scholarly journals Real-World Utilization of Oral Anticancer Agents Costs in Older Adults with Metastatic Renal Cell Carcinoma in the United States

Kidney Cancer ◽  
2021 ◽  
pp. 1-13
Author(s):  
Lauren E. Wilson ◽  
Lisa Spees ◽  
Jessica Pritchard ◽  
Melissa A. Greiner ◽  
Charles D. Scales ◽  
...  
Keyword(s):  
United States ◽  
Anticancer Agents ◽  
Patient Characteristics ◽  
The United States ◽  
Socioeconomic Indicators ◽  
Economic Implications ◽  
Southern Us ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
Oral Anticancer Agents

Background: Substantial racial and socioeconomic disparities in metastatic RCC (mRCC) have persisted following the introduction of targeted oral anticancer agents (OAAs). The relationship between patient characteristics and OAA access and costs that may underlie persistent disparities in mRCC outcomes have not been examined in a nationally representative patient population. Methods: Retrospective SEER-Medicare analysis of patients diagnosed with mRCC between 2007–2015 over age 65 with Medicare part D prescription drug coverage. Associations between patient characteristics, OAA receipt, and associated costs were analyzed in the 12 months following mRCC diagnosis and adjusted to 2015 dollars. Results: 2,792 patients met inclusion criteria, of which 32.4%received an OAA. Most patients received sunitinib (57%) or pazopanib (28%) as their first oral therapy. Receipt of OAA did not differ by race/ethnicity or socioeconomic indicators. Patients of advanced age (>  80 years), unmarried patients, and patients residing in the Southern US were less likely to receive OAAs. The mean inflation-adjusted 30-day cost to Medicare of a patient’s first OAA prescription nearly doubled from $3864 in 2007 to $7482 in 2015, while patient out-of-pocket cost decreased from $2409 to $1477. Conclusion: Race, ethnicity, and socioeconomic status were not associated with decreased OAA receipt in patients with mRCC; however, residing in the Southern United States was, as was marital status. Surprisingly, the cost to Medicare of an initial OAA prescription nearly doubled from 2007 to 2015, while patient out-of-pocket costs decreased substantially. Shifts in OAA costs may have significant economic implications in the era of personalized medicine.

Disparities in utilization of oral anticancer agents and related costs in elderly patients with metastatic renal cell carcinoma in the United States.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 106-106
Author(s):  
Lauren E Wilson ◽  
Lisa Spees ◽  
Jessica Pritchard ◽  
Melissa A. Greiner ◽  
Charles D. Scales ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Anticancer Agents ◽  
Renal Cell ◽  
Patient Characteristics ◽  
The United States ◽  
Southern Us ◽  
To Receive ◽  
Oral Anticancer Agents

106 Background: Although survival among patients with metastatic renal cell carcinoma (mRCC) has improved with the introduction of targeted therapies, substantial disparities in mRCC survival persist. The purpose of this study was to identify patient characteristics associated with differential adoption of emerging oral anticancer agents (OAAs) and related costs in the management of mRCC. Methods: SEER-Medicare patients diagnosed with mRCC aged 65 years or older from 2007-2015 continuously enrolled in Medicare Part D benefits for at least 1 year after diagnosis or until death were included. Associations between patient-level characteristics and OAA receipt were analyzed using univariable and multivariable log-binomal regression; associations between patient characteristics, OAA receipt, and total, cancer-specific, and OAA-specific costs in the 12 months following diagnosis were modeled as relative cost ratios using generalized linear regression with a gamma link. Reported costs were adjusted to 2015 dollars. Results: 2,792 patients with mRCC met inclusion criteria; 32.4% received an OAA in the 12 months following diagnosis. The majority of patients receiving an OAA used either sunitinib or pazopanib. Receipt increased slightly over the study period from 2007 (31% of patients) to 2015 (37%). In multivariable-adjusted models, patients of advanced age ( > 80 years RR 0.50; 95% CI 0.42-0.60) or residing in the Southern US (RR 0.83 95% CI 0.70-0.98) were less likely to receive OAAs. Married patients were 20% more likely (RR 1.19; 95% CI 1.04-1.37) to receive OAAs. After multivariable adjustment, receipt of OAAs was associated with higher total and cancer-specific costs, as was Hispanic ethnicity. Among patients receiving an OAA, the cost of OAAs to Medicare increased approximately 7% per year (95% CI 4%-9%), while patient out-of-pocket spending for OAAs decreased approximately 10% per year (95% CI 7%-14%). Out-of-pocket OAA costs were consistently lower for Black, Hispanic, and Other patient race/ethnicity categories compared to the White Non-Hispanic category. Conclusions: Patient characteristics including age at metastatic diagnosis, marital status, geographic region, and certain comorbidities are related to the likelihood of receiving OAAs. Future research is warranted to investigate if such differences in OAA use lead to differences in survival.

