Insurance Type Research Articles

Pre-injury frailty and clinical care trajectory of older adults with trauma injuries: A retrospective cohort analysis of A large level I US trauma center.

Pre-injury frailty among older adults with trauma injuries is a predictor of increased morbidity and mortality. We sought to determine the relationship between frailty status and the care trajectories of older adult patients who underwent frailty screening in the emergency department (ED). Using a retrospective cohort design, we pooled trauma data from a single institutional trauma database from August 2020 to June 2023. We limited the data to adults 65 years and older, who had trauma injuries and frailty screening at ED presentation (N = 2,862). The predictor variable was frailty status, measured as either robust (score 0), pre-frail (score 1-2), or frail (score 3-5) using the FRAIL index. The outcome variables were measures of clinical care trajectory: trauma team activation, inpatient admission, ED discharge, length of hospital stay, in-hospital death, home discharge, and discharge to rehabilitation. We controlled for age, sex, race/ethnicity, health insurance type, body mass index, Charlson Comorbidity Index, injury type and severity, and Glasgow Coma Scale score. We performed multivariable logistic and quantile regressions to measure the influence of frailty on post-trauma care trajectories. The mean (SD) age of the study population was 80 (8.9) years, and the population was predominantly female (64%) and non-Hispanic White (60%). Compared to those classified as robust, those categorized as frail had 2.5 (95% CI: 1.86-3.23), 3.1 (95% CI: 2.28-4.12), and 0.3 (95% CI: 0.23-0.42) times the adjusted odds of trauma team activation, inpatient admission, and ED discharge, respectively. Also, those classified as frail had significantly longer lengths of hospital stay as well as 3.7 (1.07-12.62), 0.4 (0.28-0.47), and 2.2 (95% CI: 1.71-2.91) times the odds of in-hospital death, home discharge, and discharge to rehabilitation, respectively. Pre-injury frailty is a predictor of clinical care trajectories for older adults with trauma injuries.

Effect of COVID-19 on Emergency Department Visits for Suicidal Ideation and Suicide Attempts among South Carolina Youth.

Evidence suggests that the coronavirus disease 2019 pandemic negatively affected children's mental health (MH). The emergency department (ED) is often the first point of contact with a physician for youth who are experiencing suicidal thoughts and behaviors. Population-level reports of ED utilization in South Carolina for suicidal ideation (SI) and suicide attempts (SAs) during the pandemic are lacking. This study compares trends in ED visits for SI and SAs among youth in South Carolina ages 5 to 24 years, before (ie, March-December 2019) and during (ie, March-December 2020) the coronavirus disease 2019 pandemic. We examined 16,906 deidentified patient records from the South Carolina Revenue and Fiscal Affairs Office. Dispositional outcomes, type of insurance, ED utilization, and mortality also were reviewed. The total number of ED visits for SI or an SA decreased during the pandemic, but the percentage of MH-related and total ED visits attributed to SI and SAs relative to other conditions increased. The pandemic negatively affected youth with preexisting utilization of EDs for MH reasons, SI, and SAs, but also those without prior ED visits for these reasons. Many youths who presented to an ED during the pandemic for SI or SAs had subsequent ED visits for MH concerns, SI, or an SA. The percentage of MH- and SI/SA-related visits increased during the pandemic. These data underscore the need for adequate MH services in EDs and increased access to outpatient MH resources to reduce the strain on EDs during public health emergencies.

Access to Kidney Transplantation for Minority Children With End-Stage Renal Disease and Predictors of Post-Transplant Outcome: Impact of Race and Ethnicity.

