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Geographic disparities in chronic obstructive pulmonary disease (COPD) hospitalization among Medicare beneficiaries in the United States
Holt JB, Zhang X, Presley-Cantrell L, Croft JB
International Journal of Chronic Obstructive Pulmonary Disease , 2011, DOI: http://dx.doi.org/10.2147/COPD.S19945
Abstract: graphic disparities in chronic obstructive pulmonary disease (COPD) hospitalization among Medicare beneficiaries in the United States Original Research (3501) Total Article Views Authors: Holt JB, Zhang X, Presley-Cantrell L, Croft JB Published Date June 2011 Volume 2011:6 Pages 321 - 328 DOI: http://dx.doi.org/10.2147/COPD.S19945 James B Holt, Xingyou Zhang, Letitia Presley-Cantrell, Janet B Croft National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA Background: Hospitalizations for persons with chronic obstructive pulmonary disease (COPD) result in significant health care resource use and excess expenditures. Despite well-documented sociodemographic disparities in COPD outcomes, no study has characterized geographic variations in COPD hospitalization across the US. Methods: Almost 3.8 million COPD hospitalization records were extracted from Medicare claims for 1995–2006, and the total population of eligible Medicare beneficiaries was extracted from the Medicare enrollment records to calculate COPD hospitalization rates by Health Service Area (HSA), (n = 949). Spatial cluster analysis and Bayesian hierarchical spatial modeling were used to characterize the geography of COPD hospitalizations. Results: The overall COPD hospitalization rate was 11.30 per 1,000 beneficiaries for the aggregated period 1995–2006. HSA-level COPD hospitalization rates had a median of 11.7 and a range of 3.0 (Cache, UT) to 76.3 (Pike, KY). Excessive hospitalization risk was concentrated in Appalachia, the southern Great Lakes, the Mississippi Delta, the Deep South, and west Texas. In the Bayesian spatial mixture model, 73% of variability of COPD hospitalization relative risk was attributed to unidentified regional social and physical environments shared by HSAs rather than to unique local HSA factors (27%). Conclusion: We discovered distinct geographic patterns in COPD hospitalization rates and risks attributed to both regionally-shared environmental risk factors and HSA-unique environmental contexts. The correlates of these geographic patterns remain to be determined. Geographic comparisons of COPD hospitalization risk provide insights for better public health practice, policies, and programs for COPD prevention.
Geographic disparities in chronic obstructive pulmonary disease (COPD) hospitalization among Medicare beneficiaries in the United States  [cached]
Holt JB,Zhang X,Presley-Cantrell L,Croft JB
International Journal of COPD , 2011,
Abstract: James B Holt, Xingyou Zhang, Letitia Presley-Cantrell, Janet B CroftNational Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USABackground: Hospitalizations for persons with chronic obstructive pulmonary disease (COPD) result in significant health care resource use and excess expenditures. Despite well-documented sociodemographic disparities in COPD outcomes, no study has characterized geographic variations in COPD hospitalization across the US.Methods: Almost 3.8 million COPD hospitalization records were extracted from Medicare claims for 1995–2006, and the total population of eligible Medicare beneficiaries was extracted from the Medicare enrollment records to calculate COPD hospitalization rates by Health Service Area (HSA), (n = 949). Spatial cluster analysis and Bayesian hierarchical spatial modeling were used to characterize the geography of COPD hospitalizations.Results: The overall COPD hospitalization rate was 11.30 per 1,000 beneficiaries for the aggregated period 1995–2006. HSA-level COPD hospitalization rates had a median of 11.7 and a range of 3.0 (Cache, UT) to 76.3 (Pike, KY). Excessive hospitalization risk was concentrated in Appalachia, the southern Great Lakes, the Mississippi Delta, the Deep South, and west Texas. In the Bayesian spatial mixture model, 73% of variability of COPD hospitalization relative risk was attributed to unidentified regional social and physical environments shared by HSAs rather than to unique local HSA factors (27%).Conclusion: We discovered distinct geographic patterns in COPD hospitalization rates and risks attributed to both regionally-shared environmental risk factors and HSA-unique environmental contexts. The correlates of these geographic patterns remain to be determined. Geographic comparisons of COPD hospitalization risk provide insights for better public health practice, policies, and programs for COPD prevention.Keywords: COPD prevention, environmental risk factors, public health, population
