Longitudinal Data Research Articles

Longitudinal links from attachment with mothers and fathers to adolescent substance use: Internalizing and externalizing pathways.

The present study examined whether internalizing and externalizing symptoms may mediate the association between adolescent-mother and adolescent-father attachment and substance use. The sample included 167 adolescents (47% girls) who were assessed at five time points with approximately 1 year between each assessment, beginning in middle adolescence (Mage=14.07) and ending in the transition to young adulthood (Mage=18.39). The adolescents reported their perceived attachment with both their mother and father during middle adolescence (Times 1 and 2), their internalizing and externalizing symptoms during late adolescence (Times 3 and 4), and their alcohol use during the transition to young adulthood (Time 5). The results showed that less secure adolescent-father attachment, but not adolescent-mother attachment, was predictive of heightened externalizing and internalizing symptoms. In turn, heightened externalizing symptoms were predictive of heightened alcohol use. Despite the nonsignificant direct association between adolescent-father attachment and alcohol use, less secure adolescent-father attachment was indirectly predictive of greater alcohol use, mediated through heightened externalizing symptoms. The findings highlight the importance of close and trusting father-adolescent relationships in the development of psychopathology and substance use behaviors. The developmental cascade from a less secure adolescent-father attachment to greater externalizing symptoms and heightened substance use, as well as implications for prevention and intervention of young adult substance use, are discussed. RESEARCH HIGHLIGHTS: The differential pathways from adolescent-mother and adolescent-father attachment to substance use during the transition to young adulthood are not well known. Longitudinal data were used to test whether internalizing and externalizing symptoms may mediate the association between adolescent-mother and adolescent-father attachment and substance use. Less secure adolescent-father attachment predicted heightened internalizing and externalizing symptoms, and less secure adolescent-father attachment predicted greater alcohol use, mediated through heightened externalizing symptoms. The findings suggest that addressing insecure attachment with fathers during adolescence may reduce unhealthy substance use during the transition to young adulthood.

Relative victimization scale: initial development and retrospective reports of the impact on mental health

BackgroundBullying and victimization have been studied in many contexts and classified as peer victimization in school settings and parental or sibling victimization within family settings. Yet, current research is scarce on whether victimization occurring within family settings is specific to parental or sibling victimization. Thus, the current study aims to develop a scale assessing victimization conducted by relatives and provide support for its psychometric properties.MethodsCross-sectional and longitudinal data were collected from university students (1622 and 1045 students, respectively) and participants responded to questionnaires via an online survey.ResultsEFA and CFA results demonstrated the unidimensionality of the Relative Victimization Scale (RVS) consisting of eight items. In terms of convergent validity, RVS scores were correlated with the scores on parental, sibling, and peer victimization scales and several psychological health outcomes including depression, anxiety, social anxiety, perceived stress, loneliness, negative and positive affect, life satisfaction, and resilience. Moreover, RVS explained a significant amount of variance beyond the contribution of parental, sibling, and peer victimization in those psychological health outcomes for the support of incremental validity.ConclusionsThe findings of the study indicated the potential utility of the RVS in assessing the experience of relative victimization through offering support for internal consistency reliability and construct, longitudinal predictive, and incremental validity.

Ecological and Reproductive Cycles Drive Henipavirus Seroprevalence in the African Straw-Coloured Fruit Bat (Eidolon helvum).

Bats are known to host zoonotic viruses, including henipaviruses that cause high fatality rates in humans (Nipah virus and Hendra virus). However, the determinants of zoonotic spillover are generally unknown, as the ecological and demographic drivers of viral circulation in bats are difficult to ascertain without longitudinal data. Here we analyse serological data collected from African straw-coloured fruit bats (Eidolon helvum) in Ghana over the course of 2 years and across four sites, comprising three wild roosts and one captive colony. We focus on antibody affinity to five henipavirus antigens: Ghanaian bat henipavirus (GhV), Nipah virus (NiV), Hendra virus (HeV), Mojiang virus (MojV) and Cedar virus (CedV). In the wild roosts, we detected seasonal variations in henipavirus antibody binding, possibly associated with bat life-history cycles and migration patterns. In the captive colony, we identified increases in antibody affinity levels among pregnant bats, suggesting possible shifts in the immune system during pregnancy. These bats then pass maternal antibodies to their pups, which wane before antibody affinity levels rise later in life following initial infections and/or reactivation of latent infections. These results improve our understanding of the links between bat ecology and viral circulation, including for GhV, a locally-circulating African henipavirus.

