Medical Expenditure Panel Survey Research Articles

Racial and Ethnic Disparities in Attendance to Well-Child Visit Recommendations during COVID-19

ObjectiveTo measure the impact of the COVID-19 pandemic on racial and ethnic disparities in attendance to well-child visit recommendations. MethodsWe used the nationally representative Medical Expenditure Panel Survey (MEPS) to compare pre-pandemic (2018–2019) and pandemic (2020 and 2021) ratios of well-child visits to age-based recommendations, presenting both unadjusted and adjusted attendance disparities over time. We also used the 1996–2021 MEPS to place the pandemic changes in an historical context. ResultsAverage attendance decreased from 66.6% in 2018–2019 (95% confidence interval [CI]: 64.1, 69.1) to 58.6% in 2020 (95% CI: 55.5, 61.6), rebounding to 65.1% in 2021 (95% CI: 61.5, 68.7). The unadjusted disparity in attendance between White non-Hispanic and Black non-Hispanic children widened from 9.6 percentage points in 2018–2019 (95% CI: 2.8, 16.4) to 24.8 percentage points in 2020 (95% CI: 17.5, 32.2) and 21.4 percentage points in 2021 (95% CI: 11.2, 31.5). The unadjusted disparity in attendance between White non-Hispanic and Hispanic children widened from 14.8 percentage points in 2018–2019 (95% CI: 9.7, 19.8) to 26.3 percentage points in 2020 (95% CI: 19.9, 32.7) and 24.9 percentage points in 2021 (95% CI: 17.5, 32.3). Changes in disparities were large even when we controlled for health status, demographic and socioeconomic characteristics, health insurance, and state of residence. Magnitudes of the racial and ethnic attendance disparities during the pandemic’s first two years were unprecedented since 1996. ConclusionsWidening attendance disparities during the pandemic highlight the need to build a more equitable health care system for all children.

Medical expenditures and the measurement of poverty in the United States

Using data from the Medical Expenditure Panel Survey (MEPS) we estimate the fraction of the US population that is health poor. A person is health poor if their income prior to paying health insurance premiums and out-of-pocket healthcare costs is above the poverty line, but their income net-of-premiums and out-of-pocket healthcare costs is below the poverty line. Because resources used to finance health insurance premiums and out-of-pocket costs are (A) lexicographically preferred and (B) cannot be used to maintain an individual’s standard of living, they should be excluded from official poverty estimates. Approximately 1% to 2% of the US population is health poor. Elderly individuals, individuals in ill health, and low-income individuals are more likely to be health poor than other groups. We use our estimates of the health poor to evaluate alternative healthcare reform policies. The Affordable Care Act reduced the proportion of individuals near-poverty that are health poor from 23% to 18% and reduced the proportion of all individuals that are health poor from 1.5% to 1.1%. In contrast, counterfactual simulations of a Medicare for All plan similar to Saez and Zucman’s (2019b) suggest that Medicare for All would all but eliminate health poverty.

Self-Pay Outpatient Mental Health Care for Children and Adolescents, by Socioeconomic Status.

Many parents struggle to find mental health care for their children, and many mental health clinicians do not accept insurance payments. The authors aimed to estimate the frequency and cost of self-pay psychotherapy and psychotropic medication management visits for youths and to determine how service use varies by family income. A descriptive cross-sectional analysis was performed among youths ages 5-17 years in the 2018-2020 Medical Expenditure Panel Survey. Specialist visits included those with psychiatrists, psychologists, social workers, and mental health counselors or family therapists. Approximately one in five of 13,639 outpatient mental health specialist visits were self-pay, with psychologists (23% of visits) and social workers (24% of visits) most likely to see youths on a self-pay basis. Use of self-pay care was strongly associated with higher income, but even families earning <$28,000 per year utilized some self-pay care, at a median cost of $95 per visit. Self-pay visits were associated with slightly lower clinical need than insurance-covered visits, although this measure varied by income. The self-pay market for child mental health care potentially exacerbates inequities in access to care by burdening low-income families with high costs. Incentivizing mental health providers to participate in insurance for larger portions of their patient panels, for example, by increasing reimbursement rates and reducing paperwork, may help improve equitable access to mental health care. To the extent that reimbursement rates drive insurance acceptance, the frequency of self-pay mental health visits suggests that mental health services are underreimbursed relative to their benefit to patients and families.

