectional analysis of the first follow-up wave (2018) of the Canadian Longitudinal Study on Aging (CLSA). Poor self-reported oral health (SROH), oral health problems, and edentulism were used to indicate inadequate oral health. MM was defined as having 2 or more chronic conditions out of cancer, cardiovascular diseases, chronic respiratory diseases, diabetes, and mental illnesses. Dental visiting was determined as the number of visits to a dental professional within the past 12 months. Covariates included socioeconomic, behavioural factors, and the availability of dental insurance. We constructed multivariable Poisson and logistic regression models with interactions terms and estimated the relative excess risk due to interaction prevalence ratio (RERIPR) to assess the effect measure modification of age and sex on the associations of interest. We conducted sensitivity analyses and estimated E-values for unmeasured confounding.ResultsIn this sample (n = 44,815), dental visiting was inversely associated with inadequate oral health and MM in adjusted models, reducing the odds/prevalence of poor SROH (OR 0.41, 95% CI 0.34, 0.51), oral health problems (PR 0.89, 95% CI 0.79, 0.94), edentulism (OR 0.10, 95% CI 0.06, 0.15), and MM (PR 0.86, 95% CI 0.79, 0.92). These associations were stronger in older age and females.ConclusionDental visiting may contribute to better oral health and reduced chronic diseases in the middle-aged and older population. Our findings suggest the need for age and sex-specific targeted interventions to optimize oral and overall health.

Resumption Of Medicaid Eligibility Redeterminations: Little Change In Overall Insurance Coverage.

In anticipation of the end of the COVID-19 public health emergency, Congress ended the Medicaid continuous coverage requirement on March31, 2023, allowing states to terminate coverage for ineligible people and resume eligibility determinations through a process known as unwinding. Although administrative data have documented substantial declines in Medicaid enrollment since April2023, the impact on uninsurance is unknown. Using data from the Census Bureau's Household Pulse Survey, we estimated the early effect of Medicaid unwinding on insurance coverage among people ages19-64. We found that within the first three months of unwinding, the number of people self-reporting Medicaid coverage declined by approximately two million, and there was a much smaller, statistically insignificant decline in overall coverage of approximately 467,000 people. It appears that for many people, the availability of employer-sponsored insurance and other private coverage offset Medicaid coverage loss. These results suggest that the resumption of redeterminations has had less impact on uninsurance than was initially feared. Our findings highlight the importance of tracking coverage transitions during unwinding. By identifying populations at risk for uninsurance after Medicaid loss, these data could enhance the effectiveness of state outreach and enrollment assistance for people eligible for Marketplace coverage and subsidies.

An Intersectional Approach to Cervical Cancer Screening Disparities by Race/Ethnicity and Immigrant Status.

Background: Disparities in cervical cancer (CC) screening exist within racial/ethnic minority and immigrant groups. However, few studies have explored the joint influence of race/ethnicity and immigrant status on screening, and the disparities that have been identified by existing studies remain incompletely explained. This study aims to identify the joint influence of race/ethnicity and immigrant status on CC screening and elucidate the barriers contributing to identified disparities. Methods: A cross-sectional analysis of 25,660 U.S. women from the 2005, 2010, and 2015 National Health Interview Surveys was done. The CC screening up-to-date status of cases was analyzed by race/ethnicity and immigrant status using logistic regression models. Conceptualized mediators were added to models to identify their contribution to identified disparities. Results: All immigrants had lower screening odds than U.S.-born non-Hispanic White women with foreign-born non-Hispanic Asians having the lowest odds (adjusted odds ratio [aOR]: 0.36, 95% confidence interval [CI]: 0.26-0.49) followed by foreign-born non-Hispanic White (aOR: 0.52, 95% CI: 0.36-0.76), Hispanic/Latinx (aOR: 0.58, 95% CI: 0.47-0.73), and non-Hispanic Black women (aOR: 0.62, 95% CI: 0.38-0.99). Adjusting for only socioeconomic status or access to care attenuated the aOR: for foreign-born Hispanic/Latinx and non-Hispanic Black women only. Adjusting simultaneously for language and acculturation attenuated the aOR: for all immigrants. Conclusions: Disparities in CC screening were only found in the immigrant populations of various racial/ethnic groups. Targeting insurance and health care access may address disparities in immigrant Hispanic/Latinx and non-Hispanic Black women. Focusing on culturally and linguistically competent care and education may be more crucial for immigrant non-Hispanic Asian and White women.