Does grade point average have a long-lasting impact on career success later in life? A resource caravans' perspective from adolescence to mid-career

We draw on a resource caravans' perspective to explain pathways to career success among a longitudinal sample, covering the first 15 years of their careers. By applying a latent growth model, we investigate how the role of university grade point average (GPA) on career success changes across time. The results from latent growth curve analysis revealed that GPA was not positively related to initial levels of career success (i.e., salary and leadership level), however, GPA was positively related to increases in career success over time and positively related to subjective career success. These findings indicate that the positive impact of GPA on career success accumulates over time, in line with the resource caravans and gain spirals of conservation of resources theory. Further, we examine the joint role of GPA and affective-identity motivation to lead (MTL) measured at the start of university studies to explain growth in career success over time. As expected, affective identity MTL moderated the relationship between GPA and leadership level, salary level and subjective career success, such that the positive relationship was stronger for individuals higher on affective-identity MTL. Our findings highlight that the pathway to career success is based on gain spirals that may develop slowly over time as individuals accumulate resources in their resource caravan and invest these resources further to achieve their career outcomes. Implications for practice are discussed.

COVID-19 and shifting food preferences: A panel study among Chilean students

The COVID-19 pandemic had a profound impact on various aspects of life. This study aims to investigate whether the COVID-19 pandemic changed food preferences, focusing on cost perceptions, environmental factors, and health attributes. We conducted a panel study with self-administered online surveys among undergraduate students in Chile, both before and during the first wave of the pandemic. Each survey included a discrete choice experiment (DCE) to elicit food preferences. Using mixed logit models, our analysis shows that during the COVID-19 pandemic, sensitivity to cost, preference for foods with low environmental impact, and preference for vitamin-rich foods increased. These changes in preferences can be attributed to individuals' perceived health risks. These findings suggest that the pandemic increased awareness of sustainable and healthy food choices, with important implications for promoting these choices during global crises.

Generation of preoperative anaesthetic plans by ChatGPT-4.0: a mixed-method study.

Recent advances in artificial intelligence (AI) have enabled development of natural language algorithms capable of generating coherent texts. We evaluated the quality, validity, and safety of this generative AI in preoperative anaesthetic planning. In this exploratory, single-centre, convergent mixed-method study, 10 clinical vignettes were randomly selected, and ChatGPT (OpenAI, 4.0) was prompted to create anaesthetic plans, including cardiopulmonary risk assessment, intraoperative anaesthesia technique, and postoperative management. A quantitative assessment compared these plans with those made by eight senior anaesthesia consultants. A qualitative assessment was performed by an adjudication committee through focus group discussion and thematic analysis. Agreement on cardiopulmonary risk assessment was calculated using weighted Kappa, with descriptive data representation for other outcomes. ChatGPT anaesthetic plans showed variable agreement with consultants' plans. ChatGPT, the survey panel, and adjudication committee frequently disagreed on cardiopulmonary risk estimation. The ChatGPT answers were repetitive and lacked variety, evidenced by the strong preference for general anaesthesia and absence of locoregional techniques. It also showed inconsistent choices regarding airway management, postoperative analgesia, and medication use. While some differences were not deemed clinically significant, subpar postoperative pain management advice and failure to recommend tracheal intubation for patients at high risk for pulmonary aspiration were considered inappropriate recommendations. Preoperative anaesthetic plans generated by ChatGPT did not consistently meet minimum clinical standards and were unlikely the result of clinical reasoning. Therefore, ChatGPT is currently not recommended for preoperative planning. Future large language models trained on anaesthesia-specific datasets might improve performance but should undergo vigorous evaluation before use in clinical practice.