Rising Cardiovascular Mortality Despite Increased Resource Utilization: Insights From the Nationwide Inpatient Sample Database.

Introduction The global burden of cardiovascular disease (CVD) has risen over the past decade, potentially escalating resource utilization, morbidity, and mortality. We analyzed trends in hospitalization for CVDs, outcomes of hospitalizations, and the impact of the COVID-19 pandemic on CVDhospitalizations between 2016 and 2020. Methods Adult CVD hospitalizations recorded in the2016-2020 nationwide inpatient sample (NIS) were identified using major diagnostic categories (MDC- class 5). The NIS is the largest all-payer repository of all hospitalizations in the USA within a calendar year. We compared sociodemographic factors andoutcomes (mortality, length of stay, and hospital charges) of CVD hospitalization before and during the pandemic using Pearson's χ2 tests.We used Stata ranking commands and ICD-10 (10th revision of the International Statistical Classification of Diseases and Related Health Problems) codes to identify the most recurring diagnoses associated with CVD mortality during the study period.Trends in mortality and resource use were assessed using theJonckheere-Terpstra trend test. Hospital charges wereadjusted for inflationusing the Medical Expenditure Panel Survey index. We used stepwise multivariate logistic regression analyses(P ≤ 0.05 for entry; P > 0.10 for removal) to identify covariates associated with cardiovascular mortality during the study period. Results Hospitalizations for CVDs rose from 4,283,502 in 2016 to 4,635,246 in 2019 (Ptrend< 0.001) and declined to 3,865,399 in 2020. 452,930 mortalities were recorded during the study period. In-hospital mortality rose from 111,090 (2.6%) in 2016 to 118,825 (2.8%) in 2020 (Ptrend< 0.001). Compared with the prepandemic years, mortality rates were higher during the pandemic (108,231 [2.8%] vs. 445,373 [2.5%]; P<0.001), and increased in hospitalizations for hypertensive heart disease with chronic kidney disease (CKD) (15,585[14.4%] vs. 45,873 [10.3%]; P<0.001), hypertensive heart disease with heart failure (7,468 [6.9%] vs. 21,378 [4.8%]), ventricular tachycardia (2,056 [1.9%] vs. 7,571 [1.7%]; P=0.022), and peripheral angiopathy with gangrene (1,191 [1.1%] vs. 3,118 [0.7%]; P<0.001). CVD hospitalizations totaled 80.3 million hospital days and 39.7 million hospital procedures during the period. The mean number of procedures (3 vs. 2) and mean length of hospital stay (5.6 vs. 4.5 days) increased during the pandemic (P<0.001). The mean hospital cost for CVD increased from US$ 69,394 in 2016 to US$ 89,728 in 2020 (Ptrend< 0.001). Conclusion CVD mortality increased despite increased resource use over the study period. Hospitalizations during the pandemic had poorer mortality and resource use outcomes than those in the preceding years.

Abstract SY15-02: Health insurance and outcome disparities in adolescents and young adults with cancer

Abstract SY15-02: Health insurance and outcome disparities in adolescents and young adults with cancer

Impact of increasing number of mental health conditions on healthcare costs and resource utilization among individuals with type 2 diabetes: a cross-sectional study

Abstract Objectives To evaluate the association between the number of mental health conditions among individuals with type 2 diabetes (T2D) and healthcare expenditures in the USA. Methods A cross-sectional study was conducted to evaluate the relationship between multiple mental health conditions (0, 1, and 2 or more mental health conditions) among individuals with T2D on healthcare expenditures using data from the 2019 US Medical Expenditure Panel Survey. Key findings A total of 24,091,931 weighted individuals with T2D were included for analysis; 76.8% had no co-occurring mental health conditions, 15.5% had one mental health condition, and 7.7% had two or more mental health conditions. Individuals with one and two or more mental health conditions had significantly greater total healthcare costs (+$7135 and +$7168), office-based costs (+$1196 and +$1483), prescription costs (+$2091 and +$3757), office-based visits (+3.55 and +6.46), and prescriptions fills (+13.97 and +26.77) than individuals with no mental health conditions. Conclusions Individuals with T2D and an increasing number of co-occurring mental health conditions were associated with increased healthcare costs and resource utilization. Underlying mechanisms for this relationship remain unclear, and further investigations are needed to accurately assess the impact this may have on health outcomes.