Toward Universal Health Coverage: What Socioeconomic and Clinical Factors Influence Health Insurance Coverage and Restrictions in Access to Viral Hepatitis Services in Nasarawa State, Nigeria?

Background: Viral hepatitis B and C (HBV and HCV) pose significant public health concern in Nigeria, where access to healthcare and treatment affordability are limited. This study investigated sociodemographic and clinical predictors of health insurance coverage and access to care among patients with HBV and HCV in Nasarawa State, Nigeria. Methods: A cross-sectional facility-based study was conducted at two secondary hospitals in Nasarawa State, Nigeria. Participants included patients diagnosed with HBV, HCV, or both who were ≥18 years old. Data were collected using a structured questionnaire covering sociodemographic and clinical information, health insurance details, and economic impact. Binary logistic regression was used to analyze the relationship between sociodemographic/clinical factors and health insurance status. Results: Out of 303 participants, 68% had health insurance, which mostly covered hepatitis screening and vaccination. Significant predictors of health insurance coverage included being aged 36-40 years (adjusted odds ratio [aOR]: 11.01, 95% confidence interval [CI]: 2.38-50.89, p = 0.002), having post-secondary education (aOR: 25.2, 95% CI: 9.67-65.68, p < 0.001), being employed (aOR: 27.83, 95% CI: 8.85-87.58, p < 0.001), and being HIV-positive (aOR: 4.06, 95% CI: 1.55-10.61, p = 0.004). Nearly all those insured (99%) faced restrictions in insurance coverage for viral hepatitis services. Conclusions: This study reveals that while health insurance coverage is relatively high among viral hepatitis patients in Nasarawa State, significant restrictions hinder access to comprehensive services, especially for vulnerable groups like younger adults, the unemployed, and PLHIV. Key factors influencing coverage include age, education, employment, and HIV status. Expanding benefit packages to include viral hepatitis diagnosis and treatment, raising awareness about viral hepatitis as part of insurance strategy, improving access for underserved populations, and integrating hepatitis services into existing HIV programs with strong policy implementation monitoring frameworks are crucial to advancing universal health coverage and meeting the WHO's 2030 elimination goals.

Barriers and facilitators to skin cancer prevention among Hispanics: a qualitative study

BackgroundIn the past two decades, melanoma incidence among Hispanic people has risen greatly. This qualitative study explored Hispanic people’s perceived barriers and facilitators to skin cancer-related preventive behaviors.MethodsFive focus groups among Hispanic people (2 in Spanish and 3 in English; n = 34; 11 Spanish-preferring and 23 English-preferring) were conducted, where participants discussed their perceptions and behaviors relating to skin cancer, sun protection, and skin self-examination. Additionally, healthcare providers (n = 9) and Hispanic community leaders (n = 6) were recruited for individual interviews to complement the results of focus groups. A thematic analysis was conducted on all transcripts.ResultsPerceived barriers to sun protection included: 1) Low levels of knowledge and awareness/misperception; 2) low perceived importance or not a priority, 3) economic issues or limited access, 4) downsides/concerns about engaging in sun protection behaviors, and 5) Hispanic cultural norms (e.g., machismo). Facilitators to sun protection included: 1) relevance/care for family, 2) negative consequences of sun exposure, and 3) Hispanic cultural norms (e.g., familismo). Barriers to skin examination included: 1) low levels of knowledge and awareness, 2) lack of insurance coverage or access, and 3) difficulty or discomfort associated with practicing skin self-examination. Facilitators to skin examination included: 1) relevance/previous experience and 2) having insurance coverage or access.ConclusionsFuture interventions should focus on individual, community, and system-level strategies to address misperceptions in the Hispanic community, increase knowledge and awareness, address perceptions of cultures regarding skin cancer preventive activities, and emphasize the importance or priority of health issues related to skin cancer.