Is Home Care Use Associated With Secondary Health Conditions in Persons With Spinal Cord Injury? Findings From a Longitudinal Cohort Study.

The aims of the study are to describe the use of professional home care in persons with spinal cord injury over a 10-yr period from 2012 to 2022 and to examine how the use of home care is associated with the future occurrence of secondary health conditions and hospitalizations. This is a longitudinal questionnaire survey as part of the Swiss Spinal Cord Injury Cohort Study, conducted in 2012, 2017, and 2022. There were 1549, 1294, and 1158 participants in the three surveys in 2012, 2017, and 2022. The percentage of home care users decreased from 23% in 2012 to 22% in 2017 and 19% in 2022. Fewer home care recipients reported pain (odds ratio 0.52, 95% confidence interval 0.29-0.94), with no reductions in other secondary health conditions, 5 yrs later. Study participants who received home care were more likely to be hospitalized (odds ratio 1.89, 95% confidence interval 1.05-3.42), 5 yrs later. There is a declining trend in the use of home care services among persons with SCI. While home care is associated with lesser development of pain, it does not generally reduce secondary health conditions. Individuals who receive home care are significantly more likely to report hospitalization 5 yrs later.

Pain and the risk of social isolation and loneliness in older Chinese adults: Do gender, age, and education make a difference?

ObjectivePain has long been known to affect the health and well-being of older adults. However, no longitudinal study has examined the associations between pain, social isolation, and loneliness among older adults in China. This study aims to explore the relationships between pain and older Chinese adults’ social isolation (family isolation and friend isolation) and loneliness, and whether these associations are moderated by gender, age, and education groups. MethodData derived from the four waves of the China Longitudinal Aging Social Survey (CLASS, 2014-2020). The sample included 18,692 respondents (aged 60 years and older), and mixed-effects logistic models were used. ResultsPain is not significantly associated with family isolation. In contrast, pain increases the risk of friend isolation and loneliness. Regarding the moderating roles of gender, age, and education, the results show that the relationship between pain and friend isolation is stronger among older women compared to their male counterparts. The association between pain and the risk of friend isolation is stronger among young-old adults (60-69 years) than among their older counterparts (70 years and older). Conversely, the oldest old adults (80+ years) are more likely to experience loneliness combined with pain than their younger counterparts. In addition, the negative effect of pain on the risk of loneliness is stronger among the more educated than among the less educated older adults. ConclusionsThe findings underscore the pivotal role of pain in shaping the social well-being of older adults, and highlight the need to consider sociodemographics and socioeconomic status when developing pain prevention and management strategies.

The impact of long-haul travel and 13h time change on sleep and rest activity circadian rhythm in speed skaters during World Cup competitions.

Athletes frequently compete only a few days after long-haul travel. Longitudinal real-world data on athletes' sleep and sleep-wake cycle in competitive settings remain scarce. This study assessed the impact of a long-haul travel across ∼13 time zones on sleep patterns, rest-activity circadian rhythms (RAR), and their subsequent effects on neuromuscular function and race performance in the Canadian Short-Track Speed Skating Team. Nineteen athletes (24±4years, 11 women) travelled from Montréal (UTC-5) to Asia (UTC+8, UTC+9) for World Cup races between 2017 and 2019. Actigraphy data were collected before (Baseline) and during travel, during the stay in Asia (SIA), and during competition days. RAR were computed using cosinor analyses on accelerometry data with 24h phase periods. Countermovement jump height (CMJ) was measured in a subsample (n=10). Compared to baseline (7:08±0:53), athletes obtained less sleep during travel (6:16±1:27) and competition days (6:35±1:10), and more during SIA (7:32±0:46; time effect P<0.0001). Sleep efficiency and CMJ were greater in SIA than baseline (P=0.007 and P=0.0004, respectively). During SIA, sleep time increased by 9 min per night until the fifth day (P<0.0001), with a slight decrease in sleep efficiency (P=0.005) and an increase in CMJ (P<0.0001). For RAR, mean activity peaked on day 2, shifting from late evening to ∼15:00. Race performance was not different from other races of the same season (P>0.254). Our results demonstrated that, despite the possible sleep debt from the long-haul travel, athletes recovered within 5 days, highlighting their adaptability to manage sleep debt and jetlag without impacting competitive outcomes.