scholarly journals Nonprescription Antimicrobial Use in a Primary Care Population in the United States

2016 ◽  
Vol 60 (9) ◽  
pp. 5527-5532 ◽  
Author(s):  
Roger Zoorob ◽  
Larissa Grigoryan ◽  
Susan Nash ◽  
Barbara W. Trautner
Keyword(s):  
United States ◽  
Primary Care ◽  
Random Sample ◽  
Latin American ◽  
Patient Characteristics ◽  
Antibiotic Use ◽  
Multivariate Regression Analysis ◽  
The United States ◽  
Race Ethnicity ◽  
Intended Use

ABSTRACTCommunity antimicrobial resistance rates are high in communities with frequent use of nonprescription antibiotics. Studies addressing nonprescription antibiotic use in the United States have been restricted to Latin American immigrants. We estimated the prevalence of nonprescription antibiotic use in the previous 12 months as well as intended use (intention to use antibiotics without a prescription) and storage of antibiotics and examined patient characteristics associated with nonprescription use in a random sample of adults. We selected private and public primary care clinics that serve ethnically and socioeconomically diverse patients. Within the clinics, we used race/ethnicity-stratified systematic random sampling to choose a random sample of primary care patients. We used a self-administered standardized questionnaire on antibiotic use. Multivariate regression analysis was used to identify independent predictors of nonprescription use. The response rate was 94%. Of 400 respondents, 20 (5%) reported nonprescription use of systemic antibiotics in the last 12 months, 102 (25.4%) reported intended use, and 57 (14.2%) stored antibiotics at home. These rates were similar across race/ethnicity groups. Sources of antibiotics used without prescriptions or stored for future use were stores or pharmacies in the United States, “leftover” antibiotics from previous prescriptions, antibiotics obtained abroad, or antibiotics obtained from a relative or friend. Respiratory symptoms were common reasons for the use of nonprescription antibiotics. In multivariate analyses, public clinic patients, those with less education, and younger patients were more likely to endorse intended use. The problem of nonprescription use is not confined to Latino communities. Community antimicrobial stewardship must include a focus on nonprescription antibiotics.

Prevalence of Total Daily Walking Among US Adults, 2002–2003

2008 ◽  
Vol 5 (3) ◽  
pp. 337-346 ◽  
Author(s):  
Jared P. Reis ◽  
Caroline A. Macera ◽  
Barbara E. Ainsworth ◽  
Deborah A. Hipp
Keyword(s):  
United States ◽  
Body Mass Index ◽  
Random Sample ◽  
Leisure Time ◽  
The United States ◽  
Time Activity ◽  
Representative Random Sample ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
Weekly Frequency

Background:Walking for exercise is a popular leisure-time activity pursuit among US adults; however, little information is available about total daily walking.Methods:A nationally representative random sample of 10,461 US adults (4438 men and 6023 women) was surveyed via telephone between 2002 and 2003. Weekly frequency and daily duration of walking for all purposes in bouts of at least 10 min were measured. Regular walking was defined as walking ≥5 d/wk, ≥30 min/d.Results:Overall, 49% of adults (51% of men and 47% of women) were regular walkers, and approximately 17% reported no walking. Regular walking was significantly higher in employed adults and decreased with increasing age in women and body mass index in both sexes. Total walking was significantly higher among adults with lower levels of educational attainment and did not vary significantly by race/ethnicity.Conclusions:These results affirm the popularity of walking in the United States.

scholarly journals Youth Access to School Salad Bars in the United States—2011 to 2014