Health Insurance Type and Access to the Indian Health Service Before, During, and After Childbirth Among American Indian and Alaska Native People in the United States

BackgroundAmerican Indian and Alaska Native (AI/AN) people in the United States face elevated childbirth-related risks when compared with non-Hispanic white people. Access to health care is a treaty right of many AI/AN people, often facilitated through the Indian Health Service (IHS), but many AI/AN people do not qualify for or cannot access IHS care and rely on health insurance coverage to access care in other facilities. Our goal was to describe health insurance coverage and access to IHS care before, during, and after childbirth for AI/AN birthing people in the United States. MethodsWe analyzed 2016 to 2020 Pregnancy Risk Assessment Monitoring System data (44 states and two other jurisdictions) for 102,860 postpartum individuals (12,920 AI/AN and 89,940 non-Hispanic white). We calculated weighted percentages, adjusted predicted probabilities, and percentage point differences for health care coverage (insurance type and IHS care) before, during, and after childbirth. ResultsApproximately 75% of AI/AN birthing people did not have IHS care around the time of childbirth. AI/AN people had greater variability in insurance coverage and more insurance churn (changes in type of insurance, including between coverage and no coverage) during the perinatal period, compared with non-Hispanic white people. Health care coverage differed for rural and urban AI/AN people, with rural AI/AN residents having the lowest prevalence of continuous insurance (60%). ConclusionAI/AN birthing people experience insurance churning and limited access to IHS care during the perinatal period. Efforts to improve care for AI/AN birthing people should engage federal, state, and tribal entities to ensure fulfillment of the trust responsibility of the United States and to address health inequities.

Immune-related adverse events, mood disorders, and the impact of social determinants of health among a national cohort of patients receiving immunotherapy.

364 Background: Immune checkpoint inhibitors (ICIs) are increasingly used to treat advanced cancers such as lung, bladder, head and neck, colorectal cancers, and melanoma. Psychological distress may promote pro-inflammatory states which can exacerbate immune-related adverse events (irAEs) among ICI-treated cancer patients. This study assessed the impact of mood disorders (anxiety and depression diagnoses/medications before or during treatment) on the odds of irAEs among advanced cancer patients receiving ICIs, accounting for clinical characteristics and social determinants of health. Methods: This retrospective cohort study used data from a national sample of N=8,058 deceased adult patients diagnosed with advanced melanoma, lung, colorectal, head and neck, and bladder cancers from the nationwide Flatiron Health electronic health record (EHR) derived de-identified database. Diagnostic codes and medication orders were used to assess for mood disorders and auto-immune conditions documented within 2 years of receiving an ICI (irAEs). Bivariate tests and multivariable logistic regressions with interaction terms were conducted in R. Results: Accounting for age at advanced cancer diagnosis, ethnicity, socioeconomic status, baseline performance status, and number of clinic visits, female patients (aOR 1.25, 95% CI=1.07-1.46, p=0.005), patients seen in an academic practice setting only (aOR=2.16, 95% CI=1.80-2.60, p&lt;0.001), and patients receiving combination CTLA-4 and PD-(L)1 inhibitors (aOR 1.47, 95% CI=1.11-1.95, p=0.008) had higher odds of irAEs compared with male patients, patients treated in community settings only, and patients receiving PD1/L1 inhibitors only. Non-White (aOR 0.61, 95% CI=0.49, 0.77, p&lt;0.001), bladder (aOR 0.53, 95% CI= 0.37, 0.78, p=0.001) and colorectal cancer patients (aOR=0.55, 95% CI=0.32, 0.91, p=0.024) had lower odds of irAEs compared with White and melanoma patients. Insurance type moderated the relationship between mood disorders and IrAEs; commercially-insured ICI patients with mood disorders had higher odds of irAEs (aOR 1.65, 95% CI=1.16, 2.35, p=0.006) compared with Medicare-insured ICI patients with mood disorders. Conclusions: Social determinants of health such as insurance access may exacerbate the relationship between mood disorders and irAEs. These findings have implications for health equity and are an area warranting further study. Future analyses will also examine directionality of the associations between mood disorders and irAEs.

Suboptimal Oral Health, Multimorbidity, and Access to Dental Care.

