US Seniors Research Articles

Disparities in dementia care at US mental health care facilities: Analysis of US nationwide data from 2010 to 2020

<h3>Introduction</h3> Background: The number of US seniors with dementia is projected to increase in the coming years. Deaths from Alzheimer's disease more than doubled between 2000 and 2020. Purpose: To investigate the availability of mental health treatment programs tailored for seniors with mental health disorders and Alzheimer's disease among US mental health care facilities. <h3>Methods</h3> Data (2010 – 2020) from the Substance Abuse and Mental Health Data Archive (SAMHDA) was analyzed to examine differences in proportions of US mental health care (MHC) facilities providing Alzheimer's or dementia treatment and mental health care services. <h3>Results</h3> The number of US mental health care centers that provided mental health treatment specifically designed for individuals with Alzheimer's or dementia decreased from 1,162 (11.2%) in 2010 to 866 (6.9%) in 2019. We see a decrease in all mental health care facilities in all US regions. On the other hand, the number of MHC facilities providing care for seniors in the US (66.2% in 2010 to 80.3% in 2019), the proportion providing specialized MHC to seniors (18.4% in 2010 to 26.3% in 2019), and the proportion providing substance use treatment to US seniors (6.9% in 2010 to 24.7% in 2019) all significantly increased within the examined period. <h3>Conclusions</h3> Considering the projected increase in the prevalence of Alzheimer's disease in the US, the proportion of US MHC facilities providing dementia care and other specialized MHC to the US elderly need to increase. Therefore, further investment in the mental health care of the elderly in the US is urgently warranted. <h3>This research was funded by</h3> None Chart: https://apps.aagponline.org/abstracts/uploads/2022/qsrr3g7xl4pc1ij.pdf

Publication Times and Integrated Plastic Surgery Applicant Planning.

Integrated plastic surgery is one of the most competitive residencies, with 57% of applicants matching in 2021.1 Research productivity is a shared feature of applicants with matched US MD seniors producing 19.1 abstracts, presentations, and publications compared with 11.5 for unmatched seniors in 2020.1 This reflects a substantial increase from only 3.4 for matched applicants in 2007.2 In this Viewpoint, we will analyze publication times in a major plastic surgery journal pre and post-pandemic, with the goal of determining how early applicants must start plastics research to be competitive, taking these contemporary publication cycle times into account. As per Chawla et al, 35 articles published between January 1, 2019, and November 1, 2021, in Plastic and Reconstructive Surgery were chosen at random. Plastic and Reconstructive Surgery was selected as it is the highest impact factor journal in the specialty with an impact factor of 4.763. One original research article per monthly issue was reviewed. Articles accepted before March 2020 were categorized as “pre-COVID,” between March 2020 and August 2020 as “quarantine,” and September 2020 to the present as “postquarantine.” Two-tailed T-testing assessed differences. Mean submission-to-acceptance time significantly increased from 30.97 weeks pre-COVID to 56.80 weeks postquarantine (P < 0.05), whereas acceptance-to-publication time significantly decreased from 32.67 to 25.59 weeks (see Table 1). Table 1. - Mean Submission-to-acceptance and Acceptance-to-publication Times for January 2019 to November 2021 Issues of Plastic and Reconstructive Surgery Mean Submission-to-acceptance Time, wk (SD) Mean Acceptance-to-publication Time, wk (SD) Pre-COVID (n = 21) 30.97 (10.24) 32.67 (8.26) Quarantine (n = 6) 38.10 (9.79) 29.64 (4.80) Postquarantine (n = 8) 56.80 (21.46)* 25.59 (4.34)* *Significant (P < 0.05) difference between value and respective pre-COVID value. Submission-to-acceptance times were analyzed separately from submission-to-publication times, as applicants can list accepted work as publications in ERAS and PSCA applications. Further, in 2018, Plastic and Reconstructive Surgery was found to have a mean acceptance-to-publication time of 25.8 weeks, longer than the mean among all plastic surgery journals in 2018 of 10.32 weeks.3 The same study reported a mean submission-to-acceptance time of 23.3 weeks for Plastic and Reconstructive Surgery and 21 weeks for all plastic surgery journals, suggesting this metric is more generalizable. Overall, our data suggest that article submission-to-acceptance time postquarantine is greater than 1 year. This trend is supported by a selection of general journals, which demonstrated a significantly longer submission-to-acceptance time postquarantine compared with articles from 2019 at 91.35 and 75.79 days, respectively.4 This trend is exacerbated in plastic surgery journals, which significantly lag compared to other surgical subspecialty journals with median submission-to-publication time in 2018 of 208 days versus 22.1, respectively.3 With Step 1 transitioning from numerical to pass/fail scoring in 2022, further emphasis will be placed on research.5 We recommend expressing an interest in plastic surgery 2 years before applications are due. This is early M2 year for the average US senior and allows sufficient time to start multiple research projects and go through the submission-to-acceptance process in the postquarantine era. Further, we recommend research-related gap years be taken at least 2 years before the application cycle, if applicable (between M2 and M3 year) to allow for maximum publication productivity. A final consideration is for the applicant to look at publication cycle metrics/turnaround times of target journals before submission to best evaluate how these mesh with application cycle deadlines. DISCLOSURE The authors have no financial interests to declare in relation to the content of this article.