Racial disparities in access to kidney transplantation (KT) have been described among children with end-stage renal disease in the United States. It has been suggested that these disparities stem from a combination of clinical and socioeconomic factors. We evaluated data from the US Scientific Registry of Transplant Recipients (SRTR) of all pediatric (< 18 years old) KT recipients from 1999 to 2014 and compared outcomes by race or ethnicity: Hispanic, non-Hispanic Whites (NHW), and non-Hispanic Blacks (NHB). We assessed 1- and 5-year patient survival (PS) and death-censored graft survival (DCGS) using Kaplan-Meier survival cures. Multivariate logistic regressions of graft failure by 1 and 5 years examined effects of race/ethnicity by controlling for donor and recipient characteristics including living or deceased donor, recipient age, BMI, re-transplant status, cPRA, HLA mismatch, graft rejection, cold ischemia time (CIT), and type of insurance. During the 15-year period, 11 740 (6596 NHW, 2306 NHB, and 2838 Hispanic) pediatric KT recipients were performed in the United States. Compared to NHW (250 ± 335 days), NHB (293 ± 348; p < 0.001) and Hispanics (322 ± 353; p < 0.001) spent more time on the waitlist. One-year PS for NHW, NHB, and Hispanics was 98.6%, 98.6%, and 99.0%, respectively; one-year DCGS was 95.5%, 93.7%, and 96.0%, respectively. Five-year PS for NHW, NHB, and Hispanics was 95.5%, 93.1%, and 95.5%, respectively; five-year DCGS was 80.7%, 60.3%, and 76.3%, respectively. Multivariate analysis showed that higher recipient cPRA (OR 1.0, 95% CI 1.0-1.0; p = 0.005), greater HLA mismatch (OR 1.1, 95% 1.0-1.3; p = 0.008), rejection (OR 3.9, 95% CI 2.1-7.0; p < 0.001), and secondary kidney transplantation (OR 15.0, 95% CI 11.5-19.4; p < 0.001) were associated with 1-year graft loss; older recipient age (OR 1.1, 95% CI 1.1-1.1; p < 0.001), higher recipient cPRA (OR 1.0, 95% CI 1.0-1.0; p < 0.001), greater HLA mismatch (OR 1.1, 95% CI 1.0-1.1; p = 0.002), rejection (OR 2.0; 95% CI 1.3-3.0; p = 0.001), and secondary kidney transplantation (OR 11.2, 95% CI 9.6-13.0; p < 0.001) were predictive of 5-year graft loss. Patients with public insurance have higher risks of 1-year and 5-year graft loss (p < 0.001) than those with private insurance payers. Racial and ethnic minority children in the United States have lower access to KT with clinical outcomes suggesting a disparate trajectory. NHB demonstrate unfavorable DCGS while Hispanic children have comparable or better DCGS and PS outcomes compared to NHW. Elucidating the clinical or socioeconomic roots of these differences may identify mitigating measures that can improve KT outcomes for these minoritized populations.

Receipt of respiratory vaccines among patients with heart failure in a multicenter health system registry.

Heart failure affects people of all ages and is a leading cause of death for both men and women in most racial and ethnic groups in the United States. Infections are common causes of hospitalizations in heart failure, with respiratory infections as the most frequent diagnosis. Vaccinations provide significant protection against preventable respiratory infections. Despite being an easily accessible intervention, prior studies suggest vaccines are underused in patients with heart failure. An observational study of 5089 adults with heart failure was conducted using data from an integrated, multicenter, academic health system in Southern California from 2019 to 2022. Logistic regression models were used to determine the rates of influenza, pneumococcal, and COVID-19 vaccination among a population of patients with heart failure (heart failure preserved ejection fraction [HFpEF], heart failure mildly reduced ejection fraction [HFmrEF], and heart failure reduced ejection fraction [HFrEF], and identify whether heart failure phenotype is associated with vaccination status. Vaccination rates varied between influenza, pneumococcal, and COVID-19 vaccines. Of the three respiratory vaccines, 58.0% of patients had received an influenza vaccine, 76.2% had received a pneumococcal vaccine, and 83.3% had received a COVID-19 vaccine. There were no sex-based differences by vaccination status. Differences were seen within age, race/ethnicity, insurance type, whether the patient was a member of an Accountable Care Organization (ACO), primary language, Social Vulnerability Index (SVI) score, clinician type, and number of comorbidities. Patients with HFpEF and HFmrEF had higher vaccination rates than HFrEF. In adjusted models, patients with HFrEF had lower odds of being vaccinated for influenza (aOR=0.75, 95% CI=0.66-0.86), pneumococcal (aOR=0.65, 95% CI=0.55-0.75), and COVID (aOR=0.74, 95% CI=0.62-0.89) compared to patients with HFpEF. Patients with HFrEF had the lowest levels of respiratory vaccination compared to other specified heart failure categories. Interventions are needed to increase vaccination education and offerings, especially to patients with HFrEF.

Prenatal cannabis exposure and the risk of subsequent maltreatment.

