Medical Expenditure Panel Survey Research Articles

Autism and Medical Complexity Among Children in the United States.

Ongoing systems-level changes aim to better identify and remedy the unmet health care needs of children with medical complexity (CMC). In tandem, home- and community-based services are expanding to support autistic children and their families. Despite the potential for overlap, CMC and autistic children are treated independently in services, research, and policy. We estimated the overlapping prevalence of CMC and autism among US children and health care expenditures for autistic CMC in comparison with other children. We analyzed 2 national cross-sectional surveys: the National Survey of Children's Health (NSCH; 2017-2018, 2019-2022, and 2021-2022) and the Medical Expenditures Panel Survey (MEPS; combined 2010-2021), selecting for children aged 0 to 17years. CMC were defined using 2 different algorithms varying in stringency. In the most recent 2021 to 2022 NSCH (n = 103 748), the prevalence of CMC among autistic children was 59.28% (95% CI, 55.61%-62.84%) using one algorithm and 17.56% (95% CI, 14.41%-21.24%) using the more stringent algorithm. Forty-one percent of CMC were autistic using either algorithm. In the MEPS data (n = 55 637), autistic CMC had significantly greater median health care expenditures compared with other CMC and other autistic children. There is extensive overlap of CMC and autism among children in the United States. When medical complexity and autism are both evident, expenditures are significantly higher than for either category alone. Despite this overlap and the associated high need, CMC and autism are generally treated as separate groups in services, research, and policy. These findings underscore the importance of cohesively understanding service needs across CMC, autistic children, and their caretakers.

Prevalence of Neurologic Disease Among Those in Same-Sex Relationships: Evidence from the Medical Expenditure Panel Survey.

Prior research has shown several health disparities affecting sexual minority people. Research on the neurologic health of sexual minority people has been limited. Our objective was to characterize the prevalence of neurologic disease and utilization of a neurologist among a population of sexual minority people. We conducted a cross-sectional analysis of sexual minority people, using people in same-sex relationships as a proxy for sexual minority status, from the Medical Expenditure Panel Survey (MEPS) from 2016 to 2020. The MEPS is a government-run survey that uses complex sampling to obtain a nationally representative sample. Our primary outcome was a diagnosis of any neurologic disease. We also completed stratified analyses by sex, race, and ethnicity. Our secondary outcome was visit to a neurologist within the past year. Logistic regression was used to compare the odds of both outcomes in those in same-sex relationships and those in different-sex relationships. Among 153,313 MEPS participants, there were 61,645 (40.2%) participants in relationships who were included in our sample. Of those, 822 (1.33%) participants were in same-sex relationships. Participants were, on average, aged 51 years (median 50 years, IQR 38-63); nearly 50% reported female sex and mostly non-Hispanic White (67.81%). Among those in same-sex relationships, 22.7% reported a neurologic diagnosis compared with 18.1% of those in different-sex relationships (OR 1.33; 95% CI 1.04-1.71). This difference was maintained with adjustment for age, sex, education, and insurance (OR 1.48; 95% CI 1.15-1.91). There was no significant difference in visit to a neurologist (adjusted OR 1.38; 95% CI 0.91-2.10). In this nationally representative sample, neurologic disease was more prevalent among those in same-sex relationships compared with those in different-sex relationships. Limited sample size and absent measurements of minority stress limited the etiologic search for factors driving this disparity. There was no significant difference in visit to a neurologist, and both groups reported their overall health as being similar. There is a need for more routine measurement of sexual orientation in neurologic research. This will allow us to detail differences in neurologic disease risk factors, prevalence, and outcomes. The end goal is the identification of opportunities for intervention and advancement of neurologic health equity.

Psychological Distress in Adults With Myocardial Infarction: Implications for Health Care Utilization and Expenditure.