National Estimates of Incremental Work Absenteeism Costs Associated With Adult Children of Parents With Alzheimer's Disease and Related Dementias

ObjectiveMore than half of primary caregivers for ADRD patients are adult children, yet there is little empirical evidence on how caring for parents with ADRD affects their employment. Using a nationally representative dataset, this study aimed to estimate incremental work absenteeism costs for adult children of parents with ADRD. Design, Setting, and ParticipantsThe study used the data from the 2015–2021 Medical Expenditure Panel Survey (MEPS). Multivariate regressions and two-part models were employed to estimate the incremental work absenteeism costs among adult children aged 40 to 64 who had at least one parent diagnosed with ADRD, compared with those who did not have ADRD parents. MeasurementsThe incremental work absenteeism costs due to caregiving for adult children with ADRD parents was a cumulated estimation of labor productivity cost at three stages: (1) the likelihood of not working due to unemployment, (2) the likelihood of missing any workdays for caregiving, and (3) the number of workdays missed due to caregiving. ResultsAdult children with ADRD parents were more likely to be unemployed (OR = 1.80, p = 0.024) and 2.95 times more likely to miss work for caregiving (p = 0.002) than those with non-ADRD parents. The difference in the number of workdays missed for caregiving between children with and without ADRD parents was not significant. The incremental effects of having ADRD parents were estimated to be $4,510.29 ($1,702.09–$6,723.69) per person per year. ConclusionsHaving ADRD parents significantly increases the chances of unemployment and missing any workdays for caregiving, leading to higher lost labor productivity costs for adult children with ADRD parents.

The relationship between self-reported poor mental health and complete tooth loss among the US adult population in 2019.

Very little is known about the association between poor mental health and poor oral health outcomes in the United Sates. This study investigated the prevalence of complete tooth loss among those with and without perceived poor mental health in a nationally representative sample of noninstitutionalized U.S. adults. Using a cross-sectional study design, we analyzed the 2019 Medical Expenditures Panel Survey to determine the unweighted and weighted prevalence of complete tooth loss among adults. Chi-squared and multivariate logit regression with marginal effects were used to measure the association between complete tooth loss and perceived poor mental health, controlling for respondent characteristics. The prevalence of adults (ages 18 and older) experiencing complete tooth loss was 6% (95% CI: 5.6-6.4). Individuals who have perceived poor mental health were 1.90 percentage points (pps) more likely to report missing all their natural teeth (P = 0.006: 95% CI: 0.5-3.3). Other relevant predictors of complete tooth loss included current smoking status (5.9 pps; 95% CI: 4.5 to 7.2) and secondary education (-6.4 pps (95% CI: -7.0 to -4.8). Overall, self-reported poor mental health was found to be associated with a greater likelihood of reporting complete tooth loss. Findings from this study underscore the need for greater integration of care delivery between behavioral health specialists and dental providers.

Sound the Alarm: The Sonographer Shortage Is Echoing Across Healthcare.

The growth in ultrasound usage necessitates concurrent growth in the number of sonographers. Despite the increasing importance of ultrasound, there is a shortage of sonographers in the United States that has never been specifically quantified. This study examines recent trends in the number of ultrasound exams, sonography graduates, open sonographer positions, and wages. This retrospective study uses public databases and surveys including the Medical Expenditure Panel Survey (MEPS), Bureau of Labor Statistics (BLS), Integrated Postsecondary Education Data System (IPEDS), and Zippia, a human resources platform to determine metrics. These metrics include the number of ultrasound exams conducted in the United States (excluding inpatient setting), number of sonographers and sonographer wages, sonography graduates, and open sonographer positions. Ultrasound exams in the United States from 2011 to 2021 increased from 38.6 million to 59.8 million (+55.1%,) while the number of sonographers (2011-2021) increased from 54,760 to 78,640 (+43.6%). There was a significant difference between supply and demand of sonographers with the number of sonography graduates (2011-2021) increasing from 4,386 to 5,393 (+23.0%) while the number of open sonographer positions (2012-2021) increased from 18,462 to 25,162 (+36.3%). From 2011 to 2021, the increase in the number of ultrasound exams has significantly outpaced the increase in the number of sonographers. Furthermore, the increase in demand for sonographers has grown significantly faster than the supply, leading to a shortage and consequent strain on the healthcare system. To address the shortage, the number of sonography school openings should be increased, and the attendant challenges addressed.