Making a match: trends in the application, interview, and ranking process for the neurological surgery residency programs.

Neurosurgery is a highly competitive residency field with a match rate lower than that of other specialties. The aim of this study was to analyze trends associated with the residency match process from the applicants' and program directors' perspectives. Between 2010 and 2020, the National Residency Matching Program (NRMP) Applicant and Program Director Surveys, the NRMP Charting Outcomes reports, and the Accreditation Council for Graduate Medical Education (ACGME) Data Resource Books were analyzed to identify the number of applicants interviewed and ranked in US programs, the applicants' ranking preferences, the program directors' preferential factors in offering interviews, and rank list order. Applicants were divided between US senior medical students and independent applicants. Each cohort was dichotomized for matched and unmatched applicants. Over the study period, 2935 applicants applied to neurosurgery residency, including 2135 US senior medical students and 800 independent applicants, with an overall match rate of 65%. Overall, matched applicants had a significantly higher number of publications (p < 0.05). Among US senior medical student applicants, the application-to-interview ratio more than doubled over the study period, yet the number of interview invitations received, interviews accepted, and programs ranked remained unchanged. In the US senior medical student cohort, the number of submitted applications, interview invitations, accepted interviews, and programs ranked did not significantly differ between matched and unmatched applicants. In both cohorts, applicants shifted ranking factors from a more academic focus in early years to more well-being in later years. Letters of recommendation and board scores were key factors for program directors while screening applicants for interviews and ranking. Neurosurgery residency continues to be a highly competitive field in medicine, with match rates of 65%. Recently, applicants have placed greater importance on ranking programs that value residents' well-being, as opposed to strictly academic factors. A data-driven understanding of factors important to applicants and program directors during the match process has the potential to improve resident candidate recruitment and overall resident-program fit, thereby improving well-being during residency, reducing the attrition rate, and overall enhancing the diversity of the neurosurgery resident workforce.

The Impact of Personal Protection Equipment on Intubation Times.