Myocardial infarction (MI) poses a major financial burden on the U.S. health care system, but its impact on medical expenses and health care utilization when coupled with psychological distress remains unknown. The study aims to investigate the association between psychological distress and healthcare utilization and medical expenditures in adults with a history of MI. We analyzed the 2017-2021 Medical Expenditure Panel Survey to identify 44,716 adults with a history of MI. Psychological distress was measured using the Kessler (K6) questionnaire, with a score of≥13 indicating clinically significant distress. Differences in medical expenditures and health care utilization between patients with MI with and without psychological distress were assessed using weighted generalized linear and negative binomial regression models. Expenditures, medical visits, and prescribed medications are reported as means and 95%CI. Among 9,773,458 weighted adults, 970,049 experienced psychological distress. Adults with MI and psychological distress were younger, more likely to be female (51.1% vs 37.5%; P<0.001), less educated (11.1 vs 12.5years; P<0.001), lower income, and were more likely to have public insurance, compared to those without psychological distress. Adults with psychological distress and a history of MI had higher average medical expenses ($31,577 vs $15,830;P<0.001) and greater health care utilization including office visits (8.3 vs 5.7; P=0.01), inpatient visits (0.6 vs 0.3; P<0.001), emergency room visits (0.7 vs 0.3; P<0.001), and prescribed medications including refills (42.3 vs 28; P<0.001). Psychological distress is correlated with increased medical expenditures and health care utilization in patients with MI. This research highlights the need for interventions addressing psychological needs in patients with MI.

Health Care Utilization and Expenditure Associated With Musculoskeletal Disorders Among Adults With Type 2 Diabetes: A Cross-Sectional Study.

Adults with type 2 diabetes (T2D) often experience musculoskeletal disorders (MSDs), which complicate health care provision and negatively impact their health and health care utilization and expenditure. The objective of this study was to estimate the incremental health care utilization and expenditure associated with MSD among adult T2D patients in the United States overall and by race/ethnicity. A sample (unweighted n=6205) of noninstitutionalized US adults with a T2D diagnosis was obtained from the Medical Expenditure Panel Survey (MEPS), panels 2015-2016 to 2019-2020. Propensity score matching (PSM) was used to reduce selection bias between participants with and without MSD. Differences in health care utilization were estimated using negative binomials, while expenditures were estimated using generalized linear models and 2-part models. Outcomes were estimated overall and by race and ethnicity. Among the sample of patients with T2D before PSM, 52% had MSD. In the matched sample, increased utilization associated with MSD occurred across all health care service types, with prescription medications (13.31; 95% CI: 11.12, 15.50) having the largest increase. The increased total expenditure associated with MSD among T2D patients was $5712 (95% CI: $4278, $7147), and the major drivers were office and inpatient expenditures. Increased total expenditure associated with MSD was highest among Hispanic patients ($8490; 95% CI: $4744, $12,237). MSD is associated with increased utilization and expenditure among T2D patients, particularly Hispanics. Efforts targeting earlier recognition and management of MSD may reduce excess utilization and expenditure, and also racial/ethnic disparities.

Patient-provider communication for lonely, socially isolated adults in Medicare.

Older adults experiencing loneliness or social isolation may experience poor patient-provider communication, potentially contributing to suboptimal health care utilization, particularly in mental health care. However, empirical evidence is limited. Thus, this study examined whether there were differences in patient-provider communication and health care utilization between Medicare beneficiaries with and without loneliness and social isolation. This study conducted a cross-sectional study using data from the 2021 Medical Expenditure Panel Survey. Outcomes were patient-provider communication and health care utilization. The primary independent variables were loneliness and social isolation. Regression analysis was conducted to estimate adjusted differences in outcomes between Medicare beneficiaries with and without loneliness and social isolation. The analysis was conducted in September 2024. The sample included 4,433 Medicare beneficiaries. Medicare beneficiaries experiencing loneliness were 4.0 percentage points (95% CI: 1.0-7.1) more likely to report poor patient-provider communication compared to those without loneliness. Similarly, those with social isolation were 2.0 percentage points (1.1-2.9) more likely to report poor communication than those without social isolation. The rates of mental health care utilization were higher among those with loneliness (1.8 [1.0-2.6], 1.5 [0.8-2.2], and 3.1 [1.1-5.1] for social workers, psychologists, and psychiatrists) or social isolation (2.3 [0.6, 4.0] for psychiatrists), but the overall level of mental health care utilization remained relatively low. These findings highlight significant disparities in patient-provider communication among Medicare beneficiaries experiencing loneliness and social isolation. These disparities may partly result from limited engagement with mental health services, which could help address their specific health care needs.