2016 ◽  
Vol 32 (1) ◽  
pp. 84-88 ◽  
Author(s):  
Brenna K. VanFrank ◽  
Stephen Onufrak ◽  
Diane M. Harris
Keyword(s):  
United States ◽  
Logistic Regression ◽  
Regression Models ◽  
The United States ◽  
Logistic Regression Models ◽  
Multivariable Logistic Regression ◽  
Let's Move ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
Over Time

Purpose: To examine differences in students’ access to school salad bars across sociodemographic groups and changes in availability over time. Design: Nonexperimental. Setting: Nationally representative 2011 and 2014 YouthStyles surveys. Participants: A total of 833 (2011) and 994 (2014) US youth aged 12 to 17 years. Measures: Youth-reported availability of school salad bars. Analysis: Multivariable logistic regression models were used to assess differences in school salad bar availability by sociodemographics and changes in availability from 2011 to 2014. Results: Youth-reported salad bar availability differed by age in 2011 and race/ethnicity in 2014, but not by sex, income, metropolitan residence, or region in either year. Salad bars were reported by 62% of youth in 2011 and 67% in 2014; the increase was not statistically significant ( P = .07). Significant increases from 2011 to 2014 were noted among youth aged 12 to 14 years (56%-69%; P < .01), youth of non-Hispanic other races (60%-85%; P < .01), and youth in the Midwest (58%-72%; P = .01). Conclusion: These results suggest that youth-reported access to school salad bars does not differ significantly across most sociodemographic groups. Although overall salad bar availability did not increase significantly from 2011 to 2014, some increases were observed among subgroups. Continued efforts to promote school salad bars through initiatives such as Let’s Move Salad Bars to Schools could help increase access for the nearly one-third of US youth reporting no access.

Barriers to Health Care Among Adults With Minoritized Identities in the United States, 2013–2017

2020 ◽  
Vol 110 (6) ◽  
pp. 857-862
Author(s):  
Stephanie M. Hernandez ◽  
P. Johnelle Sparks
Keyword(s):  
United States ◽  
Health Care ◽  
Access To Health Care ◽  
The United States ◽  
Barriers To Health Care ◽  
Access To Health ◽  
Interview Survey ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
Barriers To Health

Objectives. To examine the relationship between minoritized identity and barriers to health care in the United States. Methods. Nationally representative data collected from the 2013 to 2017 waves of the National Health Interview Survey were used to conduct descriptive and logistic regression analyses. Men and women were placed in 1 of 4 categories: no minoritized identities, minoritized identities of race/ethnicity (MIoRE), minoritized identities of sexuality (MIoS), or minoritized identities of both race/ethnicity and sexuality (MIoRES). Five barriers to health care were considered. Results. Relative to heterosexual White adults and after controlling for socioeconomic status, adults with MIoRE were less likely to report barriers, adults with MIoS were more likely to report barriers, and adults with MIoRES were more likely to report barriers across 2 of the study measures. Conclusions. Barriers to care varied according to gender, minoritized identity, and the measure of access to health care itself. Public Health Implications. Approaching health disparities research using an intersectional lens moves the discussion from examining individual differences to examining the role of social structures such as the health care system in maintaining and reproducing inequality.

Cross-Cohort Evidence of Disparities in Service Receipt for Speech or Language Impairments

2017 ◽  
Vol 84 (1) ◽  
pp. 27-41 ◽  
Author(s):  
Paul L. Morgan ◽  
George Farkas ◽  
Marianne M. Hillemeier ◽  
Hui Li ◽  
Wik Hung Pun ◽  
...  
Keyword(s):  
United States ◽  
Special Education ◽  
The United States ◽  
Language Impairments ◽  
Odds Ratios ◽  
White Children ◽  
English Speaking ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
To Receive

We examined the extent to which disparities in the receipt of special education services for speech or language impairments (SLIs) on the basis of race, ethnicity, or language use by kindergarten—when the delivery of these services might be expected to be most effective—have changed over a 12-year period in the United States. Logistic regression modeling of 2 nationally representative cohorts ( N = 16,800 and 12,080) indicated that children who are Black (covariate-adjusted odds ratios = 0.39 and 0.54) or from non-English-speaking households (covariate-adjusted odds ratios = 0.57 and 0.50) continue to be less likely to receive services for SLIs. Hispanic children are now less likely to receive these services (covariate adjusted odds ratio = 0.54) than otherwise similar non-Hispanic White children. Disparities in special education service receipt for SLIs attributable to race, ethnicity, and language presently occur in the United States and are not explained by many potential confounds.

