Statewide Trends Research Articles

Emergence of Recombinant SARS-CoV-2 Variants in California from 2020 to 2022.

The detection, characterization, and monitoring of SARS-CoV-2 recombinant variants constitute a challenge for public health authorities worldwide. Recombinant variants, composed of two or more SARS-CoV-2 lineages, often have unknown impacts on transmission, immune escape, and virulence in the early stages of emergence. We examined 4213 SARS-CoV-2 recombinant SARS-CoV-2 genomes collected between 2020 and 2022 in California to describe regional and statewide trends in prevalence. Many of these recombinant genomes, such as those belonging to the XZ lineage or novel recombinant lineages, likely originated within the state of California. We discuss the challenges and limitations surrounding Pango lineage assignments, the use of publicly available sequence data, and adequate sample sizes for epidemiologic analyses. Although these challenges will continue as SARS-CoV-2 sequencing volumes decrease globally, this study enhances our understanding of SARS-CoV-2 recombinant genomes to date while providing a foundation for future insights into emerging recombinant lineages.

Measuring and modeling food accessibility by transportation mode

Food accessibility has been a subject of growing interest due to its impact on public health outcomes. This paper describes a spatial analysis method to identify gaps in geographic food access and correlate them with a variety of demographic and socioeconomic factors. The proposed food accessibility metric is the square footage of supermarkets that can be reached within 10 min travel time by walking, biking, driving, and 30 min travel time by walk/transit. The spatial analysis is conducted for the centroids of each census tract within a study area, and the approach is illustrated with an application for the state of Massachusetts. Correlations between demographic and socioeconomic explanatory variables and food accessibility are explored using the Gradient Boosted machine learning model. More specifically, the explanatory variables are percent minority population, percent of population in poverty, vehicle ownership, and population density. The spatial analysis shows a strong correlation between food accessibility and population density. The machine learning model is then used to identify gaps in food accessibility for each transportation mode while controlling for community characteristics. The residuals of the model reveal which communities have the lowest food accessibility relative to other similar communities within the state. This research provides a quantitative method to identify communities that have reduced access to food relative to state-wide trends. Lastly, it provides insights for where policy interventions would be valuable for improving food access in addition to recommendations on increasing food accessibility.

Survey methods for the purple martin in California

The purple martin (Progne subis) has declined substantially in numbers and geographic range since the 1980s. Surveys and monitoring are needed to better understand the status of the species, in order to set conservation priorities and direct actions. Purple martins in California often breed in habitats that differ from those in other areas of the species’ range. The species’ sparse distribution, colonial nature, and frequent use of inaccessible nests sites require specialized methodologies to determine suitable nesting habitat, occupancy, numbers, and reproductive success. I present a range of methods available to monitor nesting purple martins in the variety of nesting substrates in which they nest in California. These methods should improve efficiency and accuracy of surveys and provide comparable results that can be used to evaluate regional or statewide trends.

Gender-Related Disparities in Sport, Physical Activity, and Physical Activity Lessons in Minnesota From 2016 to 2019

PurposeTo leverage multi-year panel data to determine statewide trends of participation in team sports, physical activity (PA) lessons, and overall PA among transgender and gender diverse (TGD) adolescents in 2016 and 2019. MethodsFrequencies and percentages for TGD adolescents' team sport and PA lesson involvement, as well as mean number of days of ≥ 60 minutes of PA in the previous week, were compared in 2016 and 2019 to cisgender youth. ResultsIn both years, cisgender students were about twice as likely to participate in sports and engaged in an average of one additional full day per week of PA for ≥ 60 minutes. Students unsure of their gender identity participated slightly more than those identifying as transgender, genderqueer, genderfluid, or nonbinary. DiscussionWe extend previous literature by demonstrating how gender-related participation gaps existed for Minnesotan high school students in 2016 and persisted into 2019, and we added distinctions for identities within the TGD umbrella (e.g., unsure).

Are the diagnostic rates of autistic females increasing? An examination of state-wide trends.