The effects of dental hygienist autonomy on dental care utilization.

We investigate the effects of regulations governing the practice autonomy of dental hygienists on dental care use with the 2001-2014 Medical Expenditure Panel Survey. We measure the strength of autonomy regulations by extending the Dental Hygiene Professional Practice Index to the years 2001-2014, allowing us to capture changes in regulations within states over time. Using a difference-in-differences framework applied to selected states, we find that relaxing supervision requirements to provide dental hygienists moderate autonomy results in an increase in total dental visits due to greater use of preventive dental care. However, the use of dental treatment decreases when states adopt the highest level of autonomy. Both sets of estimates increase in magnitude when we subset the sample to dental care provider shortage areas. In support of these findings, we show that dental visits shift to dental hygienists in shortage areas when states expand the scope of practice of hygienists, and that there is an increase in tasks performed by hygienists, such as cleanings and dental exams.

Abstract 2250: Effects of loneliness on medical expenditures among US cancer survivors

Abstract Background: Social isolation in cancer survivors associates with diminished quality of life and worse survival. However, effects of loneliness on medical expenditure are understudied. We examined associations of loneliness with medical costs, and social/psychological/behavioral determinants of health (SDHs). Methods: We identified 1,866 cancer survivors from the 2021 Medical Expenditure Panel Survey. One has loneliness if answering ‘often’ for any of: feel lack companionship/left out/isolated from others. Two-part regression models assessed marginal effect of loneliness to annual total health care expenditure (cost) in cancer survivors, aged 18-64 (young) and ≥65 years (older), adjusting for age, sex, race, region, education, health insurance, comorbid illnesses, family income, unemployment, and activity limitation. Models were sequentially adjusted for every single SDH. Ordinal regression models assessed associations of loneliness with SDHs. Results: Over one-tenth of young (19%) and older (13%) cancer survivors reported loneliness. Loneliness was associated with higher cost in older cancer survivors (conditional coefficient (CC) 0.46, 0.12-0.81), but not young survivors (-0.14, -0.62-0.36). In both age groups, cancer survivors with loneliness more often reported stress, lack of help, as well as less time talking on the phone and getting together with support persons (Table). In older patients, sequential adjustment for stress, expected help, get-togethers, or church attendance decreased effect of loneliness to cost; among which get-togethers showed the greatest decrease (CC 0.28, -0.03-0.62). Conclusions: Loneliness was associated with higher total medical expenditure in older US cancer survivors. Findings warrant further study of personal or community support to mitigate loneliness, in an effort to reduce healthcare costs and financial burden in older cancer survivors. Age (year) 18-64 (648) ≥65 (1223) Loneliness No (505, 81%) Yes (143, 19%) No (1046, 87%) Yes (177, 13%) Mean Age (years) 56 56 75 74 Female % 64.5 66.4 53.0 59.1 Non-white % 23.1 21.8 15.8 26.4 Federal poverty level &amp;lt; 100%, % 7.4 18.9 8.9 7.2 Comorbidities ≥ 3, % 25.4 44.4 60.4 67.1 Unemployment ≥ 1, % 35.8 45.3 83.3 89.6 &amp;lt; high school % 30.8 33.7 37.7 36.6 Conditional coefficient (95% CI) Ref -0.14 (-0.62-0.36) Ref 0.46 (0.12-0.81) Odds ratio (95% CI) of loneliness to SDHs Stress Ref 8.42 (5.20-13.63) Ref 6.82 (4.72-9.87) Lack of help - family 3.46 (2.32-5.14) 2.61 (1.88-3.60) Lack of help - friends 3.25 (2.00-5.29) 1.92 (1.36-2.72) Lack of help - community 2.45 (1.64-3.66) 2.16 (1.58-2.96) Times of talk on phone 0.55 (0.36-0.85) 0.77 (0.55-1.07) Times of get together 0.34 (0.21-0.55) 0.38 (0.25-0.58) Citation Format: Fangyuan Chen, Ryan Nipp, Xuesong Han, Zhiyuan Zheng, Robin Yabroff, Changchuan Jiang. Effects of loneliness on medical expenditures among US cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2250.