Race and Ethnicity as Factors in Healthcare Discrimination in the United States: A Cross-Sectional Study.

Discrimination is the unfair or prejudicial treatment of people and groups based on certain characteristics. Discrimination in health care can impede access to quality care for patients and lead to poor health outcomes. This study aimed to investigate factors, including race and ethnicity, associated with discrimination in health care in the United States. A cross-sectional study utilizing the 2021 Medical Expenditure Panel Survey (MEPS) was conducted. Adults (≥ 18years old) who responded to questions about discrimination in health care were identified. Population characteristics were summarized using weighted mean, standard deviation, and percentages. A weighted t-test for continuous variables and a chi-square test for categorical variables were used to compare subject characteristics. Weighted logistic regression was used to explore factors associated with discrimination in health care, while controlling for important covariates. A total of 238,097,086 participants (unweighted n = 17,239) were included in the study. Average (SD) age of the population was 48 (18) years old in 2021 and 52% were female. Compared to non-Hispanic White population, non-Hispanic Black and non-Hispanic other races were more likely to experience discriminated when receiving health care by 285% (OR = 3.85, p < 0.001) and 207% (OR = 3.07, p < 0.001), respectively. Females were also more likely to experience discrimination than males (OR = 1.97, p < 0.001). Other factors associated with discrimination in health care were asthma diagnosis, being a smoker and poverty. Discrimination in health care is associated with being part of a minority racial and ethnic groups, being female, being an older individual, being a smoker and living in poverty. These associations may contribute to inequitable health outcomes in the United States.

Relationship between influenza-related experience and current vaccination outcome

BackgroundThis study investigated how a person’s influenza-related experience, together with demographic, socioeconomic, and health-related factors, was associated with their current vaccination decisions.MethodsThe analysis used ten panels of the Medical Expenditure Panel Survey (MEPS) from 2006 to 2016. Linear and logistic probability models were estimated to predict influenza vaccination using a person’s vaccination status in the previous year and history of influenza infection, adjusting for demographics, socioeconomic variables, general health status, and healthcare access. The models used two-way and three-way interactions with race/ethnicity, income, education, health status, and elderly status to examine changing relationships of flu-related experience across these variables.ResultsPrevious vaccination was the most important predictor, with an increase of 63.0–71.8% probability of vaccination in the next year. Infection history could either increase or decrease the impact of past vaccination depending on race/ethnicity, income, education level, health status, and age. There were significant disparities across demographic, socioeconomic, and health-related variables.ConclusionVaccination promotion efforts could focus on those who have not been vaccinated in the past and on specific sub-populations, such as people who are Hispanic, people with lower education levels, the population aged 65 and above, and families with low-income levels. Although past infection is a predictor for some population groups, its magnitude is small and is often not a significant determinant.