Autism has been considered a 'male-dominant' condition. However, recent research suggests that autistic females are underdiagnosed, misdiagnosed, and later diagnosed. Females may also have different and more nuanced behavioral profiles. To examine diagnosis rates of females, we used 20 years of state-wide data to characterize historical trends in the diagnosis of autism in females to determine whether the proportion of females diagnosed with autism has changed over time. Data were drawn from 10,247 participants (males = 8,319, females = 1928) who received an autism diagnosis between 2000 and 2021 from state-wide autism centers associated with the University of North Carolina TEACCH Autism Program. The rates of females diagnosed with autism increased at a greater rate compared with males. Age of diagnosis remained consistently higher for females. Late diagnosis (defined as 13+) increased over time across both males and females, however, was more commonly associated with females, particularly those with co-occurring intellectual disability. Our results indicate that the proportion of females diagnosed with autism has increased steadily over a 20-year period, which likely reflects greater societal knowledge of how autism may manifest differentially in females.

State-wide Trends and Payments for Microsurgical Lymphedema Procedures in Patients Undergoing Mastectomy from 2016-2020

State-wide Trends and Payments for Microsurgical Lymphedema Procedures in Patients Undergoing Mastectomy from 2016-2020

Statewide Trends in Buprenorphine Prescribing in Rural and Nonrural Vermont: Analysis of Population-based Patient Pharmacy Claims.

Opioid-related mortality rates have risen dramatically over the past decade, and office-based opioid treatment using buprenorphine offers hope for combatting this trend. Vermont's policymakers, health care systems, and treatment providers have worked to expand access to treatment throughout the rural state. The objective of the current study was to characterize the trends in the number of buprenorphine prescribers and the number of patients per prescriber in Vermont over the past decade (2010-2020). We used Vermont's all-payer claims database to identify patients with buprenorphine claims between 2010 and 2020 and their prescribers. We conducted analyses of trends in the number of prescribers treating different numbers of patients, the number of patients treated by prescribers in those categories, and the number of rural (vs nonrural) patients filling buprenorphine prescriptions. We used Z tests to determine if there were statistical differences between trends. The number of buprenorphine prescribers treating 10+ patients grew more rapidly than other prescriber groups ( P < 0.001). Nearly half of Vermont patients in 2020 were treated by 33 high-volume prescribers who treated 100 or more patients with buprenorphine. The number of patients filling buprenorphine prescriptions in Vermont increased by 98% between 2010 and 2020, with greater increases seen among rural than nonrural residents (107% vs 72%; P = 0.008). Since 2010, Vermont has increased utilization of its office-based opioid treatment capacity, particularly in rural counties.

Prescribed stimulant medications: Trends in the last decade, pre and post COVID-19 response

BackgroundRecent studies indicate that COVID-19 has had a significant impact on access and continuity to opioid and benzodiazepine medications; little is known about its effect on access to and utilization of stimulant medications. ObjectiveTo investigate trends of dispensed stimulant medications in relation to the COVID-19 pandemic response. MethodsStimulant prescriptions dispensed during 2011–2021 were analyzed using the Massachusetts Prescription Drug Monitoring Program (PDMP), the state's data repository for all controlled substance medications dispensed to residents from retail pharmacies and out of state mail-order pharmacies. Statewide trends were estimated by age group, sex, and stimulant-naïve patients (individuals with no stimulant prescription in the prior one-year period). ResultsOverall, stimulant prescriptions increased 70% from 2011 to 2021. Wide differences by sex and age groups were found pre and post COVID response periods. Between 2019 and 2021, stimulant prescriptions for males 12–18 years old decreased 14.6% compared to 0.9% for females. Female stimulant-naïve patients ages 25–34 increased more than males between 2019 and 2021 (11.6% compared to <1%, respectively) and females ages 35–44 increased 4.1% while males decreased by 2.7%. ConclusionsAdministrators, clinicians, and policy makers should closely monitor stimulant prescribing trends, a critical step in improving access to and quality of care.