Abstract 4859: Mental health of early-onset and late-onset cancer survivors

Abstract Background: Psychiatric disorders such as anxiety and depression are shown to be common when diagnosed with early-onset cancer, often defined as cancers diagnosed in adults &amp;lt;50 years of age. We hypothesize that the mental health of early-onset cancer survivors is negatively affected compared to late-onset cancer survivors. Methods: We identified cancer survivors in the Medical Expenditure Panel Survey 2021 Full Year Consolidated Data File. We categorized cancer survivors as early-onset (≤ 50 years of age) and late-onset (&amp;gt; 50 years of age). We examined the proportion of mood and anxiety disorders, and the proportion of antidepressant and antianxiety medication use among the early and late-onset cancer survivors. We conducted chi-square tests and multivariable logistic regression models by adjusting for sex and race. Results: We identified 291 early-onset cancer survivors (mean age 41 years, 71% female) and 2556 late-onset cancer survivors (mean age 71 years, 56% female). Among the early-onset cancer survivors, 18% had mood disorders (17% took antidepressants) and 20% had anxiety disorders (6% took antianxiety medication). In comparison, 12% late-onset cancer survivors had mood disorders (21% took antidepressants) and 13% had anxiety disorders (8% took antianxiety medication). Early-onset cancer survivors were more likely to develop mood (Adjusted Odds Ratio (aOR)=1.45; 95% CI=1.06 - 1.99) and anxiety (aOR=1.42; 95% CI=1.05 - 1.92) disorders compared to late-onset cancer survivors. However, there were no differences in receiving antidepressants (aOR=0.79; 95% CI=0.57 - 1.09) or antianxiety (aOR=0.69; 95% CI=0.41 - 1.16) medication between early and late-onset cancer survivors when adjusting for sex and race. Conclusion: Early-onset cancer survivors had an elevated risk of acquiring psychiatric disorders such as mood and anxiety disorders than late-onset cancer survivors, but treatment was suboptimal. Clinician and patient awareness can help narrow the gaps of treatment for early-onset cancer survivors. Table 3. Odds Ratio for early-onset vs. late-onset cancer survivors (*Sex and Race adjusted) Variables Crude Odds Ratio Adjusted Odds Ratio * Mood Disorders 1.48 (1.09 - 2.00) 1.45 (1.06 - 1.99) Anxiety Disorder 1.52 (1.13 - 2.03) 1.42 (1.05 - 1.92) Antidepressants 0.80 (0.59 - 1.10) 0.79 (0.57 - 1.09) Antianxiety 0.70 (0.42 - 1.17) 0.69 (0.41 - 1.16) Citation Format: Jayden H. Lee, Jaejin An. Mental health of early-onset and late-onset cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4859.

Exploring the association between social determinants and aphasia impairment: A retrospective data integration approach.