Use and Costs of Supplemental Benefits in Medicare Advantage, 2017-2021

Nearly all Medicare Advantage (MA) plans offer dental, vision, and hearing benefits not covered by traditional Medicare (TM). However, little is known about MA enrollees' use of those benefits or how much they cost MA insurers or enrollees. To estimate use, out-of-pocket (OOP) spending, and insurer payments for dental, hearing, and vision services among Medicare beneficiaries. This cross-sectional analysis used pooled 2017-2021 Medical Expenditure Panel Survey (MEPS) and Medicare Current Beneficiary Survey (MCBS) data for MA and TM beneficiaries (excluding those also covered by Medicaid). The analysis was performed from September 10, 2023, to June 30, 2024. MA compared with TM coverage. The main outcome was receipt of eye examinations, corrective lenses, hearing aids, optometry and dental visits, and MA and TM enrollees' and insurers' spending for such services. MEPS and MCBS data were weighted to be nationally representative. We included 76 557 non-dually eligible Medicare beneficiaries, including 23 404 from the MEPS and 53 153 from the MCBS. Weighted demographic characteristics of MA and TM beneficiaries were similar (54.7% and 51.9% female; 39.8% and 35.2% older than 75 years, respectively). Only 54.2% (95% CI, 52.4%-55.9%) and 54.3% (95% CI 52.2%-56.3%) of MA beneficiaries were aware of having MA dental and vision coverage, respectively. MA enrollees were no more likely to receive eye examinations, hearing aids, or eyeglasses than TM enrollees. After adjustment for demographic differences, MA and TM enrollees paid OOP $205.86 (95% CI, $192.44-$219.27) and $226.12 (95% CI, $212.02-$240.23), respectively, for eyeglasses (MA - TM difference, -$20.27 [95% CI, -$33.77 to -$6.77] or -9.0% [95% CI, -14.9% to -3.0%]); $226.82 (95% CI, $202.24-$251.40) and $249.98 (95% CI, $226.22-$273.74) for dental visits, respectively (MA - TM difference, -$23.16 [95% CI, -$43.15 to -$3.17] or -9.3% [95% CI, -17.3% to -1.3%]); and no less for optometry visits or durable medical equipment (a proxy for hearing aids). Nationwide, MA plans' annual spending on vision, dental services, and durable medical equipment totaled $3.9 billion (95% CI, $3.3-$4.4 billion), while enrollees spent OOP $9.2 billion (95% CI, $8.2-$10.2 billion) annually for these services and other private insurers covered $2.8 billion (95% CI, $2.7-$3.0 billion). In this cross-sectional study of 2 nationally representative surveys, MA beneficiaries did not receive more supplemental services than TM beneficiaries, possibly because of cost-sharing and limited awareness of benefit coverage.

Trends in Obesity Care Among US Adults, 2010-2021.

Obesity is a major contributor to mortality in the United States. Clinical guidelines emphasize the need for multimodal treatment, but novel treatments may be changing care-seeking behavior. To characterize obesity treatment access patterns and factors associated with obesity care from 2010 to 2021 in the United States. This multiyear cross-sectional study was conducted using Medical Expenditure Panel Survey (MEPS) data, covering respondents from 2010 to 2021. We defined individuals with a BMI ≥30 or those with any health care event linked to a diagnosis of obesity as being clinically eligible for obesity treatment. The primary outcome was the proportion of individuals assumed eligible for obesity treatment who accessed obesity treatment or were prescribed medication to treat obesity in each calendar year from 2010 to 2021. The population of individuals eligible for obesity treatment was 82,729. In total, 1311 (1.6%) reported receiving treatment for obesity. The proportion of participants receiving a prescription for obesity increased from 0.3% (0.2%, 0.6%) in 2010 to 1.8% (1.3%, 2.5%) in 2021. Multivariable logistic regression found that female individuals, older individuals, and those with higher levels of education had higher odds of accessing obesity medication or any obesity treatment. Utilization of pharmaceutical and nonpharmaceutical obesity treatment has increased from 2010 to 2021 but remains low. The likelihood of receiving treatment was lower for groups with lower socioeconomic status. As more effective obesity therapies become available, efforts should be made to ensure equitable access.

Delayed or forgone medical care associated with increased resource utilization and health care expenditures among patients with peripheral artery disease in the United States.

PAD affects >12 million Americans and poses significant financial burdens on patients, but the relationship between delayed/forgone (D/F) care and resource use in this population is unknown. We sought to assess the relationship between D/F care, resource use, and health care expenditures among patients with PAD. Adults with PAD in the US were identified in the Medical Expenditure Panel Survey for years 2007-2017. Unweighted counts of reasons for D/F care were tabulated. Proportions of patients with ≥1 emergency department (ED), ≥1 inpatient, ≥1 outpatient, and >5 office-based encounters were compared using Rao-Scott adjusted Chi-Squared tests. Annual per capita total, out-of-pocket (OOP), ED, inpatient, outpatient, office-based visit, and prescription medication expenditures were compared using two-part econometric models. The study cohort included 2,926,654 patients with PAD. Among the 264,172 (9%) of patients with PAD reporting D/F care, 41.2% of patients cited financial barriers as the primary reason for D/F care. There were greater proportions of patients with ≥1 ED visits (52% vs 31%, P<0.001), ≥1 outpatient hospital visits (56% vs 43%, P=0.004), and >5 office-based visits (81% vs 71%, P=0.04) among those reporting D/F care versus those who did not. Patients with D/F care had $7,742 (95% CI $3,170-$12,314, P=0.001) greater per capita total and $5,156 (95% CI $692-$9,619, P=0.02) greater per capita inpatient expenditures per year than patients without D/F care. D/F care is associated with increased resource use and health care expenditures among patients with PAD. Further work is needed to elucidate the underlying causes of D/F care and mitigate financial burdens on PAD patients.