Bicuspid aortic valve interventions in Texas—2009–2019

Background: Bicuspid aortic valve (BAV) is a common congenital heart defect occurring in 0.5–2% of adults. It is associated with increased lifetime risk of aortic valve intervention (AVI). Different AVI options include surgical replacement [surgical aortic valve replacement (SAVR)], repair, the Ross procedure, and transcatheter replacement [transcatheter aortic valve replacement (TAVR)]. This study seeks to evaluate statewide trends in BAV AVI and compare in-hospital outcomes over 11 years period.

Nationwide Analysis of Motorcycle-Associated Injuries and Fatalities in the United States: Insufficient Prevention Policies or Abandoned Laws?

Motorcycle road traffic collisions are a major cause of mortality in the United States. We aimed to analyze the temporal and statewide trends in motorcycle collision fatalities (MCFs) nationwide and their association with state laws regarding motorcycle helmet requirements, lane splitting, speeding, intoxicating driving, and red light cameras. A retrospective review of United States MCF/capita from 2015 to 2019 was performed using the Fatality Analysis Reporting System database. MCF/capita was defined as a motorcyclist death per 100000 motorcyclist registrations. Independent-samples t-test and ANOVA were used to determine differences, with significance defined as P < .05. Linear regression analysis and Pearson's correlation were used to further determine associations between variables. The majority of fatalities occurred in males (n = 21354, 91.0%), ages 25-54 (n = 13728, 58.5%), and Caucasians (n = 19195, 81.8%). A total of 24 states and DC exhibited positive trends in MCF/capita from 2015 to 2019. There was no significant difference in MCF/capita between states who had mandatory helmet laws for all, partial requirements, and states with no law (63.4 vs 54.3 vs 33.6, P = .360). Among fatalities involving alcohol, a significantly greater number of MCF/capita were found above the legal limit of .08 compared to the group with a blood alcohol concentration of .01-.07 (17.8 vs 4.5, P < .001). Motorcyclist fatalities continue to pose a public health risk, with 24 states showing an upward trend. Additional interventions and laws are needed to decrease the number of motorcyclist deaths. Further strategy on implementation and enforcement of helmet laws and alcohol consumption may be an essential component.

Statewide trends and factors associated with genetic testing for hereditary cancer risk in Arkansas 2013–2018

BackgroundEarly identification of hereditary cancer risk would save lives, but genetic testing (GT) has been inadequate. We assessed i) trends for hereditary breast and ovarian cancer (HBOC), Lynch syndrome, and other GT and ii) factors associated with receipt of GT.MethodsWe used data from the Arkansas All-Payer Claims Database from January 2013 through June 2018 (commercial, Medicaid), December 2017 (state employee), or December 2016 (Medicare) and identified enrollees with ≥1 month of enrollment. Using Current Procedural Terminology (CPT-4) codes, rates for GT were calculated per 100,000 person-quarters and time series regressions estimated. Second, GT and covariate information for enrollees with 24 months of continuous enrollment were used to estimate separate logistic regression models for each GT category.ResultsAmong 2,520,575 unique enrollees, HBOC testing rates were 2.2 (Medicaid), 22.0 (commercial), 40.4 (state employee), and 13.1(Medicare) per 100,000 person-quarters and increased linearly across all plans. Older age (OR=1.24; 95%CI 1.20 – 1.28), female sex (OR=18.91; 95%CI 13.01 – 28.86), higher comorbidity burden (OR=1.08; 95%CI 1.05 – 1.12), mental disorders (OR=1.53; 95%CI 1.15 – 2.00), and state employee coverage (OR=1.65; 95%CI 1.37 – 1.97) were positively associated with HBOC testing. Less than 1 of 10,000 enrollees received Lynch syndrome testing, while < 5 of 10,000 received HBOC testing.ConclusionGT rates for hereditary cancer syndromes have increased in Arkansas but remain low. Receipt of GT was explained with high discrimination by sex and plan type.ImpactExpansion of GT for hereditary cancer risk in Arkansas is needed to identify high-risk individuals who could benefit from risk-reduction strategies.