scholarly journals Associations of Race/Ethnicity and Other Demographic and Socioeconomic Factors with Vaccination During the COVID-19 Pandemic in the United States

2021 ◽  
Author(s):  
Daniel Kim
Keyword(s):  
United States ◽  
Socioeconomic Factors ◽  
Vaccine Dose ◽  
The United States ◽  
Adverse Outcomes ◽  
Vaccine Hesitancy ◽  
Vaccine Initiation ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
Socioeconomic Data

AbstractBACKGROUNDTo date, there has been limited data available to understand the associations between race/ethnicity and socioeconomic and related characteristics with COVID-19 vaccine initiation and planned vaccination in the United States. To better characterize COVID-19 vaccinations nationally, the present study leveraged nationally-representative data with relatively complete race/ethnicity and socioeconomic data to estimate levels of vaccine initiation and the adjusted relative odds of vaccine initiation and planned vaccination among adults by race/ethnicity and socioeconomic and other characteristics.METHODSUsing pooled cross-sectional data from 66,994 adults aged 18-85 years in nationally-representative surveys by the U.S. Census Bureau administered between January 6, 2021 and January 18, 2021 and multivariable logistic regression, this study estimated the associations between race/ethnicity, education, and pre-pandemic (2019) household income with the self-reported: 1) receipt of ≥1 dose of a COVID-19 vaccine; and 2) either receipt of ≥1 dose of a COVID-19 vaccine or the plan to definitely receive a vaccine once available to the respondent.RESULTSIn Hispanics and Black non-Hispanics, the estimated prevalences of vaccine initiation were 6.1% and 6.2%, respectively, compared to 8.7% in White non-Hispanics and 15.1% in Asian non-Hispanics. Controlling for demographic and socioeconomic factors, Hispanics and Black non-Hispanics were no more or less likely than White non-Hispanics to have received ≥1 vaccine dose. However, for the combined outcome of either vaccine initiation or planned vaccination, Black non-Hispanics were 52% less likely than White non-Hispanics to have reported either outcome (P<.001). Meanwhile, both education and pre-pandemic income levels exhibited evidence of positive dose-response relationships with vaccine initiation (P for linear trend = .01 and <.001, respectively). Substantial (vs. no) financial hardship was linked to 44% lower odds of vaccination (P<.001). The most common reasons for vaccine hesitancy were concerns about side effects and safety.CONCLUSIONSIn this large, nationally-representative study with relatively complete race/ethnicity and socioeconomic data, we find that being Black non-Hispanic and having the least education and income were each independently associated with a markedly lower likelihood of definitely planning to get vaccinated or having been vaccinated. In the ensuing months of the pandemic, addressing racial/ethnic and socioeconomic inequities in vaccination due to differential access and vaccine hesitancy will be critical to mitigate the pandemic’s disproportionately higher risks of infection and adverse outcomes in Black non-Hispanics and socioeconomically disadvantaged groups and to help maximize vaccination coverage nationwide.

scholarly journals Vision Health Disparities in the United States by Race/Ethnicity, Education, and Economic Status: Findings From Two Nationally Representative Surveys

2012 ◽  
Vol 154 (6) ◽  
pp. S53-S62.e1 ◽  
Author(s):  
Xinzhi Zhang ◽  
Mary Frances Cotch ◽  
Asel Ryskulova ◽  
Susan A. Primo ◽  
Parvathy Nair ◽  
...  
Keyword(s):  
United States ◽  
Health Disparities ◽  
Economic Status ◽  
The United States ◽  
Race Ethnicity ◽  
Nationally Representative

Patient characteristics and incidence of childhood hospitalisation due to hypertrophic cardiomyopathy in the United States of America 2001–2014