Hazardous material (HAZMAT) protocols require health care providers to wear personal protective equipment (PPE) when caring for contaminated patients. Multiple levels of PPE exist (level D - level A), providing progressively more protection. Emergent endotracheal intubation (ETI) of victims can become complicated by the cumbersome nature of PPE. The null hypothesis was tested that there would be no difference in time to successful ETI between providers in different types of PPE. This randomized controlled trial assessed time to ETI with differing levels of PPE. Participants included 18 senior US Emergency Medicine (EM) residents and attendings, and nine US senior Anesthesiology residents. Each individual performed ETI on a mannequin (Laerdal SimMan Essential; Stavanger, Sweden) wearing the following levels of PPE: universal precautions (UP) controls (nitrile gloves and facemask with shield); partial level C (PC; rubber gloves and a passive air-purifying respirator [APR]); and complete level C (CC; passive APR with an anti-chemical suit). Primary outcome measures were the time in seconds (s) to successful intubation: Time 1 (T1) = inflation of the endotracheal tube (ETT) balloon; Time 2 (T2) = first ventilation. Data were reported as medians with Interquartile Ranges (IQR, 25%-75%) or percentages with 95% Confidence Intervals (95%, CI). Group comparisons were analyzed by Fisher's Exact Test or Kruskal-Wallis, as appropriate (alpha = 0.017 [three groups], two-tails). Sample size analysis was based upon the power of 80% to detect a difference of 10 seconds between groups at a P = .017; 27 subjects per group would be needed. All 27 participants completed the study. At T1, there was no statistically significant difference (P = .27) among UP 18.0s (11.5s-19.0s), PC 21.0s (14.0s-23.5s), or CC 17.0s (13.5s-27.5s). For T2, there was also no significant (P = .25) differences among UP 24.0s (17.5s-27.0s), PC 26.0s (21.0s-32.0s), or CC 24.0s (19.5s-33.5s). There were no statistically significant differences in time to balloon inflation or ventilation. Higher levels of PPE do not appear to increase time to ETI.

The Price of Fear: An Ethical Dilemma Underscored in a Virtual Residency Interview Season.

The Price of Fear: An Ethical Dilemma Underscored in a Virtual Residency Interview Season.

An analysis of applicant competitiveness to general surgery, surgical subspecialties, and integrated programs

BackgroundGeneral surgery was once the gateway into a career in surgery. Over time, surgical subspecialties developed separate residency programs, and recently, integrated programs have emerged. It is unknown what impact the presence of surgical subspecialties and integrated programs have had on general surgery. Our objective was to evaluate match trends and quantify competitiveness of the general surgery, integrated programs, and surgical subspecialties matches. MethodsNational Residency Matching Program match data and applicant characteristics from 2010 through 2020 were analyzed for US senior allopathic applicants. Integrated programs were defined as plastic and vascular surgery, and surgical subspecialties were defined as otolaryngology, orthopedic surgery, and neurosurgery. Trends were evaluated using linear regression, programs were compared on 10 metrics by Wilcoxon rank-sum tests, and a logistic regression was used to rank each specialty match. ResultsThe number of US senior applicants per position to integrated programs decreased and approached that of general surgery and surgical subspecialties, but the median number of applicants per position to general surgery was lower than to surgical subspecialties or integrated programs (1.21 interquartile range). Our logistic regression showed United States Medical Licensing Examination scores, research experience, Alpha Omega Alpha Honor Society membership, and graduation from a top medical school to be the most important factors in the match, and our weighted rank score found general surgery (2.85) to be less competitive than surgical subspecialties (1.92) or integrated programs (1.17). ConclusionThroughout the last decade, integrated programs and surgical subspecialties have matched more competitive applicants based on the most significant predictors of the match. Moving forward, it is important that general surgery strives to attract the best and brightest out of medical school.

Impact of a Targeted Rural and Underserved Track on Medical Student Match Into Family Medicine and Other Needed Workforce Specialties