Parental substance use can increase the risk of child maltreatment. The purpose of this study was to assess racial bias in newborn drug testing and to investigate the association between prenatal tetrahydrocannabinol (THC) exposure and subsequent child maltreatment. This retrospective cohort study (n=35,437) linked University of Michigan Hospital birth data and Michigan Department of Health and Human Services child maltreatment data relative to a 2018 policy change. Prior to 2018, prenatal THC exposure was routinely substantiated as physical abuse; after 2018 THC exposure was investigated but not automatically substantiated. We defined prenatal THC exposure as a positive newborn meconium drug test for THC. The primary outcome was a substantiated Child Protective Services (CPS) report of maltreatment before and after the policy change. Demographic variables included parent age, race, ethnicity, zip code and insurance type. Covariates included prenatal urine drug test orders and results, and newborn drug test orders and results. Regression models estimated the rate of subsequent maltreatment and racial disparities associated with newborn testing. Regression analyses indicated that Black and multiracial newborns were significantly more likely to be tested for substance exposure at birth. Newborns with a test positive for THC only were not more likely to experience maltreatment after the policy change as compared with newborns that tested negative and newborns not tested. The evidence strongly supports a policy to end routine CPS investigations for cannabis exposure and eliminate racially biased drug testing practices.

Regional Differences in Hepatitis C-Related Hospitalization Rates, United States, 2012-2019.

In the United States, hepatitis C is the most commonly reported bloodborne infection. It is a leading cause of liver cancer and death from liver disease and imposes a substantial burden of hospitalization. We sought to describe regional differences in hepatitis C virus (HCV)-related hospitalizations during 2012 through 2019 to guide planning for hepatitis C elimination. We analyzed discharge data from the National Inpatient Sample for 2012 through 2019. We considered hospitalizations to be HCV-related if (1) hepatitis C was the primary diagnosis or (2) hepatitis C was any secondary diagnosis and the primary diagnosis was a liver disease-related condition. We analyzed demographic and clinical characteristics of HCV-related hospitalizations and modeled the annual percentage change in HCV-related hospitalization rates, nationally and according to the 9 US Census Bureau geographic divisions. During 2012-2019, an estimated 553 900 HCV-related hospitalizations occurred in the United States. The highest hospitalization rate (34.7 per 100 000 population) was in the West South Central region, while the lowest (17.6 per 100 000 population) was in the West North Central region. During 2012-2019, annual hospitalization rates decreased in each region, with decreases ranging from 15.3% in the East South Central region to 48.8% in the Pacific region. By type of health insurance, Medicaid had the highest hospitalization rate nationally and in all but 1 geographic region. HCV-related hospitalization rates decreased nationally and in each geographic region during 2012-2019; however, decreases were not uniform. Expanded access to direct-acting antiviral treatment in early-stage hepatitis C would reduce future hospitalizations related to advanced liver disease and interrupt HCV transmission.

The Predictors of Dietary Supplement Use Among Women With Musculoskeletal Disease: A Population-Based Complex Sample Designed Study.

Supplement use is influenced by personal factors such as sex, knowledge, health status, and sociocultural factors. Korean women with musculoskeletal disease commonly use dietary supplements for purposes such as symptom relief. This study aimed to identify the differences in demographics, health status, and functional health literacy depending on the use of dietary supplements in Korean women with musculoskeletal disease. A cross-sectional study and secondary data analysis were designed using a representative, multilevel stratified cluster sample from the 8th wave (2019) of the National Health and Nutrition Examination Survey, a national statistical survey encompassing health status, health behaviors, and food and nutrient consumption. Data on 804 women aged 20 years or older with musculoskeletal disease were included. A complex samples χ2-test was conducted to compare all variables such as demographics, health status, and functional health literacy. As results, significant differences were found between the dietary supplement user and non-user groups in terms of age (χ2 = 12.21, P = .009), type of health insurance (χ2 = 4.01, P = .049), education level (χ2 = 42.86, P < .001), and presence of diabetes mellitus (χ2 = 9.16, P = .005). Functional health literacy was higher in the user group than in the non-user group (χ² = 5.48, P = .050). We found that younger individuals with health insurance, higher educational levels, and functional health literacy, and who do not have diabetes are likely to use dietary supplements. Healthcare providers should continue to monitor the use of dietary supplements among women with musculoskeletal diseases to ensure their safe and effective use.

The Impact of Racial and Low Socioeconomic Status on the Implementation of Spinal Cord Stimulation for Chronic Pain in the United States.