The Impact of Anxiety and Depression on Health-Related Quality of Life in Hyperlipidemic Adults in the United States.

Background: Mental health issues can significantly affect the health-related quality of life (HRQoL) of adults suffering from hyperlipidemia. Therefore, in this study, the aim was to examine how depression and anxiety are related to the HRQoL of adults with hyperlipidemia. Methods: Data from the Medical Expenditure Panel Survey for 2016 through 2022 were used to identify adult patients diagnosed with hyperlipidemia aged 18 or older. The RAND-12 Physical and Mental Component Summary (PCS and MCS) was used to determine HRQoL. After considering variables such as age, gender, socioeconomic status, and comorbidities, linear regression was used to investigate the relationship between anxiety, depression, and HRQoL in individuals with hyperlipidemia. Results: A sample of 7984 adults with hyperlipidemia was identified; 9.0% experienced depression, 10.2% had anxiety, and 6.8% had both disorders. The HRQoL mean scores were lowest for adults with depression and anxiety compared to those with hyperlipidemia only. Results from the adjusted linear regression analysis revealed that hyperlipidemia patients with depression (MCS: β = -5.535, p-value < 0.0001), anxiety (MCS: β = -4.406, p-value < 0.0001), and both depression and anxiety (MCS: β = -8.730, p-value < 0.0001) had a significantly lower HRQoL compared to patients with hyperlipidemia only. However, in this study, it was also found that those who were physically active and employed had notably higher scores on the PCS and MCS than those who were not. Conclusions: The links between anxiety, depression, and lower HRQoL in patients with hyperlipidemia are clarified in this nationally representative study. This research also revealed the adverse effects of coexisting chronic conditions on HRQoL while emphasizing the benefits of employment and regular exercise. Importantly, these findings provide a compelling case for enhancing healthcare planning, allocating resources, and promoting lifestyle changes in adults with hyperlipidemia, underlining the importance of addressing mental health issues in this population.

Cost-Effectiveness of a Polypill for Cardiovascular Disease Prevention in an Underserved Population

The Southern Community Cohort Study (SCCS) Polypill Trial showed that a cardiovascular polypill (a single pill containing a statin and 3 half-standard dose antihypertensive medications) effectively controls cardiovascular disease (CVD) risk factors in a majority Black race and low-income population. The cost-effectiveness of polypill treatment in this population has not been previously studied. To determine the cost-effectiveness of the cardiovascular polypill. A discrete-event simulation version of the well-established CVD policy model simulated clinical and economic outcomes of the SCCS Polypill Trial from a health care sector perspective. A time horizon of 10 years was adopted. Polypill treatment was priced at $463 per year in the base-case analysis. Model input data were derived from the National Health and Nutrition Examination Survey, Medical Expenditure Panel Survey, pooled longitudinal cohort studies, the SCCS Polypill Trial, and published literature. Two cohorts were analyzed: an SCCS Polypill Trial-representative cohort of 100 000 individuals and all trial-eligible non-Hispanic Black US adults. Study parameters and model inputs were varied extensively in 1-way and probabilistic sensitivity analysis. Polypill treatment or usual care. Primary outcomes were direct health care costs (US dollar 2023) and quality-adjusted life-years (QALYs), both discounted 3% annually, and the incremental cost per QALY gained. In the trial-representative cohort of 100 000 individuals (mean [SD] age, 56.9 [5.9] years; 61 807 female [61.8%]), polypill treatment was projected to yield a mean of 1190 (95% uncertainty interval, 287-2159) additional QALYs compared with usual care, at a cost of approximately $10 152 000. Hence, polypill treatment was estimated to cost $8560 per QALY gained compared with usual care and was high value (<$50 000 per QALY gained) in 99% of simulations. Polypill treatment was estimated to be high value when priced at $559 or less per year and cost saving when priced at $443 or less per year. In almost all sensitivity analyses, polypill treatment remained high value. In a secondary analysis of 3 602 427 trial-eligible non-Hispanic Black US adults (mean [SD] age, 55.4 [7.6] years; 2 006 597 female [55.7%]), polypill treatment was high value, with an estimated cost of $13 400 per QALY gained. Results of this economic evaluation suggest that polypill treatment could be a high value intervention for a low-income, majority Black population with limited access to health care services. It could additionally reduce health disparities.