Traditionally, the study of aphasia focused on brain trauma, clinical biomarkers, and cognitive processes, rarely considering the social determinants of health. This study evaluates the relationship between aphasia impairment and demographic, socioeconomic, and contextual determinants among people with aphasia (PWA). PWA indexed within AphasiaBank-a database populated by multiple clinical aphasiology centers with standardized protocols characterizing language, neuropsychological functioning, and demographic information-were matched with respondents in the Medical Expenditure Panel Survey based on response year, age, sex, race, ethnicity, time post stroke, and mental health status. Generalized log-linear regression models with bootstrapped standard errors evaluated the association between scores on the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R AQ) and demographic, economic, and contextual characteristics accounting for clustering of respondents and the stratification of data collection. Region, age, and income specific models tested the sensitivity of results. PWA over age 60 had 2.4% (SE = 0.020) lower WAB-R AQ scores compared with younger PWA. Compared to White PWA, Black and Hispanic PWA had 4.7% (SE = 0.03) and 0.81% (SE = 0.06) lower WAB-R AQ scores, respectively, as did those and living in the Southern US (-2.2%, SE = 0.03) even after controlling for age, family size, and aphasia type. Those living in larger families (β = 0.005, SE = 0.008), with income over $30,000 (β = 0.017, SE = 0.022), and a college degree (β = 0.030, SE = 0.035) had higher WAB-R AQ relative to their counterparts. Region-specific models showed that racial differences were only significant in the South and Midwest, while ethnic differences are only significant in the West. Sex differences only appeared in age-specific models. Racial and ethnic differences were not significant in the high-income group regression. These findings support evidence that circumstances in which individuals live, work, and age are significantly associated with their health outcomes including aphasia impairment.

Abstract P102: Costs, Accessibility, and Utilization: Disparities in Anti-Arrhythmic Drug Use in Atrial Fibrillation Patients

Background: Patients with atrial fibrillation (AF) have an increased risk of stroke, heart failure, and other cardiac-related complications. AF is recognized as a significant contributor to rising healthcare costs due to increased hospitalizations, medical visits, and medications. However, utilization and costs of anti-arrhythmic drugs (AADs) for AF treatment remain unknown. Methods: This cross-sectional study uses data from the Medical Expenditure Panel Survey for 2016-21 and includes AF patients prescribed Class I-V AADs. Our survey-weighted model calculates national estimates and adjusted odds ratios (OR) for associations between demographic factors, days of medication supplied, and out-of-pocket (OOP) cost. Results: Patients with AF were significantly more likely to receive the lowest decile of days’ supply of AADs (&lt;85 days) if they were below age 60 (OR 4.93, p = 0.005) compared to patients older than age 80 or insured through only Medicare (OR 2.93, p = 0.023) or other federal or state insurances (OR 3.70, p = 0.007) compared to private insurance. Compared to patients with a family income of less than $15k per year, AF patients were significantly more likely to pay in the top decile for cost per day supply of AADs (91 cents/day) if they had a family income between $15-30K. AF patients with Medicaid were significantly less likely to pay in the top decile for cost per day supply of AADs (OR 0.19, p = 0.001) compared to patients with private insurance. Patients with AF underutilized AADs significantly more in 2021 compared to 2016 (OR 3.28, p = 0.029). Conclusions: Younger age and public insurance were associated with a lower days’ supply of AADs for AF patients. Patients with a family income around the typical state’s Medicaid income limit ($15-30K) pay significantly higher OOP costs for AADs. To increase AAD adherence, policies should aim to decrease AAD cost for patients marginally above public insurance income limits and to educate patients below age 60 on the importance of AADs in treating AF.

Abstract P225: Heartfelt Savings: Health Savings Accounts Assist in Alleviating Financial Burdens and Prompt Timely Treatment for Patients With Cardiovascular Disease