Incidence and Distribution of New Renal Cell Carcinoma Cases: 27-Year Trends from a Statewide Cancer Registry.

Nationwide databases have implicated an increased incidence of renal cell carcinoma (RCC). The Pennsylvania (PA) Cancer Registry was queried to better define incidence, geographic distribution, and statewide trends of new RCC cases over a 27-year period. JoinPoint Trend Analysis Software modeled average annual percent changes (APCs) in age-adjusted rates (AAR). Maps plotting county-level incidence rates and stage distribution of disease across the state in 5-year time intervals were created using R 4.0.2 software. Overall, 59,628 cases of RCC were recorded in PA from 1990 to 2017. Eighty six percent of patients were >50 years of age, 61% were males, and 89% were Caucasian. Stage distribution using the SEER staging system included 64% local, 17% regional, and 16% distant. Over the study interval, AAR of all RCC cases increased from 9.9 to 18.0 patients per 100,000 population with an APC of 2.3% (p < 0.01). AAR of local disease increased from 5.4 to 12.7 patients per 100,000 population with an APC of 3.2% (p < 0.01). AAR of regional disease also increased from 1.9 to 2.9 patients per 100,000 population with an APC of 1.0% (p = 0.01). Younger patients (<50 years) had a greater rate of increase than older counterparts (APC 3.8% vs. 2.0%, p < 0.05). Geospatial investigation of new RCC cases noted certain geographic concentrations of greater disease incidence. The incidence of RCC in PA has increased over the past 27 years in PA. One-third of the cases are regional or metastatic at presentation and rates of increase were most notable in younger patients.

Trends in COVID-19 Vaccine Administration and Effectiveness Through October 2021

COVID-19 vaccines are effective, but inequities in vaccine administration and waning immunity may limit vaccine effectiveness. To report statewide trends in vaccine administration and vaccine effectiveness in Minnesota. This cohort study used COVID-19 vaccine data from the Minnesota Immunization Information Connection from October 25, 2020, through October 30, 2021 that were linked with electronic health record (EHR) data from health systems collaborating as part of the Minnesota EHR Consortium (MNEHRC). Participants included individuals who were seen at a participating health system in Minnesota. Individuals were considered fully vaccinated in the second week after receipt of a second dose of a BNT162b2 or mRNA-1273 vaccine or a single dose of an Ad26.COV.2.S vaccine. A completed vaccination series and vaccine breakthrough, defined as either a positive SARS-CoV-2 polymerase chain reaction (PCR) test or a hospital admission the same week or within the 3 weeks following a positive SARS-CoV-2 PCR test. A test-negative design and incident rate ratio were used to evaluate COVID-19 vaccine effectiveness separately for the BNT162b2, mRNA-1273, and Ad26.COV.2.S vaccines. Rurality and social vulnerability index were assessed at the area level. This study included 4 431 190 unique individuals at participating health systems, and 3 013 704 (68%) of the individuals were fully vaccinated. Vaccination rates were lowest among Minnesotans who identified as Hispanic (116 422 of 217 019 [54%]), multiracial (30 066 of 57 412 [52%]), American Indian or Alaska Native (22 190 of 41 437 [54%]), and Black or African American (158 860 of 326 595 [49%]) compared with Minnesotans who identified as Asian or Pacific Islander (159 999 of 210 994 [76%]) or White (2 402 928 of 3 391 747 [71%]). Among individuals aged 19 to 64 years, vaccination rates were lower in rural areas (196 479 of 308 047 [64%]) compared with urban areas (151 541 of 1 951 265 [77%]) and areas with high social vulnerability (544 433 of 774 952 [70%]) compared with areas with low social vulnerability (571 613 of 724 369 [79%]). In the 9 weeks ending October 30, 2021, vaccine effectiveness as assessed by a test-negative design was 33% (95% CI, 30%-37%) for Ad26.COV.2.S; 53% (95% CI, 52%-54%) for BNT162b2; and 66% (95% CI, 65%-67%) for mRNA-1273. For SARS-CoV-2-related hospitalizations, vaccine effectiveness in the 9 weeks ending October 30, 2021, was 78% (95% CI, 75%-81%) for Ad26.COV.2.S; 81% (95% CI, 79%-82%) for BNT162b2; and 81% (95% CI, 79%-82%) for mRNA-1273. This cohort study of data from a Minnesota statewide consortium suggests disparities in vaccine administration and effectiveness. Vaccine effectiveness against infection was lower for Ad26.COV.2.S and BNT162b2 but was associated with protection against SARS-CoV-2-related hospitalizations despite the increased prevalence of the Delta variant in Minnesota.