There is a shortage of physicians in rural communities in the United States. More than other types of primary care physicians, family physicians are the foundation for care in rural areas.1 There are also critical shortages of other specialties such as general surgery, pediatrics, internal medicine, and psychiatry in rural America.2-7 This study assessed student participation in the University of Washington School of Medicine's (UWSOM) Targeted Rural Underserved Track (TRUST) program as a predictor for family medicine (FM) and needed workforce specialty residency match. The study group was 156 medical students from 2009-2014; 102 were accepted to the TRUST program compared to a control group of 54 who were not accepted into the TRUST program but did matriculate to UWSOM. Student characteristics for the two groups were compared using t tests. Logistic regression analysis determined whether acceptance in TRUST predicted the outcomes measures of FM residency match or residency match into a needed rural physician workforce specialty; t tests compared match rates to family medicine for TRUST applicants and graduates, UWSOM graduates, and US allopathic seniors. TRUST program graduates had the same FM residency match rate and match rate in needed workforce specialties as the control group. The FM match rate for TRUST graduates was 29.1% compared to UWSOM at 16.9% and US seniors at 8.7% (P&lt;.001). Although match rates in FM and needed workforce specialties were not different in accepted versus not accepted groups, all TRUST applicants had an FM match rate that approaches 30%, which is higher than the general UWSOM class and the United States. In order to help reach the goal of 25% of medical students matching into FM by 2030, medical schools should consider having a rural program and using rural-focused admissions widely.

The Mortality Risk of Proton Pump Inhibitors in 1.9 Million US Seniors: An Extended Cox Survival Analysis

Observational studies have linked proton pump inhibitors (PPIs) with increased risk of mortality and other safety outcomes, in contradiction with a recent PPI randomized controlled trial (RCT). Observational studies may be prone to reverse causality, where deaths are attributed to the treatment rather than the conditions that are treated (protopathic bias). We analyzed an incident drug user cohort of 1,930,728 elderly Medicare fee-for-service beneficiaries to evaluate the PPI-associated risk of death with a Cox regression analysis with time-varying covariates and propensity score adjustments. To correct for protopathic bias which occurs when a given drug is associated with prodromal signs of death, we implemented a lag-time approach by which any study drug taken during a 90-day look-back window before each death was disregarded. Among 1,930,728 study individuals, 80,972 (4.2%) died during a median 3.8 years of follow-up, yielding an overall unadjusted death rate/1000 person-years of 9.85; 14.31 for PPI users and 7.93 for non- users. With no lag-time, PPI use (vs no use) was associated with 10% increased mortality risk (adjusted HR=1.10; 95% CI 1.08-1.12). However, with a lag-time of 90 days, mortality risk associated with PPI use was near zero (adjusted HR=1.01; 95% CI 0.99-1.02). Given the usage patterns of PPIs in patients with conditions that may presage death, protopathic bias may explain the association of PPIs with increased risk of death reported in observational studies.

Strategies to reduce healthcare costs: what medical conditions are US seniors treating with Mexican pharmaceuticals?

Abstract Objectives The high price of pharmaceuticals in USA has caused patients, health insurance plans and policy makers to explore the possibility of purchasing pharmaceuticals in Mexico. However, it is unclear if the practice would lower costs and whether US patients would be willing to purchase pharmaceuticals in Mexico. Focusing on seniors who spend the winter along the Texas/Mexico border, Winter Texans, the purpose of this study was to identify their most common health problems and whether they used Mexican pharmaceuticals to manage those problems. Methods Data for this cross-sectional pilot study were collected through sending an online survey to 1040 seniors on the Winter Texan Migrant Panel. A total of 311 completed the survey and the data were analysed. Key findings The most common medical conditions were pain (69%), high cholesterol (37%) and arthritis (32%). Half of the respondents purchased a total of 293 Mexican pharmaceuticals with 77.5% indicating that the lower cost influenced their decision. The most frequently treated conditions with Mexican pharmaceuticals were infections (37%), pain (28%) and acid reflux (24.4%). Conclusions Seniors did not treat their most common medical conditions with Mexican medication, except for pain. Instead, they used it for more minor and acute problems. This suggests that the decision of where to purchase a pharmaceutical is complex and not exclusively dependent on cost. Therefore, legislation and health insurance plans that encourage seniors to purchase pharmaceuticals abroad might be successful for lowering the cost of treatment for some medical conditions but not others.