This study aims to review the societal, economic, and racial factors that impact the usage of spinal cord stimulation for chronic pain. Our working hypothesis is that patients of ethnic minority groups or of lower socioeconomic status (SES) status may have lower implantation rates and usage of spinal cord stimulation (SCS). Our study sourced publications from PubMed, Embase, and Cochrane Library on December 21st, 2023 for SCS for the purposes of pain management. Articles were excluded from the review if the study was not USA based, did not involve SCS for the purpose of pain or did not allow for the subgroup analysis. There were 1028 reports that resulted after the initial search with 184 duplicates which were removed. Six reports met the inclusion and exclusionary criteria and were included in the review. Several trends were able to be extrapolated from the pooled reviews. Orhurhu et al. found that Black and Hispanic minorities had a higher utilization rate of SCSs than their White and Asian counterparts in the inpatient setting. Jones and Missios et al. found that in the outpatient setting, White and privately insured patients were more likely to utilize SCS. Ovrom et al. observed an increased cost associated with Hispanic ethnicity and inpatient SCS utilization. Wondwossen et al. found that in the US military system White patients were more likely to receive SCS earlier in their care than Black patients. Labaran et al. concluded the Southern US completed more SCS implants, particularly in White patients with Medicare insurance. White patients are recipients of SCS earlier and more frequently than minority patients in the outpatient setting. There is mixed evidence regarding inpatient SCS and how household income relates to SCS usage. Insurance type and coverage may be more accurately predictive than simple household income for SCS utilization.

P-1639. Assessing Disparities in Inappropriate Outpatient Antibiotic Prescriptions in Tennessee

Abstract Background The Centers for Disease Control and Prevention (CDC) estimates almost 47 million antibiotics are prescribed each year for indications that do not warrant antibiotic use. Identifying populations that are inappropriately prescribed antibiotics is imperative to address health inequities and prevent antimicrobial resistance. Tennessee Department of Health (TDH) evaluated disparities in outpatient antibiotic prescriptions in patients of different age groups, gender, geographical location, and insurance type. Methods The IQVIA Medical Claims and Longitudinal Prescription Claims databases were used to perform a cross-sectional study to evaluate the appropriateness of all outpatient antibiotics dispensed from retail pharmacies in TN from January 1–December 31, 2022. Data were categorized using a tiered system utilizing ICD-10 codes. Logistic regression was performed to predict whether age, gender, insurance type, and residence were associated with receiving an antibiotic in encounters for which antibiotics are rarely indicated (tier 3). Results In 2022, 2,017,863 prescribed antibiotics were linked to the medical claims database. Over half of these antibiotics were classified as a tier 3 encounter. Females were prescribed more antibiotics (62.0%). For tier 3 encounters specifically: 41.0% of antibiotics were prescribed to patients 65 and older. Residence in low and high socially vulnerable index (SVI) counties accounted for 27.9% and 24.9% of antibiotics, respectively. 37.2%, 16.5%, and 44.5% of antibiotics prescribed were billed to third-party payers (e.g., private health insurance), Medicaid, and Medicare Part D, respectively. Logistic regression showed female gender, younger age, and residence in low SVI had significantly higher odds of receiving an antibiotic for a tier 3 encounter; whereas prescriptions filled with Medicaid and Medicare were less likely to be associated with tier 3 encounters. Conclusion Previously TDH had not explored outpatient antibiotic use through a health equity lens. While the study provided basic demographic information about patients, there is a need to continue exploring disparities within various populations to aid in targeting inventions that drive appropriate antimicrobial use in ambulatory clinical settings. Disclosures All Authors: No reported disclosures

368. Impact of Social Determinants of Health (SDOH) on Outcomes of OPAT (Outpatient Parenteral Antimicrobial Therapy)

Abstract Background Complex infections may warrant extended antibiotics traditionally reserved for inpatient settings. OPAT is safe and cost effective, allowing return to regular activities and decreased risk of hospitalization. Understanding of SDOH-sensitive risk parameters and impact on adverse events is needed to guide safety and adherence interventions.Figure 1.Most Common OPAT Antibiotics and Indications in Study Cohort Methods Records of patients treated 7/15-10/31/2023 by URMC OPAT program, exclusive of concurrent Transitions of Care Program, were retrospectively reviewed for race, social vulnerability index, insurance type, substance use, needs insecurity, household composition, and outcomes such as OPAT-related orders errors, intravascular device (IVAD) complications, emergency utilization, organ system adverse events, and clinical outcome. A composite Undesirable OPAT Outcome was derived. The impact of SDOH was assessed by chi-square, univariate and multivariate logistic regression using R v4.3 3, rstatix v0.7.2, and sjPlotv2.8.15.Table 1.Proportion and Rates of Errors, Complications, and OPAT Treatment Outcomes in Study Cohort Results Total 116 patients received 3573 OPAT days for varying indications (Fig 1). High rates of discharge order errors, ED utilization, IVAD complications, adverse events, and composite Undesirable Outcomes were noted (Table 1). Those with public insurance (OR=13.6, CI: 1.95-322) or who used cannabis (OR=5.23 CI: 1.1- 27.2) were more likely to incur a laboratory order error on discharge. Patients of color were more likely to experience IVAD complications (OR=3.61, CI: 1.1-12.6) and multiple organ system adverse events (OR= 6.55, CI: 1.45-34.9). High-risk tobacco use was associated with shortened OPAT duration due to adverse event (OR=28.47, CI: 1.72-1299) (Fig 2). OPAT patients with public insurance were least likely to follow up with the ID clinic (OR=7.65, CI: 1.27-152). Time to ID follow-up correlated with multiple SDOH parameters, with publicly insured and persons of color experiencing significantly longer time to follow-up appointments (Fig 3). Incurring a non-IVAD adverse event correlated to composite undesirable outcome in multivariate analysis.Figure 2.Odds Ratios in Univariate Analysis of OPAT Complications Based on Social Determinants of Health Conclusion Social determinants may be predictors in OPAT-related unwanted events. A dedicated focus of evaluating SDOH as contributing drivers of adverse OPAT outcomes may assist creating interventions to support marginalized patient groups.Figure 3:Time-to-event probability analysis for timing of post-discharge ID clinic follow up among OPAT patients by Insurance Type (3A), Race (3B), and All Patients (3C) Disclosures All Authors: No reported disclosures