Racial Disparities in Access to Preventive Dental Services in Pediatric Population: A Secondary Data Analysis.

Though preventive measures are available to alleviate the burden of dental caries, there remain racial disparities in the utilization of preventative dental care. Our objectives were to determine whether racial disparities persisted in receiving preventive oral procedures between (1) black children and white children; and (2) Hispanic children and white children. We used pooled Medical Expenditure Panel Survey data in the United States from 2018 to 2021. The key outcome variable involved the use of preventive dental services (ie, examination, x-rays, cleaning, dental sealant fitting, and fluoride treatment), while the main predictor variable involved race (ie, whether they were white, black, or Hispanic children). Controlling for covariates, there was no statistical significance in the odds of Hispanic and white children in receiving x-rays, sealants, and fluoride treatment (P <.001). black children had significantly lower odds of receiving oral examination, x-rays, and fluoride treatment than their white counterparts (P <.01). This study highlights the massive strides made in the utilization of preventive dental services by Hispanic children in the United States along with the persisting disparities largely present for black children; however, further studies are needed focusing on structural, sociocultural, and factors contributing to these disparities.

ASSOCIATION OF HEALTHCARE USE AND EXPENDITURE BASED ON DUAL ELIGIBILITY AND ENROLLMENT IN MANAGED CARE

Abstract Individuals enrolled in both Medicaid and Medicare, also known as duals, have complex and high healthcare needs and disproportionately account for higher state and federal spending. In recent years, most of these beneficiaries have been enrolled in some form of managed care plans. In this study, using the 2020-2021 Medical Expenditure Panel Survey, we evaluate the association of dual-eligibility status and different forms of healthcare use and expenditures: inpatient, emergency room and outpatient. We also explore if enrollment in a managed care affects this relationship. We estimate a series of Poisson regressions for use variables and generalized linear models for expenditure variables that account for the interaction between dual-eligibility status and enrollment in managed care. Postestimation, we calculate marginal effects and use analysis of variance contrast tests to estimate the differences in the predicted use events and average expenditure based on managed care and dual-eligibility status. We find that, on average, duals eligibles have a higher use of inpatient and emergency room than non-duals but similar outpatient visits. We also find that non-duals enrolled in managed care have lower outpatient and emergency room visits than their non-managed care counterparts. No significant differences are observed for dual eligibles in terms of their managed care status for both use and expenditures. While more research and years of data are needed to establish whether managed care improves utilization and lowers spending for dual eligibles, we find that managed care affects duals and non-duals differently and stakeholders should consider this to provide equitable health.

ASSOCIATION OF HEALTHCARE ACCESS AND DUAL ELIGIBILITY STATUS BASED ON ENROLLMENT IN MANAGED CARE

Abstract Dual-eligible beneficiaries (enrolled in both Medicare and Medicaid) remain a growing population with complex care needs. However, there are limited studies evaluating self-reported access to healthcare among these individuals. Using six key outcomes that describe the characteristics of beneficiaries’ usual source of care from the 2021 Medical Expenditure Panel Survey, we retrospectively analyzed self-assessment questionnaire data among individuals age 18 and older (N = 12,924) to evaluate the association between healthcare access and dual-eligibility status based on enrollment in managed care. A series of survey-weighted multivariable logistic regression models were estimated. After adjusting the models for demographic factors, socioeconomic factors, and interaction term between dual-eligible and managed care status, we calculated marginal effects of managed care and dual-eligibility on healthcare access outcomes and used analysis of variance contrast tests to estimate the difference in the probability of outcomes based on managed care and dual-eligibility status. The results demonstrate non-dual managed care beneficiaries were significantly less likely to seek care [4.1% versus 2.5%, p-value = 0.0338] and experienced greater delays in care [6.6% versus 4.9%, p-value = 0.0398] due to cost. We also noted no significant impact on established and regular care access independently based on dual-eligibility status or managed care status. These findings suggest managed care may not significantly influence dual-eligibles’ access to healthcare but should be analyzed further for associations with healthcare disparities before making policy recommendations. Future research should also examine associations between quality of care measures and dual-eligibility status to continue holistically evaluating healthcare equity.