Association between tendon ruptures and use of fluoroquinolone, and other oral antibiotics: a 10-year retrospective study of 1 million US senior Medicare beneficiaries

ObjectivesTo assess the association of fluoroquinolone use with tendon ruptures compared with no fluoroquinolone and that of the four most commonly prescribed non-fluoroquinolone antibiotics in the USA.DesignRetrospective observational study.SettingUS seniors...

Association of Job Expectations Among High School Students With Early Death During Adulthood

Deaths from self-injury are increasing. Understanding the sources of risk is important for prevention and treatment. To estimate the risks of suicide and drug poisoning deaths among adult men whose adolescent occupational expectations were not met in adulthood. This cohort study included a sample of men interviewed as part of the High School and Beyond study, a nationally representative study of US high school sophomores and seniors in 1980, who were interviewed every 2 years through 1986; those who were sophomores in 1980 were reinterviewed in 1992. Men who survived to 1992 and reported occupational expectations were included in the present study. Death records prior to 2018 were linked to mortality databases and released in 2019. Data analysis was conducted from May to October 2020. Occupational expectations. Survival or death by suicide, drug poisoning, chronic liver disease, heart disease, cancer, or some other cause, categorized from International Classification of Diseases, Ninth Revision and Tenth Revision codes. Competing risk Fine-Gray survival models regressed cause of death on adolescent occupational expectations and covariates. The 11 680 men in the High School and Beyond cohort study had a median (interquartile range) age of 29 (28-30) years in 1992, when the analysis of their future mortality began. Most men survived until 2015 (11 060 [weighted percentage, 95.0%]). Reported causes of death were suicide (60 [weighted percentage, 0.5%]), drug poisoning (40 [weighted percentage, 0.4%]), chronic liver disease (20 [weighted percentage, 0.2%]), heart disease (130 [weighted percentage, 1.0%]), cancer (100 [weighted percentage, 1.0%]), and other (280 [weighted percentage, 2.0%]). Subhazard ratios for death by suicide and drug poisoning were 2.91 (95% CI, 1.07-7.88; P = .04) and 2.62 (95% CI, 1.15-5.94; P = .02) times higher, respectively, among those who in 1980 expected to hold a subbaccalaureate occupation that later declined in labor market share compared with those with professional occupational expectations. The actual job held by men did not attenuate the hazards of deaths from suicide and drug poisoning. In this cohort study, men whose occupational expectations were not met because of labor market declines were at a higher risk of death from suicide or drug poisoning than men with different occupational expectations. Interventions to mitigate labor market changes should account for individuals' expectational ideals.

An Analysis of Trends in National Residency Matching Program Match Data for Orthopedic Surgery.

Due to electronic residency applications, US Medical Licensing Examination Step 1 scores are frequently used by orthopedic surgery program directors to screen applicants. Prospective applicants therefore often use Step 1 scores as a proxy for specialty competitiveness. The goal of this investigation was two-fold: (1) to determine whether trends in Step 1 scores are indicative of trends in competitiveness of orthopedic surgery and (2) to report the characteristics that optimize a US medical student's match success. A retrospective review of published National Resident Matching Program data from 2009 to 2018 was performed for orthopedic surgery residency applicants. Additional data from the Charting Outcomes reports were used for specific analyses of applicant characteristics. From 2009 to 2018, the number of orthopedic surgery residency positions grew at an annual rate of 1.51% (95% confidence interval [CI], 1.37% to 1.64%; P<.001), accommodating the 1.26% (95% CI, 0.63% to 1.90%; P=.006) annual increase in the number of applicants who ranked orthopedic surgery as their preferred specialty choice (only choice or first choice). There were no significant changes in the applicant-to-position ratio (95% CI, -0.85% to 0.37%; P=.483) or the match rate for US seniors who ranked orthopedic surgery as their preferred choice (95% CI, -0.23% to 0.87%; P=.313). Increases in mean Step 1 scores of matched orthopedic surgery applicants parallel national Step 1 growth trends (0.49% vs 0.44%, respectively). Although orthopedic surgery is currently a competitive specialty to match into, this has been the case since 2009. Increasing Step 1 scores of matched applicants is not unique to orthopedic surgery and should not be misinterpreted as a proxy for increasing competitiveness of the specialty. [Orthopedics. 2020;43(6):e616-e622.].