A life course perspective on mental disorders and psychopharmacologic drug use among persons living with cerebral palsy

In this study, we investigated the prevalence of mental disorders and the use of psychopharmacologic drugs among individuals with cerebral palsy (CP). We studied how the association between CP and mental illness develops over the life course (between ages 5 and 65 years), and how it varies across disability specific factors (intellectual disability, gross motor function and communicative ability). We used logistic regression models on a longitudinal matched case-control data material on all persons with CP in Sweden linked to several administrative registers including, the national patient registers and the pharmaceutical registers.Our results showed that the probability of being diagnosed with mental disorders and being dispensed psychopharmacologic drug was significantly higher among persons with CP compared to persons without CP across the different outcomes [OR=1.52–4.7]. For some mental and neurodevelopmental disorders including sleep disorders, autism, and ADHD, and for the use of anxiolytics and sedatives, there was a sizeable gap already in childhood. However, the excess burden of mental illness appeared to grow over the life course, indicating that adults with CP may be a particularly disadvantaged group. Diagnosis for mental disorders and dispensation for psychopharmacologic drugs were not consistent with respect to disability specific factors, especially communicative and intellectual function, which indicates the need for systematic approaches in the mental health care of individuals with CP.

Best practice guidelines for use of reference points in radiation oncology information systems to aggregate longitudinal dosimetric data.

Tracking patient dose in radiation oncology is challenging due to disparate electronic systems from various vendors. Treatment planning systems (TPS), radiation oncology information systems (ROIS), and electronic health records (EHR) lack uniformity, complicating dose tracking and reporting. To address this, we examined practices in multiple radiation oncology settings and proposed guidelines for current systems. A survey was conducted among members of various professional groups to understand dose reporting practices in TPS, ROIS, and EHR systems. The aim was to identify consistent components and develop guidelines. We identified six treatment scenarios where current ROIS defaults fail in accurately representing dose totals. A standardized approach involving three reference point types - Primary Treatment Plan Reference, Dose Check, and Prescription Tracking - was proposed to address these scenarios. Standardizing naming conventions for reference points was also recommended for easier integration with EHRs. The approach requires minimal modifications to existing systems and facilitates easier data transfer and display in EHRs. Standardizing reference points in commercial TPS and ROIS can bridge infrastructure gaps and improve dose tracking in complex clinical scenarios. This standardization, aligned with AAPM's TG-263, paves the way for continual development of automated, standardized, interoperable tools, enhancing the ease of sharing reference point information.

Labor Market Participation of Persons With Spinal Cord Injury Living in Switzerland Between 2012 and 2022: A Comparison to the General Population.

The aim of the study is to examine labor market participation of individuals with spinal cord injury living in Switzerland over the past decade and in relation to the general population. This is a descriptive study, using longitudinal panel data from the 2012, 2017, and 2022 community surveys of the Swiss Spinal Cord Injury Cohort Study and general population data from the Swiss Labor Force Survey. Employment rates among spinal cord injury responders were 56% in 2012, 61% in 2017, and 64.6% in 2022. Employment gaps between the spinal cord injury and the Swiss general population samples decreased from 22.5% (2012) to 15.4% (2022). This decrease was particularly evident for females, middle-aged individuals, and people with tetraplegia but contrasted with increased employment gaps in Southwestern Switzerland. By identifying increased employment rates among spinal cord injury responders along with decreased employment gaps in relation to the general population, our study indicates improved opportunities for persons with impairments in the Swiss labor market over the past decade. While there is still room to improve the labor market participation prospects among the Swiss spinal cord injury population, particular efforts at the regional level are required to ensure equal labor market participation opportunities for all individuals with spinal cord injury living in Switzerland.