Obesity Status and Colorectal Cancer Screening in the United States  [PDF]
Karima A. Kendall,Euni Lee,Ilene H. Zuckerman,Linda Simoni-Wastila,Marlon Daniel,Pauline M. Green,Beatrice Adderley-Kelly,Anthony K. Wutoh
Journal of Obesity , 2013, DOI: 10.1155/2013/920270
Abstract: Background. Findings from previous studies on an association between obesity and colorectal cancer (CRC) screening are inconsistent and very few studies have utilized national level databases in the United States (US). Methods. A cross-sectional study was conducted using data from the 2005 Medicare Current Beneficiary Survey to describe CRC screening rate by obesity status. Results. Of a 15,769 Medicare beneficiaries sample aged 50 years and older reflecting 39 million Medicare beneficiaries in the United States, 25% were classified as obese, consisting of 22.4% “obese” (30 ≤ body mass index (BMI) < 35) and 3.1% “morbidly obese” (BMI ≥ 35) beneficiaries. Almost 38% of the beneficiaries had a body mass index level equivalent to overweight (25 ≤ BMI < 30). Of the study population, 65.3% reported having CRC screening (fecal occult blood testing or colonoscopy). Medicare beneficiaries classified as “obese” had greater odds of CRC screening compared to “nonobese” beneficiaries after controlling for other covariates ( = 1.25; 95% CI: 1.12–1.39). Conclusions. Findings indicate that obesity was not a barrier but rather an assisting factor to CRC screening among Medicare beneficiaries. Future studies are needed to evaluate physicians’ ordering of screening tests compared to screening claims among Medicare beneficiaries to better understand patterns of patients’ and doctors’ adherence to national CRC screening guidelines. 1. Introduction According to the American Cancer Society, colorectal cancer (CRC) is the third most common cancer diagnosed and the third leading cause of cancer-related mortality in both men and women in the United States (US) [1]. While these statistics are alarming, the death rate from CRC has decreased for more than 20 years due to early detection of removable polyps by colorectal screening tests [2]. According to the US Preventive Services Task Force (USPSTF), routine screening may reduce the number of people who die of colorectal cancer [3]. Additionally, treatment for CRC has vastly improved over the last several years, and as a result, there are now more than one million survivors of CRC in the US [4]. The risk of developing colorectal cancer in a lifetime is about 1 in 19 and a number of risk factors associated with CRC have been identified [2]. Established risk factors include increased age, personal history of inflammatory bowel disease, colorectal polyps, and family history of colorectal cancer [5]. In addition, certain behavioral factors such as smoking, heavy alcohol use, and obesity, have shown to be the strongest links to an
Persistence in health behaviors among Medicare beneficiaries  [PDF]
Bruce Stuart, Amy Davidoff, Francoise Pradel, Ruth Lopert, Thomas Shaffer, Eberechukwu Onukwugha, Franklin Hendrick, Jennifer Lloyd
Open Journal of Preventive Medicine (OJPM) , 2012, DOI: 10.4236/ojpm.2012.21008
Abstract: We examined persistence in seven common preventive health practices for a nationally representative sample of Medicare beneficiaries over 4-year observation periods. Six panels from the 1997-2005 Medicare Current Beneficiary Survey (MCBS) were used resulting in 13,913 unique individuals with ages ranging from below 65 (disabled) to over 80 years old. Persistence in behavior was defined as the proportion of the observation period beneficiaries participated in each activity. We estimated behavioral persistence as a function of baseline demographic, socioeconomic, and health characteristics using multivariate regression analysis. Beneficiaries were most persistent in smoking abstinence (81% reported not smoking) and least persistent with routine exercise (47% reporting none). From multivariate regression results, there was greater persistence among beneficiaries who were married when compared to those living alone (p < 0.01 except for weekly exercise, p < 0.05 and cholesterol screening, ns), with at least a high school education compared to no high school (p < 0.01 for weekly exercise, prostate cancer screening, pap smear, p < 0.05 for influenza vaccination and mammography, but ns for smoking cessation and cholesterol screening), and of higher income (>300% FPL compared to <100% FPL all p < 0.01). Increasing age (greater than 80 compared to 65 - 69) was associated with increased compliance in influenza vaccination and smoking cessation (p < 0.01) while negatively associated with weekly exercise and cancer screenings (p < 0.01). Medicare beneficiaries are inconsistently persistent with common preventive health practices.