Emerging studies on the links between suboptimal oral health and multimorbidity (MM), or the co-existence of multiple chronic conditions, have raised controversy as to whether enhancing access to dental care may mitigate MM in those with suboptimal oral health. In this study, we aim to assess the extent of the association between suboptimal oral health and MM and whether access to dental care can modify this association. We conducted a cross-sectional analysis using data from the Canadian Longitudinal Study on Aging (CLSA) (N = 44,815, 45 to 84 y old). Edentulism, self-reported oral health (SROH), and other oral health problems (e.g., toothache, bleeding gums) were used as indicators of suboptimal oral health. MM was defined according to the Public Health Agency of Canada as having 2 or more of the following chronic conditions: cancer, cardiovascular diseases, chronic respiratory diseases, diabetes, and mental illnesses. For robustness, we also used a cutoff of having 3 or more of these chronic conditions. Variables for access to dental care included (1) dental visits within the past year, (2) availability of dental insurance, and (3) cost barriers to dental care. We constructed robust Poisson regression models to estimate the association between suboptimal oral health and MM and then assessed the effect measure modification by indicators of access to dental care on a multiplicative scale. We also calculated the relative excess risk due to interaction for prevalence ratio (PR) on an additive scale. Indicators of suboptimal oral health were significantly associated with MM (edentulism PR 1.17, 95% confidence interval [CI] 1.08, 1.27; poor SROH PR 1.44, 95% CI 1.33, 1.54; other oral health problems PR 1.52, 95% CI 1.44, 1.78). The magnitude of this association was higher in individuals who reported fewer dental visits within the past year, lacked dental insurance, and avoided dental care due to costs. The association between suboptimal oral health and MM may be exacerbated by barriers to accessing dental care. Policies aiming to enhance access to dental care may help mitigate MM in middle-aged and older Canadians with suboptimal oral health. This study offers insights into the connection among suboptimal oral health, multimorbidity, and access to dental care factors in middle-aged and older Canadians. The findings can be of value for clinicians and policy makers aiming to enhance medical-dental integration and improve accessibility to dental care and to patients seeking information about the connections between oral health and chronic conditions. Implementation has the potential to enhance individual well-being and drive systemic improvements in health care.

Development of a Clinical Guideline for Suicide Prevention in Psychiatric Patients Based on the ADAPTE Methodology.

Suicide is a significant public health issue, with South Korea having the highest suicide rate among Organisation for Economic Cooperation and Development countries. This study aimed to develop clinical guidelines for suicide prevention in psychiatric patients in Korea using the ADAPTE methodology. The development process involved a comprehensive review of literature, expert consultations, and consensus-building using the Nominal Group Technique and Delphi method. The guidelines focus on evidence-based psychiatric treatments, including both pharmacological and non-pharmacological approaches, tailored to the Korean context. Key findings underscoring the need for standardized treatment protocols for patients with major psychiatric disorders, including bipolar disorder, major depressive disorder, and schizophrenia. The guidelines incorporate treatments like lithium, clozapine, atypical antipsychotics, electroconvulsive therapy, and cognitive behavioral therapy, which have shown effectiveness in suicide prevention. Applicability and acceptability within Korea's healthcare system were addressed, ensuring feasibility given the country's medical insurance coverage and accessibility. The guidelines were validated through expert reviews and Delphi rounds, achieving consensus on the final recommendations. The developed guidelines provide a structured, evidence-based approach to reducing suicide rates among psychiatric patients in Korea. Future research will focus on expanding these guidelines to include screening protocols for high-risk groups.

High Out-of-Pocket Cost Burden of Mental Health Care for Adult Outpatients in the United States.

This report describes characteristics of patients who had high out-of-pocket (OOP) spending on mental health care relative to income. A sample of 8,923 U.S. adults with outpatient mental health visits was drawn from the 2018-2021 Medical Expenditure Panel Survey. Respondents who spent ≥10% of their disposable family incomes on OOP mental health visits were defined as having a high OOP cost burden. Using weighted percentages, the authors found that 2.4% of psychiatric outpatients had a high OOP burden; among those below the federal poverty level, 12.8% had a high OOP burden. Patients with a high (vs. low) OOP burden were statistically significantly more likely to be uninsured (7.5% vs. 2.4%) or diagnosed as having a substance use disorder (8.7% vs. 2.8%) or bipolar disorder (14.5% vs. 8.0%). Despite federal policies extending the availability of insurance for mental health care, many low-income psychiatric outpatients experience high OOP cost burden.