Impact of Psychosocial Resources on Mental Health During the Transition From the Initial Rehabilitation to Community: The Case of Spinal Cord Injury.

This study aims to examine the change in mental health from the clinical to community setting in persons with spinal cord injury and to identify the role of psychosocial resources for this transition. Longitudinal survey self-report data from N = 240 persons with spinal cord injury from the Swiss Spinal Cord Injury Cohort study. Latent profile analysis identified three profiles for each the clinical and the community setting: low, medium, and high mental health load. Latent transition analysis revealed that persons with spinal cord injury were most likely to stay in the same profile from discharge of initial rehabilitation to community, followed by a decrease from a high mental health load to a medium mental health load and an increase from a low mental health load to a medium mental health load. Individuals staying in the low mental health load profile showed significantly higher levels of psychosocial resources compared to individuals increasing to the medium mental health load profile, whereas individuals who stayed in the high mental health load profile showed lower levels of psychosocial resources compared to individuals decreasing to the medium mental health load profile. This study highlights a positive role of psychosocial resources on mental health transitions, underlining the need for strengthening psychosocial resources beyond initial rehabilitation.

Development of hunting oscillation detection algorithm for railway vehicles by using accelerometers

In this study, an algorithm was developed to detect hunting oscillation in railway vehicles using only accelerometers. Typically, the wheel profile of most railway vehicles has a conical shape, causing inherent hunting oscillation. The critical speed at which hunting oscillation occurs is determined by the wheel profile, rail profile, and dynamic characteristics of the railway vehicles. Hunting oscillation significantly impairs ride comfort, reduces running stability, and increases the risk of accidents such as derailment. Therefore, if hunting oscillation occurs during railway operation, it must be detected, and a deceleration procedure should be applied immediately to ensure dynamic stability. The detection algorithm in this study is based on the geometric behavior of the bogie. It utilizes longitudinal and lateral acceleration data from accelerometers installed on the upper frame of the bogie above the axle boxes. The algorithm processes the acceleration data to obtain the hunting oscillation frequency and harmonics, integrating all this data to calculate the Index of Hunting Oscillation. Validation was performed through simulations using a standard electric train model, confirming the algorithm’s effectiveness. Additionally, tests on actual bogies using a roller rig validated the algorithm’s performance in detecting hunting oscillation effectively.

Effects of List-Mode-Based Intraframe Motion Correction in Dynamic Brain PET Imaging.

Motion is unavoidable in dynamic [18F]-MK6240 Positron Emission Tomography (PET) imaging, especially in Alzheimer's disease (AD) research requiring long scan duration. To understand how motion correction affects quantitative analysis, we investigated two approaches: II-MC, which corrects for both inter-frame and intra-frame motion, and IO-MC, which only corrects for inter-frame motion. These methods were applied to 83 scans from 34 subjects, and we calculated distribution volume ratios (DVR) using the multilinear reference tissue model with two parameters (MRTM2) in tau-rich brain regions. Most of the studies yielded similar DVR results for both II-MC and IO-MC. However, in one scan of an AD subject, the inferior temporal region showed 14% higher DVR with II-MC compared to IO-MC. This difference was reasonable given the AD diagnosis, although similar results were not observed in other regions. Although discrepancies between IO-MC and II-MC results were rare, they underscore the importance of incorporating intra-frame motion correction for more accurate and dependable PET quantitation, particularly in the context of dynamic imaging. These findings suggest that while the overall impact of intra-frame motion correction may be subtle, it can improve the reliability of longitudinal PET data, ultimately enhancing our understanding of tau protein distribution in AD pathology.