Prevalence of multiple chronic conditions in the United States' Medicare population
Kathleen M Schneider, Brian E O'Donnell, Debbie Dean
Health and Quality of Life Outcomes , 2009, DOI: 10.1186/1477-7525-7-82
Abstract: The current article describes this new data source, and the authors demonstrate the utility of the CCW in describing the extent of chronic disease among Medicare beneficiaries. Medicare claims were analyzed to determine the prevalence, utilization, and Medicare program costs for some common and high cost chronic conditions in the Medicare FFS population in 2005. Chronic conditions explored include diabetes, chronic obstructive pulmonary disease (COPD), heart failure, cancer, chronic kidney disease (CKD), and depression.Fifty percent of Medicare FFS beneficiaries were receiving care for one or more of these chronic conditions. The highest prevalence is observed for diabetes, with nearly one-fourth of the Medicare FFS study cohort receiving treatment for this condition (24.3 percent). The annual number of inpatient days during 2005 is highest for CKD (9.51 days) and COPD (8.18 days). As the number of chronic conditions increases, the average per beneficiary Medicare payment amount increases dramatically. The annual Medicare payment amounts for a beneficiary with only one of the chronic conditions is $7,172. For those with two conditions, payment jumps to $14,931, and for those with three or more conditions, the annual Medicare payments per beneficiary is $32,498.The CCW data files have tremendous value for health services research. The longitudinal data and beneficiary linkage within the CCW are features of this data source which make it ideal for further studies regarding disease prevalence and progression over time. As additional years of administrative data are accumulated in the CCW, the expanded history of beneficiary services increases the value of this already rich data source.The presence of chronic conditions has become epidemic. In the United States over 133 million people, or nearly half of the population, suffer from a chronic condition [1]. The high prevalence of chronic disease among the Medicare population has been well documented [2,1]. Of particular c
Costs and outcomes associated with clopidogrel discontinuation in Medicare beneficiaries with acute coronary syndrome in the coverage gap  [cached]
Page RL 2nd,Ghushchyan V,Allen RR,Roper L
Drug, Healthcare and Patient Safety , 2012,
Abstract: Robert Lee Page II,1,2 Vahram Ghushchyan,1 Richard R Allen,3 Lisa Roper,4 Don Beck,4 Bamrom H Jonathan,4 Feride Frech-Tamas,5 Wing Chan,5 R Brett McQueen,1 Kavita V Nair11School of Pharmacy, Department of Clinical Pharmacy, 2School of Medicine, Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 3Peakstat Statistical Services, Evergreen, CO, 4Universal American, Houston, TX, 5Novartis Pharmaceuticals, East Hanover, New Jersey, USABackground: Current guidelines for acute coronary syndrome recommend clopidogrel for an optimal period of 12 months in order to reduce the risk of reinfarction and mortality. Premature clopidogrel discontinuation has been associated with higher rates of rehospitalization, coronary stent thrombosis, and mortality. No data exist regarding the effect of the Medicare Part D coverage gap on medical costs and outcomes in Medicare beneficiaries who discontinue their clopidogrel upon entering the coverage gap.Methods: Beneficiaries with a Medicare Advantage plan in 2009 who had a diagnosis of acute coronary syndrome were taking clopidogrel 75 mg daily, and reached the gap in the same year representing the study sample. From this cohort, those who filled at least two prescriptions for clopidogrel (continued) versus those that did not (discontinued) while in the gap were compared with regard to outcomes related to acute coronary syndrome and expenditure 30 days after the last prescription was filled and during any time while in the gap. Descriptive and multivariate analyses were used to compare these differences.Results: A total of 1365 beneficiaries with acute coronary syndrome met the inclusion criteria, of which 705 beneficiaries entered into the coverage gap, wherein 103 (14.6%) and 602 (85.4%) of beneficiaries discontinued and continued clopidogrel, respectively. Compared with those who continued clopidogrel during the gap, beneficiaries who discontinued clopidogrel showed a higher trend in the number of hospitalizations related to acute coronary syndrome and emergency room visits, albeit not statistically significant. Those who discontinued clopidogrel showed a higher mean adjusted cost per member per month in hospitalizations ($3604) related to acute coronary syndrome and outpatient visits ($1144) related to acute coronary syndrome and total medical costs ($5614), albeit not statistically significant.Conclusion: Medicare beneficiaries who face large out-of-pocket costs for clopidogrel while in the coverage gap and discontinue therapy may experience adverse events related to acute coronary syn
Costs and outcomes associated with clopidogrel discontinuation in Medicare beneficiaries with acute coronary syndrome in the coverage gap