Enrollment in Medicare is associated with fewer outpatient mental healthcare visits among those with mental health symptoms.

To test whether enrolling in traditional Medicare (TM) or Medicare Advantage (MA) at age 65 reduces mental healthcare utilization among individuals with mental health symptoms and low or moderate family incomes. We employ a fuzzy regression discontinuity design, comparing the likelihood of having an outpatient mental health visit or a psychotropic drug fill among individuals younger than or older than the age 65 Medicare eligibility threshold. We analyze 2014-2021 Medical Expenditure Panel Survey data. Our primary sample is restricted to individuals with probable mental health symptoms as indicated by their score on the Kessler K6 psychological distress scale (K6) and Patient Health Questionnaire-2 instrument (PHQ-2) and who have incomes less than 400% of the federal poverty level. Among individuals with probable mental health symptoms and low or moderate incomes, enrolling in Medicare (combining the effect of MA and TM) is associated with a 24.9 percentage point reduction (95% CI -49.1 to -0.8; p = 0.043) in the likelihood of having any type of outpatient mental health visit and a 31.3 percentage point reduction (95% CI -54.2 to -8.4; p = 0.008) in the likelihood of having a prescription drug fill for a psychotropic drug. Effects of MA and TM on mental healthcare utilization are not statistically different from each other. We observe no impact of enrolling in Medicare on the likelihood of having a visit to a primary care provider, having a visit to a non-mental healthcare specialist, or having a fill for a prescribed non-psychotropic drug. Enrolling in Medicare is associated with a reduction in the use of mental healthcare among individuals with probable mental health symptoms and low or moderate family incomes. Our findings suggest that the program poses access barriers specific to mental healthcare.

Colon Cancer Rates Among Asian Americans: A 2017-2021 Epidemiological Analysis.

Background: Colon cancer (CC) is a significant public health concern. With Asian Americans (AAs) representing a rapidly growing demographic in the United States, our study examined CC prevalence among AAs. Methods: The study merged the 2017-2021 Medical Expenditure Panel Survey and County Health Ranking. Our analysis calculated age-adjusted CC rates and examined its prevalence across states. Regression analyses were conducted to study county-level risk factors of CC. Results: The CC age-adjusted rate among AAs increased by five-fold, from 155 per 100,000 in 2017 to 753 per 100,000 in 2021. State-level disparities revealed the highest CC prevalence in Arkansas, Rhode Island, and New Hampshire. Not speaking other languages and having insurance were significantly associated with higher CC rates, suggesting barriers to preventions and greater use of screening (p < 0.05). County-level analysis identified lower CC prevalence in regions with a greater socioeconomic advantage (p < 0.05). Socioeconomic advantage seemed to facilitate higher screening rates, which then translated into higher CC rates. Conclusions: Our findings underscore the need for early preventions to address rising CC rates among AAs. Future research should also explore geographic factors to better understand the disparities in CC risk.

Association Between Delayed/Forgone Medical Care and Resource Utilization Among Women with Breast Cancer in the United States.