Background: Cardiovascular diseases (CVD) are among most costly in the U.S, with a significant portion of CVD patients unable to afford care. Use of health savings accounts (HSA) to increase financial savings for medical expenditures is controversial. While HSA have shown to not decrease medical expenditures, the financial impact of HSA on patients with CVD remains unknown. Methods: This cross-sectional study used data from the Medical Expenditure Panel Survey for 2014-19 and included patients aged 18-64 who reported having at least one CVD (i.e., hypertension, angina, myocardial infarction, heart failure, stroke, or all other CVD). A survey-weighted model was utilized to determine the adjusted odds ratios (OR) for associations between CVD patients with HSA and 1) demographics factors and 2) metrics associated with financial difficulty by adjusting for age, sex, race, total out of pocket (OOP) yearly premiums, total yearly medical expenditures, total OOP yearly medical expenditures, total yearly income, annual deductibles, and other demographic factors (Figure 1) . Results: CVD patients with HSA were significantly less likely to experience financial difficulties such as affording medical care (OR 0.586, 95% CI 0.344-0.998, p = 0.049) and trouble paying medical bills (OR 0.762, 95% CI 0.582-0.996, p = 0.047). Furthermore, CVD patients with HSA were significantly less likely to delay medical care (OR 0.614, 95% CI 0.389-0.970, p = 0.037) and preventive medicine (OR 0.575, 95% CI 0.336-0.983, p = 0.046) due to cost. However, CVD patients who earn lower income, self-identify as Hispanic or Black, from the South or West, or have lower years of education were significantly less likely to benefit from an HSA (Figure 1) . Conclusions: CVD patients with HSA were significantly associated with decreased financial difficulties and were less likely to delay care. Policies intended to support minority and lower-income CVD patients such as increased financial education may reduce healthcare disparities and promote access to care.

Racial/Ethnic Disparities in Use of Angiotensin II Receptor Type 2/4 Stimulatory Vs. Inhibitory Antihypertensive Among Hypertensive Adults in theUSA.

Studies showed angiotensin II type 2 receptor/angiotensin II type 4 receptor (AT2R/AT4R) stimulatory antihypertensive was associated with a lower risk of dementia and cognitive impairment compared to the inhibitory one. This study aimed to identify the racial and ethnic differences in using these agents among theUSA adults with hypertension. A cross-sectional study was conducted using data from the Medical Expenditure Panel Survey (MEPS, 2016-2019). Individuals with a diagnosis of hypertension or self-reported hypertension and without dementia or Alzheimer's disease diagnosis were included in the analysis. We applied two multivariable logistic regressions to compare racial/ethnic differences in AT2R/AT4R stimulatory antihypertensive use and AT2R/AT4R inhibitory antihypertensive use, adjusting for covariates. Twenty-four thousand five hundred eighty-one individuals with hypertension and without dementia or Alzheimer's disease were identified. Among non-Hispanic Whites, 72.39% were using AT2R/AT4R inhibitory antihypertensive agents, vs. 66.97% using AT2R/AT4R stimulatory antihypertensive agents. In contrast, both non-Hispanic Black and Asian Americans were using more AT2R/AT4R stimulatory agents than inhibitory ones (16.40% vs. 12.16% and 4.79% vs. 3.43%, respectively). Compared to non-Hispanic White, non-Hispanic Black (OR 1.980, 95% CI 1.839-2.132) and non-Hispanic Asian Americans (OR 1.545, 95% CI 1.356-1.761) were significantly associated with higher odds of prescribing AT2R/AT4R stimulatory agents, while Hispanics (OR 0.744, 95% CI 0.685-0.808) were associated with lower odds of prescribing AT2R/AT4R inhibitory agents compared to non-Hispanic Whites. The results showed that the high-dementia risk populations like non-Hispanic Black and Asian American races are proportionally prescribed with higher use of low-dementia risk antihypertensive agents, compared to non-Hispanic Whites.

The Affordable Care Act and Racial Disparities in Healthcare Utilization: New Evidence From Employer Mandate

The 2010 United States Affordable Care Act (ACA) mandates small and mid-size firms to provide health insurance for full-time workers. This study investigates whether a key provision of the ACA employer mandate has reduced racial disparities in health services use among uterine cancer (UC) survivors. Employing a nationally representative Medical Expenditure Panel Survey (MEPS) data from 2008 to 2017 and the Difference-in-Differences empirical model, we find that the ACA employer mandate increases the utilization of pap smear tests among all groups of UC survivors. Additionally, our results suggest a rise in physician's office visits among non-Hispanic Black and Hispanic UC survivors driven by the announcement of the employer mandate in the post-ACA period. Our results further suggest a reduction in out-of-pocket prescription drug expenditure among UC survivors of racial and ethnic minorities. Study findings have implications for improving ethnic minority female population health outcomes.

Health care Utilization and Expenditures in Health Professional Shortage Areas.