Page RL 2nd, Ghushchyan V, Allen RR, Roper L, Beck D, Johnathan BH, Frech-Tamas F, Chan W, McQueen RB, Nair KV
Drug, Healthcare and Patient Safety , 2012, DOI: http://dx.doi.org/10.2147/DHPS.S32473
Abstract: sts and outcomes associated with clopidogrel discontinuation in Medicare beneficiaries with acute coronary syndrome in the coverage gap Short Report (1544) Total Article Views Authors: Page RL 2nd, Ghushchyan V, Allen RR, Roper L, Beck D, Johnathan BH, Frech-Tamas F, Chan W, McQueen RB, Nair KV Published Date July 2012 Volume 2012:4 Pages 67 - 74 DOI: http://dx.doi.org/10.2147/DHPS.S32473 Received: 31 March 2012 Accepted: 12 May 2012 Published: 10 July 2012 Robert Lee Page II,1,2 Vahram Ghushchyan,1 Richard R Allen,3 Lisa Roper,4 Don Beck,4 Bamrom H Jonathan,4 Feride Frech-Tamas,5 Wing Chan,5 R Brett McQueen,1 Kavita V Nair1 1School of Pharmacy, Department of Clinical Pharmacy, 2School of Medicine, Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 3Peakstat Statistical Services, Evergreen, CO, 4Universal American, Houston, TX, 5Novartis Pharmaceuticals, East Hanover, New Jersey, USA Background: Current guidelines for acute coronary syndrome recommend clopidogrel for an optimal period of 12 months in order to reduce the risk of reinfarction and mortality. Premature clopidogrel discontinuation has been associated with higher rates of rehospitalization, coronary stent thrombosis, and mortality. No data exist regarding the effect of the Medicare Part D coverage gap on medical costs and outcomes in Medicare beneficiaries who discontinue their clopidogrel upon entering the coverage gap. Methods: Beneficiaries with a Medicare Advantage plan in 2009 who had a diagnosis of acute coronary syndrome were taking clopidogrel 75 mg daily, and reached the gap in the same year representing the study sample. From this cohort, those who filled at least two prescriptions for clopidogrel (continued) versus those that did not (discontinued) while in the gap were compared with regard to outcomes related to acute coronary syndrome and expenditure 30 days after the last prescription was filled and during any time while in the gap. Descriptive and multivariate analyses were used to compare these differences. Results: A total of 1365 beneficiaries with acute coronary syndrome met the inclusion criteria, of which 705 beneficiaries entered into the coverage gap, wherein 103 (14.6%) and 602 (85.4%) of beneficiaries discontinued and continued clopidogrel, respectively. Compared with those who continued clopidogrel during the gap, beneficiaries who discontinued clopidogrel showed a higher trend in the number of hospitalizations related to acute coronary syndrome and emergency room visits, albeit not statistically significant. Those who discontinued clopidogrel showed a higher mean adjusted cost per member per month in hospitalizations ($3604) related to acute coronary syndrome and outpatient visits ($1144) related to acute coronary syndrome and total medical costs ($5614), albeit not statistically significant. Conclusion: Medicare beneficiaries who face large out-of-pocket costs for clopidogrel while in the coverage gap and discontinue t
Healthcare costs and utilization for Medicare beneficiaries with Alzheimer's
Yang Zhao, Tzu-Chun Kuo, Sharada Weir, Marilyn S Kramer, Arlene S Ash
BMC Health Services Research , 2008, DOI: 10.1186/1472-6963-8-108
Abstract: Demographically matched cohorts age 65 and over with comprehensive medical and pharmacy claims from the 2003–2004 MEDSTAT MarketScan? Medicare Supplemental and Coordination of Benefits (COB) Database were examined: 1) 25,109 individuals with an AD diagnosis or a filled prescription for an exclusively AD treatment; and 2) 75,327 matched controls. Illness burden for each person was measured using Diagnostic Cost Groups (DCGs), a comprehensive morbidity assessment system. Cost distributions and reasons for ER visits and inpatient admissions in 2004 were compared for both cohorts. Regression was used to quantify the marginal contribution of AD to health care costs and utilization, and the most common reasons for ER and inpatient admissions, using DCGs to control for overall illness burden.Compared with controls, the AD cohort had more co-morbid medical conditions, higher overall illness burden, and higher but less variable costs ($13,936 s. $10,369; Coefficient of variation = 181 vs. 324). Significant excess utilization was attributed to AD for inpatient services, pharmacy, ER visits, and home health care (all p < 0.05). In particular, AD patients were far more likely to be hospitalized for infections, pneumonia and falls (hip fracture, syncope, collapse).Patients with AD have significantly more co-morbid medical conditions and higher healthcare costs and utilization than demographically-matched Medicare beneficiaries. Even after adjusting for differences in co-morbidity, AD patients incur excess ER visits and inpatient admissions.Alzheimer's disease (AD) is a progressive, irreversible neurodegenerative disorder with high social and economic costs. Currently, an estimated 5.1 million Americans have AD, 4.9 million of them over the age of 65 [1]. Alzheimer's disease affects 13% of people over age 65 and nearly half of those over age 85, accounting for 50 to 70% of all dementia cases [1]. By 2050, 11.6 to 16 million Americans may have AD [2]. With the expected increase in