Association Between Preterm Birth and Fulfillment of Desired Permanent Contraception.

In cases of preterm delivery, the Medicaid sterilization policy mandates a signed consent form at least 72h before surgery for permanent contraception, which is less than the 30day minimum waiting period for term births. This study evaluated the association between preterm birth and fulfillment of planned permanent contraception. This was a secondary analysis of a multi-center retrospective cohort study of 3013 patients with a postpartum contraceptive plan of permanent contraception. Primary outcomes were permanent contraception fulfillment, compared between preterm and term deliveries. Secondary analyses examined moderation by delivery mode and insurance type. At hospital discharge, patients who had a preterm delivery were less likely to undergo desired permanent contraception than those with a term delivery (adjusted odds ratio (aOR): 0.67, 95% CI: 0.53-0.84), and this finding persisted up to one year postpartum (aOR: 0.65, 95% CI: 0.53-0.8). For patients with cesarean deliveries, the odds of permanent contraception fulfillment were significantly lower among those with preterm compared to term deliveries (aOR: 0.54, 95% CI: 0.39-0.76). Among patients with Medicaid insurance, those who delivered preterm were less likely than those who delivered term to undergo desired permanent contraception (aOR: 0.66, 95% CI: 0.59-0.88). Patients delivering preterm face barriers to fulfillment of desired permanent contraception postpartum. Prioritization of contraceptive goals is important for patient autonomy and increasing equitable access to contraception for all.

P-1201. Impact of Demographic Factors and Social Determinants of Health on RSV Immunoprophylaxis in Infants

Abstract Background In 2023, two highly effective forms of respiratory syncytial virus (RSV) immunoprophylaxis to prevent severe RSV disease in young children were approved: Abrysvo (vaccine in pregnancy) and nirsevimab (infant monoclonal antibody). However, challenges with supply and insurance reimbursement limited widespread availability during the 2023-2024 RSV season.Table.Demographics of NICU Infants Eligible for Immunoprophylaxis Methods From October 9, 2023 through March 31, 2024, all St. Louis Children’s Hospital Neonatal Intensive Care Unit (NICU) discharges were offered nirsevimab with no out-of-pocket cost, per CDC recommendations to prioritize infants at highest risk. Data abstraction followed by statistical analyses were performed to identify differences in demographic factors between the following groups: Group 1: Infants who received RSV monoprophylaxis (infant nirsevimab or maternal Abrysvo) prior to hospitalization Group 2: Infants who received RSV immunoprophylaxis (nirsevimab) during hospitalization Group 3: Infants who did not receive RSV immunopropylaxis Area Deprivation Index (ADI) maps were generated using ArcGIS Pro to identify the proportion of infants in the above groups from zip codes with higher or lower ADI. Area Deprivation Index for Patients who Received Previous RSV Immunoprophylaxis The state rank area deprivation index (ADI) overlaid with the total number and percentage of patients within that zip code who received RSV immunoprophylaxis prior to their NICU hospitalization. Results Of 667 eligible infants, 88% received RSV immunoprophylaxis prior to/during hospitalization. Differences in gestational age at birth, chronologic age at hospitalization, age at discharge, duration of hospitalization, and insurance type were observed between groups (Table). Infants who received immunoprophylaxis prior to their hospitalization were primarily clustered in areas with lower ADI (Figure 1). Infants who received immunoprophylaxis during their hospitalization were from areas with variable ADI (Figure 2). Infants who did not receive immunoprophylaxis were primarily clustered in areas with higher ADI, indicating higher social vulnerability (Figure 3). Area Deprivation Index for Patients who Received RSV Immunoprophylaxis During NICU Hospitalization The state rank area deprivation index (ADI) overlaid with the total number and percentage of patients within that zip code who received RSV immunoprophylaxis during to their NICU hospitalization. Conclusion Differences in demographics and ADI were identified in infants who received RSV immunoprophylaxis prior to or during their NICU hospitalization compared to those who did not. Future strategies to improve access and availability of RSV immunoprophylaxis that consider social determinants of health are critical to increase coverage and prevent severe RSV infections in infants. Area Deprivation Index for Patients who Did Not Receive RSV Immunoprophylaxis The state rank area deprivation index (ADI) overlaid with the total number and percentage of patients within that zip code who did not receive RSV immunoprophylaxis. Disclosures Jason G. Newland, MD, MEd, Moderna: Grant/Research Support|Pfizer: Grant/Research Support