Understanding young caring in the UK pre- and post-COVID-19: Prevalence, correlates, and insights from three UK longitudinal surveys

BackgroundDespite increasing awareness of young carers in recent years, there remains a significant gap in our understanding of both the prevalence and the characteristics of young carers. Our study aims to address this gap by examining the impact of the COVID-19 pandemic on the prevalence and characteristics of young carers. MethodsThis research utilised data from three UK longitudinal surveys: the UK Household Longitudinal Study (UKHLS), the COVID Social Mobility and Opportunities (COSMO) study, and the Millennium Cohort Study (MCS). We focused on adolescents aged 16–18, and examined two pre-COVID (UKHLS and MCS) and two post-COVID (UKHLS and COSMO) samples. ResultsThe prevalence of young carers increased from 8.0 % pre-COVID to 9.8–11.9 % since COVID. Young carers were more commonly found in single-parent and socioeconomically disadvantaged households, with a higher prevalence of young carers in homes where parents were out of paid employment or held lower educational qualifications. Young carers were also more likely to reside in deprived areas. Most young carers engaged in low-intensity caring (< 10 h/week), but post-COVID there was an increase in high-intensity caring (10 + hours/week), predominantly assumed by young female carers. The primary recipients of care were parents, followed by grandparents and siblings, with no change in the care recipient type since COVID. ConclusionThis study showed an increase in the prevalence of young carers, particularly those providing high-intensity care, since the onset of the COVID pandemic. Further, young carers were more likely to come from socioeconomically disadvantaged households and areas. Given the potential impacts that young caring can have on young peoples’ lives, it is imperative that support for young carers is increased, particularly for those facing multiple disadvantages. In tandem, services that support adult health and social care need to play a key role in identifying young carers.

Mapping the 9-year sleep trajectory and its implications for chronic disease risks among middle-aged and older adults

ObjectiveTo identify the 9-year trajectories of sleep duration and to assess the relationship between time-dependent sleep duration and sleep trajectories with 14 chronic diseases in adults. MethodsThis study used five waves of data of the China Health and Retirement Longitudinal Survey. Participants with complete sleep duration data and at least one record of 14 chronic diseases were included. The group-based trajectory model was used to identify sleep trajectories from 2011 to 2020. Time-dependent survival analysis and logistic regression were used to examine the relationship between time-dependent sleep duration and sleep trajectories with chronic diseases. ResultsA total of 9063 participants were included, with a mean (standard deviation, SD) sleep duration of 6.37 (1.83) h/d. Sleeping <7 h/d predicted higher risks of 11 chronic diseases at follow-up, with hazard ratios (HR) and 95 % confidence intervals (CI) ranging from 1.71 (1.26–2.33) for psychiatric disease to 1.15 (1.04–1.27) for dyslipidemia. Five sleep trajectories were identified and labeled as group 1–5 based on ascending order of sleep duration. Consistently sleeping <4 h/d (group 1) and 4–6 h/d predicted higher risks of most chronic diseases, with the highest HR (95 %CI) of 3.50 (1.73–6.92) and 2.94 (1.82–4.49) for psychiatric diseases, respectively. Consistently sleeping 6–7 h/d (group 3) predicted higher risks of digestive diseases and arthritis. Decreasing sleep (group 4) predicted higher risks of psychiatric diseases and memory-related diseases. ConclusionsConsistently sleeping <6 h/d predicted higher risks of most chronic diseases, especially psychiatric diseases. Digestive disease and arthritis were more sensitive to consistently inadequate sleep.

The Association Between Accelerated Biological Aging and Cardiovascular Outcomes in Older Adults with Hypertension.