Healthcare provider shortages are associated with adverse health outcomes, presumably stemming from the lack of access to primary care. This study examines the impact of Health Professional Shortage Areas (HPSAs) on healthcare utilization and spending across different types of care. Using the Medical Expenditure Panel Survey from 2002 to 2019, this study estimates the difference in healthcare utilization in HPSAs compared with non-HPSAs using a generalized random forest, which allows for more complex modeling of the outcome and a principled examination of heterogenous treatment effects. The results indicate HPSAs are associated with a 5% reduction in medical office visits, but no reduction in hospital-based care. These effects are concentrated in older persons living in urban areas, Black persons, and Medicaid beneficiaries. No statistically significant effects on annual spending were observed. These results offer insight into potential areas for further policy efforts aimed at reducing provider shortages.

Association between self-reported pain severity and characteristics of United States adults (age ≥50 years) who used opioids.

The aim of this study was to assess the associations between the characteristics of United States (US) adults (≥50 years) who used opioids and self-reported pain severity using a nationally representative dataset. This retrospective cross-sectional database study used 2019 Medical Expenditure Panel Survey data to identify US adults aged ≥50 years with self-reported pain within the past 4 weeks and ≥1 opioid prescription within the calendar year (n = 1,077). Weighted multivariable logistic regression analysis modeled associations between various characteristics and self-reported pain severity (quite a bit/extreme vs less/moderate pain). The adjusted logistic regression model indicated that greater odds of reporting quite a bit/extreme pain was associated with the following: age 50-64 vs ≥65 (adjusted odds ratio [AOR] = 1.76; 95% confidence interval [CI] = 1.22-2.54), non-Hispanic vs Hispanic (AOR = 2.0; CI = 1.18-3.39), unemployed vs employed (AOR = 2.01; CI = 1.33-3.05), no health insurance vs private insurance (AOR = 6.80; CI = 1.43-32.26), fair/poor vs excellent/very good/good health (AOR = 3.10; CI = 2.19-4.39), fair/poor vs excellent/very good/good mental health (AOR = 2.16; CI = 1.39-3.38), non-smoker vs smoker (AOR = 1.80; CI = 1.19-2.71), and instrumental activity of daily living, yes vs no (AOR = 2.27; CI = 1.30-3.96). Understanding the several characteristics associated with pain severity in US adults ≥50 years who used an opioid may help transform healthcare approaches to prevention, education, and management of pain severity in later life.

Catastrophic health expenditures: a disproportionate risk in uninsured ethnic minorities with diabetes

BackgroundChargemaster prices are the list prices that providers and health systems assign to each of their medical services in the US. These charges are often several factors of magnitude higher than those extended to individuals with either private or public insurance, however, these list prices are billed in full to uninsured patients, putting them at increased risk of catastrophic health expenditures (CHE). The objective of this study was to examine the risk of CHE across insurance status, diabetes diagnosis and to examine disparity gaps across race/ethnicity.MethodsWe perform a retrospective observational study on a nationally representative cohort of adult patients from the Medical Expenditure Panel Survey for the years 2002–2017. Using logistic regression models we estimate the risk of CHE across insurance status, diabetes diagnosis and explore disparity gaps across race/ethnicity.ResultsOur fully adjusted results show that the relative odds of having CHE if uninsured is 5.9 (p < 0.01) compared to if insured, and 1.1 (p < 0.01) for patients with a diabetes diagnosis (compared to those without one). We note significant interactions between insurance status and diabetes diagnosis, with uninsured patients with a diabetes diagnosis being 9.5 times (p < 0.01) more likely to experience CHE than insured patients without a diabetes diagnosis. In terms of racial/ethnic disparities, we find that among the uninsured, non-Hispanic blacks are 13% (p < 0.05), and Hispanics 14.2% (p < 0.05), more likely to experience CHE than non-Hispanic whites. Among uninsured patients with diabetes, we further find that Hispanic patients are 39.3% (p < 0.05) more likely to have CHE than non-Hispanic white patients.ConclusionsOur findings indicate that uninsured patients with diabetes are at significantly elevated risks for CHE. These risks are further found to be disproportionately higher among uninsured racial/ethnic minorities, suggesting that CHE may present a channel through which structural economic and health disparities are perpetuated.