P-633. Implementation and Uptake of Nirsevimab within Nemours Children’s Health Delaware Healthcare System

Abstract Background Nirsevimab, the first FDA approved monoclonal antibody to protect against Respiratory Syncytial Virus (RSV), became available for the 2023-2024 RSV season. Distribution of nirsevimab was affected by cost and a supply shortage, limiting overall uptake. Nemour’s Children’s Hospital in Delaware (NCH) implemented several strategic measures to promote immunization despite these barriers, including educational series and periodic communication of regional supply chain status. The purpose of this project was to analyze characteristics of patients who received nirsevimab at NCH and corresponding trends over the 2023-2024 season. Methods We report descriptive summaries of patients who received nirsevimab at NCH from October 2023 to March 2024. Variables analyzed included age, timing of immunization, clinical site and setting, race, sex, insurance status, and state where the patient received the immunization (PA or DE). We compared the distributions of these characteristics by vaccination month using chi-square tests. Results 1,842 infants received nirsevimab, most of which were under 8 months of age (95.7%) at time of immunization (Table 1). Nirsevimab uptake varied by month (Figure 1), with most patients receiving the immunization in November and December. The distribution of immunizations across visit type (outpatient/inpatient, p&amp;lt; 0.001), insurance type (public/private, p&amp;lt; 0.001), and state (DE/PA) varied significantly across months. The distributions of patient-reported sex and race did not vary significantly by month (Table 2). Conclusion Unpredictable supplies of nirsevimab and varying immunization strategies among clinic sites affected distribution and uptake among patients. Some clinics were faced with prioritizing high-risk populations or were restricted by patient insurance policies. These challenges resulted in differing populations having access to nirsevimab based on time of year. Further efforts can focus on unifying immunization promotion techniques and identifying ways to ensure equitable distribution to our target populations. Disclosures All Authors: No reported disclosures

90. Impact of anti-CD20 therapy on COVID-19 in immunocompromised patients: A nationwide cohort study in Korea

Abstract Background During the coronavirus disease 2019 (COVID-19) pandemic, we observed that patients received anti-CD20 therapy progressed to severe pneumonia and underwent persistent viral shedding. We aimed to identify the association between anti-CD20 therapy and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as well as the outcomes of COVID-19. Methods Using claims data derived from the Korean National Health Insurance Service, we conducted a matched nationwide retrospective cohort study. We included individuals aged ≥ 20 years diagnosed with conditions for which anti-CD20 therapy could be considered from January 2020 to December 2021. We defined the exposure variable by prescribing rituximab (RTX) at least once according to the database. COVID-19-related outcomes included hospitalization for COVID-19, ICU admission, mechanical ventilation administration, and all-case death. Patients prescribed RTX and those not prescribed RTX were defined as RTX users and non-users, respectively. The RTX users and non-users were 1:10 propensity score matched using sex, age, insurance type, and comorbidities. Logistic regression analyses were used to estimate the association between RTX and SARS-CoV-2 infection, as well as COVID-19-related outcomes. Results After 1:10 propensity score matching, 932 RTX users and 8,361 RTX non-users were analyzed. The proportion of vaccinated individuals was significantly lower in RTX users than in RTX non-users (69.3% vs. 90.9%; P &amp;lt; 0.001). RTX use was associated with an increased risk of all-case death (adjusted odds ratio [aOR] 1.85, 95% confidence interval [CI] 1.39–2.46, P &amp;lt; 0.001). In the subgroup analysis for vaccinated individuals, the risk of SARS-CoV-2 infection was significantly greater for RTX users compared to non-users (aOR 2.48, 95% CI 1.02–6.04, P = 0.045), and RTX use was also associated with a significantly increased risk of hospitalization (aOR 3.79, 95% CI 1.28–11.23, P = 0.016) and all-case death (aOR 3.85, 95% CI 2.54–5.84, P &amp;lt; 0.001). Conclusion The use of RTX was associated with an increased risk of all-cause death in immunocompromised patients. Among vaccinated individuals, RTX users were at an increased risk of SARS-CoV-2 infection, as well as an increased risk for hospitalization of COVID-19 and all-cause death. Disclosures All Authors: No reported disclosures