Exploring How Fines and Fees Finance Community Supervision

Every state relies on fines and fees to defray the costs of community supervision, and many rely on a combination of monetary sanctions and government aid to operate these programs. Texas is one such state that designs their system to provide approximately two-thirds of funding necessary for supervision operations while the rest is meant to be obtained via local supervisee fees. This study questions the accuracy of the 65/35 split in counties involved in the Community Corrections Fines and Fees (CCFF) Study and examines how programs’ offender fees and state appropriated funding have changed over time. Gathering data from local fiscal reports, three programs covering six counties are studied. Our findings indicate that fees are over-relied upon in every jurisdiction examined, with increasing contributions each year while supervisee counts fall. Further, these individuals also supply money to other funds used for supervision and/or criminal justice not accounted for in the core programming (i.e., local supplemental programs, general fund contributions). Though few, the CCFF programs examined appear representative of state-wide trends and data suggests the fluctuations in fee reliance may largely result from targeted funding changes to competitive program grants. In all, Texas and specific program appropriations and fees are all increasing, but the state appears to be failing to keep up with local needs. This has large potential for collateral consequences to system and supervisee alike.

Results from Kentucky’s 10-year Bobwhite Recovery Plan

The northern bobwhite (Colinus virginianus; hereafter, bobwhite) has experienced a precipitous population decline through almost all its historical range over the last 6 decades. We initiated a 10-year restoration plan in Kentucky, USA in 2008 and reported on it through 3 published “Road to Recovery” reports along with 30 peer-reviewed articles and abstracts, 2 technical documents, 7 theses or dissertations, and 11 popular literature pieces. Seven Quail Focus Areas were selected across the state based on site personnel, geographic position (east to west), and land ownership (e.g., private, public, state, federal) for monitoring and habitat management. The focus areas averaged 11,895 acres and area managed for quail on an annual basis ranged from 9% to 42%. Management took the form of herbicide applications, disking, fire, planting, grazing, control of woody vegetation, and mowing. Hierarchical distance sampling models using time-of-removal information to inform detection processes were used to assess bobwhite density on each focus area. Models were based on spring breeding bird point counts in which a suite of grassland songbirds were recorded and fall covey counts in which only bobwhite were recorded. Roadside surveys (direct observation) and hunter harvest information were also used for statewide comparisons of focus areas and statewide trends. Across all years and focus areas a 40% increase in the quail population was observed in 20 years (38%) of the possible 53 years of survey data. Stable to increasing trends were also observed in focal area populations of dickcissel (Spiza americana), eastern meadowlark (Sturnella magna), eastern kingbird (Tyrannus tyrannus), field sparrow (Spizella pusilla), prairie warbler (Setophaga discolor), and Bell’s vireo (Vireo bellii). A focus on habitat management and associated monitoring on relatively small (<20,000 acres) areas was shown to be successful on an individual area, as determined by increases in bird numbers across years and challenges completed in the Quail Plan but did not result in an observed increase in statewide quail indices. Future quail restoration plans in Kentucky should be directed more toward open production land, which is made up of 6 million acres of pastureland, hay land, row crop agriculture, reverting fields, reclaimed mineland, and grasslands. This work will be completed by utilizing working lands, such as field borders in row crop systems and grazing native warm-season grasses in pasture or hay systems, for wildlife activities. Monitoring systems on these production lands will be in the breeding season only and autonomous recording devices will be