2019 ◽  
Vol 29 (3) ◽  
pp. 344-354 ◽  
Author(s):  
Rie Sakai-Bizmark ◽  
Eliza J. Webber ◽  
Emily H. Marr ◽  
Laurie A. Mena ◽  
Ruey-Kang R. Chang
Keyword(s):  
United States ◽  
Emergency Department ◽  
Hypertrophic Cardiomyopathy ◽  
Odds Ratio ◽  
Age Groups ◽  
Patient Characteristics ◽  
The United States ◽  
Age Group ◽  
White Children ◽  
Nationally Representative

AbstractThis study investigated patient characteristics in paediatric hospitalisations for hypertrophic cardiomyopathy. We used Nationwide Inpatient Sample, which is the largest all-payer inpatient database in the United States, yielding nationally representative estimates, from 2001 to 2014. ICD-9-CM diagnostic codes identified hospitalisations for patients with hypertrophic cardiomyopathy and <18 years. Outcomes included yearly rate of hospitalisation, death, admission via emergency department, and need for surgery. Predictors of interest were age groups (<1, 1–9, and ⩾10 y/o), sex, and race/ethnicity. Logistic regression modelled associations, adjusted by patient- and hospital-level variables. With 2302 weighted hospitalisations, hospitalisation rates were 0.22 per 100,000 children/year, with higher rates for <1 y/o (0.42) and ⩾10 y/o (0.31). Male-to-female ratios were more prominent in the oldest age group; 2.7:1 in ⩾10 y/o versus less than 1.7:1 for <10 y/o. In-hospital mortality was 1.5%, with highest mortality rates among the <1 y/o (6.3%). Children ⩾10 y/o had 5.59 times higher risk of admission from the emergency department than 1–9 y/o age group. Both ⩾10 and <1 y/o age groups had lower risk of surgical intervention compared to the 1–9 y/o group with odds ratio 0.56 and 0.26, respectively. Black children had higher risk of admission from the emergency department than White children with odds ratio 2.78. A relation between age group and sex was observed, with sex-based differences in prevalence and treatment of hypertrophic cardiomyopathy becoming more pronounced with age. Further studies are needed to clarify mechanisms behind age and racial disparity in hospitalisation, especially admission source.

scholarly journals Prevalence of Intimate Partner Reproductive Coercion in the United States: Racial and Ethnic Differences

2019 ◽  
pp. 088626051988820 ◽  
Author(s):  
Kathleen C. Basile ◽  
Sharon G. Smith ◽  
Yang Liu ◽  
Elizabeth Miller ◽  
Marcie-jo Kresnow
Keyword(s):  
United States ◽  
Black Women ◽  
Partner Violence ◽  
Adult Population ◽  
The United States ◽  
Intimate Partner ◽  
Racial And Ethnic Differences ◽  
Reproductive Coercion ◽  
Race Ethnicity ◽  
Nationally Representative

Reproductive coercion (RC) is a specific type of intimate partner violence (IPV). Although clinical studies have highlighted women’s experiences of RC, we know little about its national prevalence and differences in prevalence by sex category and race/ethnicity. Data are from the National Intimate Partner and Sexual Violence Survey (NISVS), years 2010 to 2012. NISVS is an ongoing, nationally representative random-digit-dial telephone survey of the noninstitutionalized English- or Spanish-speaking U.S. adult population. This article reports the national lifetime and 12-month prevalence of two RC victimization measures, and proportions among IPV victims. T tests were used to examine differences in estimates across racial/ethnic groups. In the United States, 9.7% of men and 8.4% of women experienced any RC by an intimate partner during their lifetime. Men reported more commonly than women that a partner tried to get pregnant when the man did not want her to; women reported higher prevalence of partner condom refusal. Examination by race/ethnicity revealed that non-Hispanic (NH) Black women and men had significantly higher lifetime prevalence of both RC types than all other groups; in the last 12 months, NH Blacks had significantly higher prevalence across the board than NH Whites. Hispanics had significantly higher lifetime and 12-month prevalence of any RC and partner condom refusal than NH Whites. RC is at the intersection of two public health concerns—IPV and reproductive health. Documenting its prevalence and differences by sex and race/ethnicity may inform prevention efforts to reduce occurrence and negative health outcomes among specific populations.

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