Implications of Change to USMLE Step 1 Scoring for Otolaryngology Residency Programs.

Otolaryngology is a competitive specialty, with 398 US seniors applying to an offered 328 positions in 2019. Recent changes to US Medical Licensing Exam (USMLE) Step 1 scoring raise many questions for both medical student applicants and program directors. Otolaryngologists are known to be collegial and thoughtful physicians. Focusing on other nonstandardized testing scores may help the specialty "reboot" and refocus on recruiting the best people, not just applicants with a high Step 1 score and Alpha Omega Alpha (AOA) status.

Relative vaccine efficacy of high-dose versus standard-dose influenza vaccines in preventing probable influenza in a Medicare Fee-for-Service population

BackgroundHigh-dose (HD) influenza vaccine, currently the most commonly used vaccine among US seniors (aged ≥ 65 years), has been shown to be more efficacious than standard-dose (SD) vaccine in multiple randomized trials. This study evaluated the real-world relative vaccine effectiveness (rVE) of HD vs SD over four influenza seasons. MethodsThis study included Medicare Fee-for-Service enrollees who received HD or SD at an outpatient clinic or pharmacy during influenza seasons 2011–2012 through 2014–2015. Probable influenza (an inpatient stay with an influenza diagnosis on the claim, or an outpatient visit with a rapid influenza test/culture followed by an antiviral prescription) was assessed among HD recipients matched 1:1 with SD recipients by location, vaccination date, age, and sex. Fine-Gray subdistribution hazard models with competing risk of death were used to adjust for residual confounding. Analyses were stratified by outpatient vs pharmacy vaccination. ResultsAcross the four influenza seasons, there were 535,598, 1,017,552, 1,548,164, and 2,420,450 in the pharmacy cohort; and 821,662, 1,151,080, 1,559,488, and 2,421,758 in the outpatient cohort. During peak influenza season, rVEs for 2011–12 through 2014–15 were 21.8% (95% CI: −5.9%, 42.3%), 14.8% (9.3%, 19.9%), 16.9% (9.2%, 23.9%), and 17.2% (14.5%, 19.9%), respectively, in the pharmacy cohort; and 16.5% (−5.9%, 34.2%), 15.1% (10.9%, 19.1%), 10.0% (2.9%, 16.6%), and −0.2% (−3.0%, 2.5%), respectively, in the outpatient cohort. ConclusionHD was consistently associated with better protection against probable influenza. The lower treatment effect observed in the outpatient cohort could reflect provider bias due to physicians triaging HD to frailer patients.

Lack of Additional Advanced Graduate Training by Orthopaedic Surgeons in Academic Practice: Current Employment and Recruitment Trends.

Background:Orthopaedic surgery is ever changing and depends on diverse technical and intellectual skill sets. The purpose of the current study was to evaluate the percentage of academic orthopaedic surgeons with additional graduate degrees in the United States.Methods:Data including advanced degree(s) (eg, PhD, MS, MBA, MPH, JD, and DVM), academic rank, leadership position, subspecialty, years since training completion, and sex were collected from websites for all academic orthopaedic surgery departments in the United States. Univariate analyses were performed to evaluate for differences in demographic data based on the advanced degree status. Data from the National Resident Matching Program (NRMP) were used to characterize graduate degree-holding US senior medical students who ranked orthopaedic surgery first relative to peers without additional advanced degrees and to applicants who ranked other specialties first.Results:Of 4,519 faculty at 175 academic orthopaedic surgery departments in the United States, 7.1% held a graduate degree in addition to a medical doctorate. There was no difference in the percentage of faculty who held departmental leadership positions (P = 0.62) or who were full professors (P = 0.66) based on holding an additional graduate degree. Of 678 US senior applicants who ranked orthopaedic surgery first and successfully matched into the specialty in 2018, 12.5% held an additional graduate degree and 1.3% were MD-PhDs. Orthopaedic surgery had the second lowest percentage of matched medical students with additional advanced degrees, which was significantly lower than the top 10 specialties (range 16.1% to 21.6%; P < 0.05). Orthopaedic surgery recruited 1.6% of all MD-PhD applicants in 2018.Discussion:Few academic orthopaedic surgery faculty and admitted orthopaedic residency candidates have additional graduate school training. The low percentage of orthopaedic faculty and trainees with additional advanced degrees relative to other specialties may represent a missed opportunity to recruit individuals with diverse skills to advance the field of orthopaedic surgery.