1209. The Evolving Nature of Syndromic Surveillance During the COVID-19 Pandemic in Massachusetts

BackgroundWe developed a syndromic algorithm for COVID-19 like illness (CLI) to provide supplementary surveillance data on COVID-19 activity. MethodsThe CLI algorithm was developed using the Electronic Medical Record Support for Public Health platform (esphealth.org) and data from five clinical practice groups in Massachusetts that collectively care for 25% of the state’s population. Signs and symptoms of CLI were identified using ICD-10 diagnosis codes and measured temperature. The algorithm originally included three categories: Category 1 required codes for coronavirus infection and lower respiratory tract infections (LRTI); Category 2 required an LRTI-related diagnosis and fever; Category 3 required an upper or lower RTI and fever.The three categories mirrored statewide laboratory-confirmed case trends during spring and summer 2020 but did not detect the increase in late fall. We hypothesized this was due to the requirements for fever and LRTI. Therefore, we added three new categories defined by milder symptoms without fever: Category 4 requires LRTI-related diagnoses only; Category 5 requires upper or lower RTI or olfactory/taste disorders; and Category 6 requires at least one sign of CLI not identified by another category.ResultsThe six-category algorithm detected the initial surge in April 2020, the summer lull, and the second surge in late fall (see figure). Category 1 cases were not identified until mid-March, which coincides with the first laboratory-confirmed cases in Massachusetts. Categories 2 and 3, which required fever, were prominent during the initial surge but declined over time. Category 5, the broadest category, declined during February and March 2020, likely capturing the end of the influenza season, and successfully detected the spring surge and fall resurgence. Weekly number of COVID-19 like illnesses by category, February 2, 2020 through May 8, 2021 ConclusionA syndromic definition that included mild upper RTI and olfactory/taste disorders, with or without fever or LRTI, mirrored changes in laboratory-confirmed COVID-19 cases better than definitions that required fever and LRTI. This suggests a shift in medically attended care and/or coding practices during initial vs subsequent surges of COVID-19, and the importance of using a broad definition of CLI for ongoing surveillance.Disclosures Michael Klompas, MD, MPH, UpToDate (Other Financial or Material Support, Chapter Author)

Did Juvenile Domestic Violence Offending Change During COVID-19?

The current study castssome of the first light into the initial impacts of the largest global health crisis in a generation on family and domestic violence, the long-term repercussions of which may take decades to unpack. Statewide trends in juvenile arrests for domestic violence (DV)-related offending are examined, taking into account school closures for in-person learning in March 2020 and the subsequent mandate for an in-person learning option in Florida in August 2020. Additionally, trends by sex, race/ethnicity, and severity of the offense are examined. Contrasting with growing studies demonstrating an increase in DV-related arrests among adults, we find a significant decrease upon school closures then subsequent increase when schools reopened with an in-person option. Results held across examined subgroups, yet the extent of increase following mandatory in-person learning availability was not as uniform, with Hispanic youth showing the smallest increase and Black youth the largest. Implications are discussed.

Assessing consistency among indices to measure socioeconomic barriers to health care access.

Many places within rural America lack ready access to health care facilities. Barriers to access can be both spatial and non-spatial. Measurements of spatial access, such as the Enhanced Floating 2-Step Catchment Area and other floating catchment area measures, produce similar patterns of access. However, the extent to which different measurements of socioeconomic barriers to access correspond with each other has not been examined. Using West Virginia as a case study, we compute indices based upon the literature and measure the correlations among them. We find that all indices positively correlate with each other, although the strength of the correlation varies. Also, while there is broad agreement in the general spatial trends, such as fewer barriers in urban areas, and more barriers in the impoverished southwestern portion of the state, there are regions within the state that have more disagreement among the indices. These indices are to be used to support decision-making with respect to placement of rural residency students from medical schools within West Virginia to provide students with educational experiences as well as address health care inequalities within the state. The results indicate that for decisions and policies that address statewide trends, the choice of metric is not critical. However, when the decisions involve specific locations for receiving rural residents or opening clinics, the results can become more sensitive to the selection of the index. Therefore, for fine-grained policy decision-making, it is important that the chosen index best represents the processes under consideration.