Impact of HIV Infection on Medicare Beneficiaries with Lung Cancer  [PDF]
Jeannette Y. Lee,Page C. Moore,Shelly Y. Lensing
Journal of Cancer Epidemiology , 2012, DOI: 10.1155/2012/706469
Abstract: The incidence of lung cancer among individuals infected with the human immunodeficiency virus (HIV) is elevated compared to that among the general population. This study examines the prevalence of HIV and its impact on outcomes among Medicare beneficiaries who are 65 years of age or older and were diagnosed with nonsmall cell lung cancer (NSCLC) between 1997 and 2008. Prevalence of HIV was estimated using the Poisson point estimate and its 95% confidence interval. Relative risks for potential risk factors were estimated using the log-binomial model. A total of 111,219 Medicare beneficiaries met the study criteria. The prevalence of HIV was 156.4 per 100,000 (95% CI: 140.8 to 173.8) and has increased with time. Stage at NSCLC diagnosis did not vary by HIV status. Mortality rates due to all causes were 44%, 76%, and 88% for patients with stage I/II, III, and IV NSCLC, respectively. Across stages of disease, there was no difference between those who were HIV-infected and those who were not with respect to overall mortality. HIV patients, however, were more likely to die of causes other than lung cancer than their immunocompetent counterparts. 1. Introduction With the widespread use of highly active antiretroviral therapy (HAART), the incidence of non-AIDS defining malignancies among HIV-infected persons has increased [1, 2]. The most frequently reported non-AIDS defining cancer among HIV-infected individuals is lung cancer. The incidence of lung cancer among individuals infected with human immunodeficiency virus (HIV) is elevated compared to the incidence in the general population [1–8] and has increased with time [2]. HIV-infected individuals are at least twice as likely as those who are not infected with HIV to be diagnosed with lung cancer [1, 6, 8]. The risk of lung cancer among HIV-infected patients is inversely related to CD4 count, a measure of immune function [9], and it has been suggested that use of antiretroviral viral therapy may reduce the risk of lung cancer [10]. At the time of lung cancer diagnosis, HIV-infected patients were younger than those who were not shown to have HIV [11, 12]. Survival of HIV-infected lung cancer patients was similar to that of their immunocompetent counterparts when the majority of HIV-infected patients were on HAART [11, 13]. Positive prognostic factors for survival among HIV-infected lung cancer cases are the use of HAART [14] and CD4 counts [15]. The impact of HIV infection on the population of lung cancer patients is unclear. This study uses data from the SEER-Medicare database to determine the prevalence of
The morbidity of urethral stricture disease among male Medicare beneficiaries
Jennifer T Anger, Richard Santucci, Anna L Grossberg, Christopher S Saigal
BMC Urology , 2010, DOI: 10.1186/1471-2490-10-3
Abstract: We analyzed Medicare claims data for 1992, 1995, 1998, and 2001 to estimate the rate of dual diagnoses of urethral stricture with urinary tract infection and with urinary incontinence occurring in the same year among a 5% sample of beneficiaries. Male Medicare beneficiaries receiving co-incident ICD-9 codes indicating diagnoses of urethral stricture and either urinary tract infection or urinary incontinence within the same year were counted.The percentage of male patients with a diagnosis of urethral stricture who also were diagnosed with a urinary tract infection was 42% in 2001, an increase from 35% in 1992. Eleven percent of male Medicare beneficiaries with urethral stricture disease in 2001 were diagnosed with urinary incontinence in the same year. This represents an increase from 8% in 1992.Among male Medicare beneficiaries diagnosed with urethral stricture disease in 2001, 42% were also diagnosed with a urinary tract infection, and 11% with incontinence. Although the overall incidence of stricture disease decreased over this time period, these rates of dual diagnoses increased from 1992 to 2001. Our findings shed light into the health burden of stricture disease on American men. In order to decrease the morbidity of stricture disease, early definitive management of strictures is warranted.Although the true incidence of urethral stricture disease in men is unknown, Medicare utilization rates for men age 65 and over were 0.9% in 2001, a decrease from 1.4% in 1992 [1]. Utilization data from the Veteran Affairs (VA) in 2003 revealed a prevalence rate of 193 per 100,000 diagnoses (0.2%) [2]. Urethral stricture disease imposes a great burden on both health and quality of life in men. Previous studies of male urethral stricture disease have shown that nearly 90% of men present with complications [2]. The majority of men with a stricture suffer from obstructive and irritative voiding symptoms, and many experience hematuria, recurrent urinary tract infections, and the
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