P-513. Recruitment Challenges for Youth HIV Pre-exposure Prophylaxis (PrEP) Research

Abstract Background Recruitment for youth-focused PrEP studies among sexual and gender minority (SGM) youth is a challenge. We report on recruitment strategies and lessons learned from a youth TelePrEP study in Colorado.Table 1:Recruitment strategies used for youth PrEP study Methods Youth assigned male at birth, ages 18-24 years, eligible for PrEP using FTC/TAF, and at risk for HIV in Colorado were recruited to participate in a pilot feasibility trial of PrEP services provided via telehealth. Participants agreed to be seen via telehealth and to obtain initial lab testing at one of seven sites located throughout the state. PrEP medications were offered free for up to 12 months via in-person pick up or mail delivery. Youth were able to enroll and receive clinical care regardless of insurance type. HIV self-test kits were available via mail for follow up testing. Participants received $25 at time of enrollment. Recruitment methods were informed by two electronic youth surveys (N= 375 total), student young adult advisors, youth PrEP providers, and research team experience in youth HIV treatment and prevention studies.Figure 1:Recruitment Flow Chart Results A total of 319 individuals completed an online recruitment survey of which 44 (14%) were eligible and 21 (48%) of those enrolled between January 2023 and March 2024 out of a target of 100 study participants. (Figure 1) An estimated 107,500 individuals received at least one form of study recruitment. (Table 1) Direct recruitment occurred through adolescent clinics (including family planning/STI, transgender care, adolescent primary care, and youth HIV clinics) and pediatric primary care offices via primary care provider referral (N=4 enrolled). Community recruitment was done through SGM youth-serving organizations, community events, during community HIV education sessions (N=4 enrolled). On-line recruitment utilized social media (including targeted ads and sponsored influencers), dating apps, and survey outreach (N=6 enrolled). (Figure 2) Dating apps and social media were the most common recruitment strategies among eligible participants.Figure 2:Examples of Youth TelePrEP Recruitment Materials Conclusion Despite a multipronged approach to recruitment of SGM youth for a study on youth TelePrEP, recruitment was below targets. Additional innovation and evaluation of strategies are needed to not only increase recruitment to youth PrEP studies but also youth PrEP services. Disclosures Lisa Abuogi, MD, MS, Gilead Sciences: Grant/Research Support Alexander Limas, MSW, Gilead Sciences: Grant/Research Support AJ De La Garza, BSW, Gilead Sciences: Grant/Research Support Katherine Leonard, MSN, FNP-BC, Gilead Sciences: Grant/Research Support Sam Gallegos, BS, Gilead Sciences: Grant/Research Support

Health disparities among youth admitted for an eating disorder in an inpatient hospital setting

ABSTRACT The rise of eating disorders (EDs) in youth has become increasingly studied and understood among the health care community in recent years. With the frequency at which these youths are requiring medical stabilization, the importance of further examining factors that may contribute to these rates, such as health disparities, has become of primary concern for prevention and treatment efforts. Health disparities and related factors among youth hospitalized for medical stabilization secondary to an ED are examined to expand provider knowledge about this population and identify areas for improvement. Electronic medical record (EMR) retrospective (2017–2022) review was conducted within a southeast metropolitan children’s hospital (N = 91, ages 9–19 years) examining comparisons between Latinx and non-Latinx youth, insurance type, previous admissions for similar presentation, and ED-related characteristics. Results show Latinx patients were found to be admitted (p = .013, p = .002) and discharged (p = .003, p < .001) with higher scores on measures of body composition than non-Latinx patients. Additionally, higher rates of public insurance among Latinx patients (p < .001) and higher readmission rates among patients with public insurance (p < .001) were observed. Authors provide suggestions for improving screening practices and advocacy efforts to help increase ED treatment options for youth that may have limited access.

Evaluating patients on CDK-4/6 inhibitor treatment for differences in treatment according to demographic variables.