Determinants of medical specialty competitiveness

BackgroundAlthough the concept of medical specialty competitiveness may seem intuitive, there are very little existing empirical data on the determinants of specialty competitiveness in USA. An understanding of the determinants...

Relative Vaccine Efficacy of High-Dose Versus Standard-Dose Influenza Vaccines in Preventing Probable Influenza in a Medicare Fee-for-Service Population

Background: High-dose (HD) influenza vaccine, currently the most commonly used vaccine among US seniors (aged ≥ 65 years), has been shown to be more efficacious than standard-dose (SD) vaccine in multiple randomized trials. This study evaluated the real-world relative vaccine effectiveness (rVE) of HD vs SD over four influenza seasons. Methods: This study included Medicare Fee-for-Service enrollees who received HD or SD at an outpatient clinic or pharmacy during influenza seasons 2011-12 through 2014-15. Probable influenza (an inpatient stay with an influenza diagnosis on the claim, or an outpatient visit with a rapid influenza test/culture followed by an antiviral prescription) was assessed among HD recipients matched 1:1 with SD recipients by location, vaccination date, age, and sex. Fine-Gray subdistribution hazard models with competing risk of death were used to adjust for residual confounding. Analyses were stratified by outpatient vs pharmacy vaccination. Findings: Across the four influenza seasons, there were 535,598, 1,017,552, 1,548,164, and 2,420,450 in the pharmacy cohort; and 821,662, 1,151,080, 1,559,488, and 2,421,758 in the outpatient cohort. During peak influenza season, rVEs for 2011-12 through 2014-15 were 21·8% (95% CI: -5·9%, 42·3%), 14·8% (9·3%, 19·9%), 16·9% (9·2%, 23·9%), and 17·2% (14·5%, 19·9%), respectively, in the pharmacy cohort; and 16·5% (-5·9%, 34·2%), 15·1% (10·9%, 19·1%), 10·0% (2·9%, 16·6%), and -0·2% (-3·0%, 2·5%), respectively, in the outpatient cohort. Interpretation: HD was consistently associated with better protection against probable influenza. The lower treatment effect observed in the outpatient cohort could reflect provider bias due to physicians triaging HD to frailer patients. Funding Statement: This study was supported by Sanofi Pasteur (Swiftwater, PA). Declaration of Interests: A.C. is an employee of Sanofi Pasteur (Swiftwater, PA, USA), the funder of this study. M.P., A.B., S.K., D.V., and L.B. are employees of Optum (Eden Prairie, MN, USA), which was contracted by Sanofi Pasteur to conduct this study and provide medical writing support. SMM has received unrestricted research grants from Merck, GlaxoSmithKline, Sanofi Pasteur, Pfizer and Roche-Assurex for unrelated studies. SMM has received fees as an advisory board member for Sanofi Pasteur. Ethics Approval Statement: This study was approved by the New England Institutional Review Board (approval #120160896), with waived consent for analyses of deidentified administrative claims.