Opioid use disorder among hospitalized adults in North Carolina: Comparative analysis of national and statewide trends.

Hospital resource utilization is reported to be higher among patients with opioid use disorder (OUD) compared with those without OUD at national and local levels. However, utilization of healthcare services associated with OUD in North Carolina (NC) has not been adequately characterized. We describe inpatient hospital resource utilization among adults with an OUD-diagnosed in NC and the United States (US). We hypothesize that hospitalized adults with OUD will have longer hospital stays, more frequent use of emergency services, a higher number of diagnoses, and comparable hospital charges compared with hospitalized adults without OUD. A retrospective cross-sectional study analyzing hospital discharge abstracts included in the 2016 NC State Inpatient Databases (SIDs) and the 2016 National Inpatient Sample (NIS). OUD and non-OUD groups were compared using the Student's t-test for continuous variables and the χ2 test for categorical variables. Adults 18 years and older from SID (n = 25,871) and NIS (n = 148,255) databases were included in the analysis. Length of stay (LOS), use of emergency services, discharge diagnosis, and hospital charge among hospitalized adults with OUD. In NC, patients with OUD were younger (age 18-35), more likely to be white, and more likely to be hospitalized in areas with the lowest median income compared with patients without OUD. Compared to the US, twice as many NC OUD patients were self-payers. Hispanic patients, Medicare beneficiaries, and those in the highest income areas experienced the longest LOS and highest hospital charge. Patients with OUD were more likely to have five or more diagnoses and those with five or more diagnoses had higher LOS and hospital charges. OUD hospitalizations were also associated with more frequent use of emergency services. The most common co-occurring diagnoses were psychoses, substance abuse or dependence, and septicemia or severe sepsis. High percentages of self-payers and lower-income OUD patients indicate the need for Medicaid eligibility outreach programs in NC. High LOS and hospital charges among Hispanic, Medicare-covered, and high-income OUD patients call for a more detailed examination to identify underlying causes of disproportionate resource utilization in NC hospitals.

PIH14 Statewide Trends in Genetic Testing for Hereditary Cancers in Arkansas 2013-2018

To study the trends in genetic testing for hereditary breast and ovarian cancers (HBOC), lynch syndrome, and non-specific general genetic tests and receipt of any genetic test for Medicaid, commercial, state employee, and Medicare enrollees in Arkansas. Arkansas All Payers’ Claims Database (APCD) data from 2013 through 2018 was used for commercial, state employee and Medicaid enrollees and due to lags in access 2013-2016 data Medicare recipients. Individuals with at least one month of enrollment with both pharmacy and medical benefits in each quarter were included. Genetic tests were identified using Current Procedural Terminology (CPT-4) codes. Quarterly rates were calculated per 100,000 person-quarters. Age and gender stratified analyses were performed and scatter plots were used to visualize the trends. Time series models using ordinary least squares were estimated to identify trends. There were 1,516,850, 1,501,828, 154,529 and 519,955 individuals in Medicaid, commercial, state employee and Medicare plans respectively. The average age across the total sample was 38, and 54% were female. Across all years, rates of HBOC tests were 2, 22, 40 and 13 per 100,000 person-quarters respectively in Medicaid, commercial, state employee and Medicare. Likewise, the rates of lynch syndrome, general and any genetic tests were: 0.5, 7 and 10 (Medicaid); 2, 21 and 49 (commercial); 6, 77 and 134 (state employee); and 2, 114 and 133 (Medicare) per 100,000 persons-quarters. All measures had increasing linear trends in Medicaid, commercial and state employee (p<0.05), while only tests for HBOC (p=0.020) and lynch syndrome (p=0.004) had significant increasing linear trends in Medicare. HBOC and lynch syndrome test rates were highest among 18–64 females, while general and any genetic test rates were highest among 18–64 males. Genetic tests for hereditary cancers have increased linearly from 2013 to 2018, however the rates of testing to detect cancer remain low.