The accessibility and outcomes of cyclin-dependent kinase 4 and 6 inhibitors (CDKi) in metastatic breast cancer (MBC) according to demographic factors are unknown. Retrospective review of patients with ER+ MBC prescribed first-line CDKi therapy from January 2015 through December 2022. Abstraction included time from CDKi prescription to drug initiation (TTI), time from CDKi initiation to progression (TTP), time from CDKi initiation to death or 6/30/2022, and variables (age, race, partner status, insurance type, BMI, number of comorbidities). Descriptive, comparative, and correlational statistics are used. N = 173 patients. No significant demographic differences in TTI or TTP. In the multivariate model TTI to death, patients with Medicaid insurance had significantly shorter overall survival than patients with private insurance. Medicaid insurance is associated with worse outcomes of MBC therapy, not attributed to TTI delay. Personalization of support may be helpful.

Commodity-Material Values (Goods) in Current Turnover Insurance in the Field of Judicial and Business Practice

The demand for this type of insurance, such as commodity-material values (goods) in turnover is increasing. This is caused by an increase in the concentration of material resources in warehouses and distribution centers due to the activation of trade through marketplaces and online stores and large cases of loss of goods. Significant losses that may arise from sellers and intermediaries encourage business practices to enter into insurance agreements with special conditions depending on the purpose of insurance. If the purpose of insurance is to protect the property interest of the creditor then such contracts usually provide for a condition on the non-reduced balance of the pledged goods. In the case of concluding an insurance agreement for the purpose of maximum protection of interests (at the upper or middle limit of the value of goods in turnover) judicial and business practice, given the lack of legal regulation of insurance relations, does not currently have unified positions regarding a number of conditions of such agreements: what features of the insured object are necessary and sufficient for its individualization; how to determine the essential condition of the agreement and the insurance amount if the insured value of goods in turnover is variable; and finally what rules should be applied when calculating the insurance indemnity.

Barriers to Adherence with Clinic Visits in Patients with Uveitis

ABSTRACT Purpose To assess the patient barriers to adherence with appointment follow-up in patients with ocular inflammatory disorders across the United States. Methods This was a multicenter study of adult and pediatric patients at the Wilmer Eye Institute, University of Texas at Austin, University of Wisconsin-Madison, University of Minnesota, Minneapolis Veterans Administration Hospital, and Washington University of St. Louis. The primary outcome was self-reported adherence to follow-up visits. Secondary outcomes were the reasons for missing follow-up including sub analyses of patient demographics. Eligible patients completed a self-reporting survey to assess barriers to attending follow-up visits. Results The survey was fully completed by 210 subjects and partially by 40 (250 in total), of whom were 67% white, 59% female, and 51% had a college or advanced degree. Most patients had bilateral (68%), anterior (51%) uveitis. Patients were treated with topical corticosteroids (33%), immunosuppressive agents (23%), or both (22%). Most patients (79%) did not miss or cancel appointments. Ninety-seven percent of patients had medical insurance and some paid (39%) more than 40 dollars for their copay. Copay costs limited the number of visits patients could attend in 7% of patients. Eight percent of patients missed appointments due to inability to take off time from work and 5% missed visits due to lack of transportation. Conclusion Most patients with ocular inflammation reported good adherence to follow-up appointments. Insurance type, copay costs, transportation, patient scheduling, and patient understanding were all minimally reported to effect patient visit attendance.

Uptake of Recommended Vaccines During Pregnancy Among Publicly and Privately Insured People in the United States, December 2020-September 2022.

Objectives. To estimate maternal COVID-19, influenza, and pertussis vaccine uptake during pregnancy by insurance type and identify factors characterizing those vaccinated and unvaccinated. Methods. We conducted a US cohort study of pregnant individuals (for pregnancies ending December 11, 2020-September 30, 2022) using insurance claims data. We calculated vaccination probability using Kaplan-Meier methods and identified factors associated with vaccination through binomial regression with inverse probability weights. Results. Among 695 887 pregnant individuals (median age = 32 years for privately and 27 years for publicly insured), the cumulative probability of COVID-19 vaccination was 43.0% (privately insured) and 11.8% (publicly insured). We observed marked disparities between influenza (33.2% vs 14.2%) and pertussis (70.3% vs 42.8%) vaccination. Only 6.8% (privately insured) and 1.1% (publicly insured) received all 3 vaccines. COVID-19 and influenza vaccination odds were lower among drug and tobacco users. People with high-risk medical conditions, particularly the publicly insured, commonly were vaccinated. Conclusions. Marked vaccine uptake disparities exist between privately and publicly insured pregnant people. Understanding structural barriers, particularly for Medicaid enrollees, is critical to improving maternal vaccine access. (Am J Public Health. Published online ahead of print January 23, 2025:e1-e10. https://doi.org/10.2105/AJPH.2024.307899).