Current hypertension treatments rely on chronological age, which may not reflect individual differences in aging and its impact on cardiovascular health. This study aimed to determine whether biological age can predict adverse outcomes in older adults with hypertension, independent of traditional risk factors including chronological age. An analysis of a prospective cohort was conducted using data from the Health and Retirement Study, a longitudinal survey of older adults in the United States. The Klemera-Doubal method was employed to calculate the biological age of the participants with hypertension at the time of enrollment in 2016. Discrete-time survival analysis was conducted to analyze the relationship between accelerated biological aging and the risk of mortality, heart disease, and stroke over four years of follow-up. A total of 4,442 individuals were analyzed. Of these, 2,438 showed decelerated aging, whereas 2,004 experienced accelerated aging (biological age > chronological age). The median age of the patients in both groups was around 70 years. Both groups had similar racial and ethnic distributions and predominantly consisted of non-Hispanic whites. The accelerated aging group had a higher prevalence of chronic diseases, lower education levels, and less wealth than the decelerated aging group. After adjustment for these differences, accelerated aging was associated with a higher risk of a composite outcome of death, heart disease, and stroke, with an adjusted hazard ratio (a-HR) of 1.62 (95% confidence interval: 1.27-2.06, p= 0.001). Accelerated biological age is a predictor of cardiovascular outcomes and death in patients with hypertension.

Use and Cost Patterns of Antihypertensive Medications in the United States From 1996 to 2021.

Antihypertensive medication use patterns have likely been influenced by changing costs and accessibility over the past 3 decades. This study examines the relationships between patent exclusivity loss, medication costs, and national health policies on antihypertensive medication use. Using 1996 to 2021 Medical Expenditure Panel Survey data of US adults with hypertension taking at least 1 antihypertensive medication, we conducted a cross-sectional analysis. We explored the associations between patent exclusivity loss, per-pill costs, and Medicare Part D enactment on medication use over time, focusing on the most commonly used medications (lisinopril, amlodipine, losartan, hydrochlorothiazide, and metoprolol). The unweighted sample comprised 50 095 US adults (mean age, 62 years; 53% female). The survey-weighted number of adults taking antihypertensive medications increased from 22 million (95% CIs, 20-23 million) to 55 million (95% CI, 51-60 million) between 1996 and 2021. Loss of patent exclusivity led to increased medication fills, notably for lisinopril, amlodipine, and losartan, which all exhibited within-class dominance. However, per-pill cost decreases coinciding with Medicare Part D did not increase the number of individuals treated or the use of specific antihypertensive medications or classes. The increase in antihypertensive medication use over the past decades highlights the significant impact of loss of patent exclusivity on the uptake in the use of specific medications. These findings underscore the complexity of factors influencing medication use, beyond cost reductions alone, and suggest that policies need to consider multiple facets to effectively improve antihypertensive medication accessibility and utilization.

Recent cohorts aging into Medicare use more counseling and psychotherapy than past cohorts.

Despite recent policy interest in improving access to mental health care in Medicare, little is known about how demand for care will change among the Medicare population as newer cohorts age into the program. We documented the growing rate of counseling and psychotherapy use in the decade prior to turning age 65years among subsequent cohorts aging into Medicare. We characterized how this growth varied across demographic groups, income levels, and mental and physical health status. We present trends using data from the 2002-2017 Medical Expenditure Panel Survey HouseholdComponent. We categorized individuals into 5-year Medicare entry cohorts based on the year they turned age 65 years. Our outcome was an indicator for having a visit for counseling or psychotherapy in a given year. Employing a probit regression, we characterized visit rates across 5-year cohorts, presenting both unadjusted and covariate-adjusted results. We ran stratified regressions by subpopulations. Our sample included 54,666 individuals aged 55to 64 years, weighted to be nationally representative. The cohort aging into Medicare between 2021 and 2025 was 88% (95% CI, 57%-119%) more likely to have a counseling or psychotherapy visit between the ages of 55 and 64years compared with the cohort that gained eligibility for Medicare between 2006 and 2010 at the same age. Growth in utilization was pervasive across many subpopulations. Our findings suggest that more recent cohorts aging into Medicare seek significantly more counseling and psychotherapy than prior cohorts. This increased utilization is pervasive across subpopulations, suggesting that plans must prepare to accommodate the needs of new Medicare entrants.