2747. Relative Vaccine Efficacy of High-Dose vs. Standard Dose Influenza Vaccines in Preventing Probable Influenza in a US Medicare Fee-for-Service Population

BackgroundHigh dose (HD) influenza vaccine has been shown to be more efficacious than standard dose (SD) vaccine in multiple randomized trials. HD is currently the most commonly used vaccine in US seniors (≥65 years of age). In this study, we evaluated the real-world relative vaccine effectiveness (rVE) of HD vs SD over 3 influenza seasons.MethodsThis study includes a cohort of Medicare fee-for-service enrollees during influenza seasons 2011–2012 to 2013–2014 who received either HD or SD at a pharmacy or an outpatient clinic. HD recipients were matched 1:1 to SD recipients based on location, date of vaccination, age, and gender. Fine-Gray subdistribution hazard models with competing risk of death were used to adjust for residual confounding. The study outcome of probable influenza was defined as any inpatient stay with an influenza diagnosis on the claim, or an outpatient medical encounter with a rapid influenza test/culture followed by an antiviral prescription. Analyses were stratified based on vaccination location (clinic vs pharmacy) as it is expected that physicians carrying both vaccines may prioritize HD to frailer patients, while pharmacists may not exercise clinical judgment.ResultsOver the influenza seasons 2011–2012, 2012/–2013, and 2013–2014, 1.6–2.2 million seniors were immunized at a pharmacy; and 3.3–3.5 million at a clinic. After matching, there were 535,598; 1,017,552; and 1,548,164 in the pharmacy cohort, and 821,662; 1,151,080; and 1,559,488 in the clinic cohort, across study years. The rVE over 2011/12, 2012/13, and 2013/14 during peak influenza circulation was 21.8% (95% CI: −5.9%, 42.3%), 14.8% (9.3%,19.9%), and 16.9% (9.2%, 23.9%), respectively, in the pharmacy cohort; and 16.5% (−5.9%, 34.2%), 15.1% (10.9%, 19.1%), 10.0% (2.9%, 16.6%), respectively, in the clinic cohort.ConclusionHD was consistently associated with better protection against probable influenza events requiring outpatient or inpatient care. The slightly lower treatment effects observed in the outpatient clinic cohort could be a result of confounding by indication due to physicians triaging HD to frailer patients.Disclosures All authors: No reported disclosures.

Are Female Radiation Oncologists Still Underrepresented in the Published Literature? An Analysis of Authorship Trends During the Past Decade

PurposeWe examined whether female authorship, traditionally underrepresented in the radiation oncology (RO) literature, has improved during the past decade, and whether the introduction of double-blind peer review (where reviewers are blinded to author names and vice-versa) improved female authorship rates. MethodsWe analyzed authorship lists during a 10-year period (2007-2016) from the 2 highest impact-factor RO journals: The International Journal of Radiation Oncology, Biology, Physics (IJROBP) and Radiotherapy and Oncology (R&O). From each journal, 20 articles per year were randomly selected. Gender trends of the first, second, last, and collaborating authors (defined as all other positions), were analyzed. A one-sample proportion test was used to compare US female senior authorship (2012-2016) with the 2015 benchmark for female US academic radiation oncologists (30.6%). ResultsAcross 400 articles, the mean ± standard deviation percentage of female authors was 30.9% ± 22.0% with 34.8% of first, 36.7% of second, and 25.4% of last authors being female. The total percentage of female authors per year increased from 2007 to 2016 (P = .005), with no significant increase in the percentage of first (P = .250), second (P = .063), or last (P = .213) female authors. Double-blind peer review was associated with an increase in the mean percentage of female authors (2007-2011: 27.4% vs 2012-2016: 34.0%; P = .012). The proportion of US female senior authors in the latter period (27.6%) and the proportion of female US academic radiation oncologists (30.6%) were not significantly different (P = .570). ConclusionsAlthough the percentage of female authors in RO has increased during the past decade, this did not correspond to a higher representation of women in high-profile authorship positions. Introduction of double-blind peer review was associated with a rise in female authorship. The proportion of female US senior authors and academic radiation oncologists is similar, suggesting that senior authorship rates are approaching appropriate levels in the United States.

Oral health trends for older Americans

Oral health trends for older Americans