Although high treatment costs of breast cancer care are well documented, the relationship between delayed/forgone (D/F) care and resource utilization among patients with breast cancer is unknown. This study sought to investigate the relationship between D/F care, resource use, and healthcare expenditures among patients with breast cancer. Data on adult female patients with breast cancer were obtained from the Medical Expenditure Panel Survey to assess resource utilization and expenditures in the United States from 2007 to 2017. Weighted proportions of patients with ≥1 emergency department, ≥1 inpatient, ≥1 outpatient, and >5 office-based encounters were compared between those experiencing D/F care versus those who did not using Rao-Scott adjusted chi-squared tests. Annual, per capita total, out-of-pocket, emergency department, inpatient, outpatient, office-based visit, and prescription medication expenditures were compared by using two-part econometric models. Five percent of patients with breast cancer experienced D/F care, and 42.9% of patients cited financial barriers as the primary reason for D/F care. In unweighted estimates, there were higher proportions of patients with ≥1 hospitalizations (37% vs. 16%, P<0.001) among those experiencing D/F care versus those who did not. Patients with D/F care had $5372 (95% CI $35-$10,709, P=0.04) higher per capita inpatient expenditures than patients without D/F care. Delayed/forgone care is associated with increased resource utilization and healthcare spending among breast cancer patients. Further work is needed to address the root causes of D/F breast cancer care, with a view to mitigating disparate outcomes and increasing costs.

Exploring Racial and Ethnic Differences in Utilization of Medications for Obesity Management in a Nationally Representative Survey.

The burden of obesity falls disproportionately on some racial and ethnic minority groups. To assess for racial and ethnic differences in the utilization of obesity-management medications among clinically eligible individuals. Medical Expenditure Panel Survey (2011-2016, 2018 and 2020) data and a cross-sectional study design was used to assess for racial and ethnic differences in obesity-management medication utilization. Descriptive statistics and multivariable logistic regression models were used to identify the association of race and ethnicity with obesity-management medication utilization. Adjusted models controlled for demographics, socioeconomic status, obesity class, diabetes status, number of chronic conditions, insurance status, and geographic region. Adults with a BMI ≥ 30 kg/m2 and individuals with a BMI ≥ 27 kg/m2 with ≥ 1 weight-related condition. The primary outcome measure was utilization of an FDA-approved medication for obesity-management during the study period. The primary independent predictor was race and ethnicity. Separate indicator variables were created for each racial and ethnic group (Non-Hispanic Asian, Non-Hispanic Black, Hispanic, and Non-Hispanic White (reference group)). In adjusted analyses, Asian (aOR, 0.36; 95% CI, 0.16 to 0.77; P < 0.01), Black (aOR, 0.51; 95% CI, 0.39 to 0.68; P < 0.001) and Hispanic individuals (aOR, 0.70; 95% CI, 0.49 to 0.98; P = 0.04) had significantly lower odds of utilizing obesity-management medications compared to White individuals. The results of this study suggest that there are racial and ethnic disparities in the use of obesity-management medications.

Relationship between pain severity and self-perceived health among United States adults: A cross-sectional, retrospective database study.

Self-perceived health is related to outcomes such as morbidity and mortality. However, little is known about the relationship between pain severity and self-perceived health, which could be useful to know to help improve health. This study assessed the association of pain severity and other contributing factors with self-perceived health among United States adults. This cross-sectional, retrospective database study used 2019 Medical Expenditure Panel Survey data and included United States adults aged ≥18 years who responded to the pain item in the survey. The independent variable was self-reported pain severity, and the dependent variable was self-perceived health. Various potentially confounding variables were controlled for in the analysis. Adjusted logistic regression models were used to identify statistical associations between each variable and self-perceived health. The complex survey design was maintained, while nationally representative estimates were obtained. Among the sample of 17,261 United States adults, 88.1% (95% confidence interval, 87.4%-88.8%) reported excellent, very good, or good self-perceived health, while 11.9% (95% confidence interval, 11.2%-12.6%) reported fair or poor self-perceived health. In adjusted analyses, there were significant associations between fair or poor self-perceived health and any level of pain severity versus no pain, age 40 to 64 versus 18 to 39 years, male versus female, Hispanic versus non-Hispanic, high school diploma or less versus more than high school, unemployed versus employed, poor, near poor, or low versus middle or high income, fair or poor versus excellent, very good, or good mental health, exercising <5 times versus ≥5 times per week, smoker versus nonsmoker, and ≥2 versus <2 comorbid conditions. This study found that greater levels of pain severity (and several other variables) were associated with greater odds of reporting fair or poor self-perceived health. These associations provide greater insight into the variables associated with self-perceived health, which may be useful targets to improve health.