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Hill S.C.,Agency for Healthcare Research and Quality | Abdus S.,Social and Scientific Systems | Hudson J.L.,Agency for Healthcare Research and Quality
Health Affairs | Year: 2014

The Affordable Care Act (ACA) has dramatically increased the number of low-income nonelderly adults eligible for Medicaid. Starting in 2014, states can elect to cover individuals and families with modified adjusted gross incomes below a threshold of 133 percent of federal poverty guidelines, with a 5 percent income disregard. We used simulation methods and data from the Medical Expenditure Panel Survey to compare nondisabled adults enrolled in Medicaid prior to the ACA with two other groups: adults who were eligible for Medicaid but not enrolled in it, and adults who were in the income range for the ACA's Medicaid expansion and thus newly eligible for coverage. Although differences in health across the groups were not large, both the newly eligible and those eligible before the ACA but not enrolled were healthier on several measures than pre-ACA enrollees. Twenty-five states have opted not to use the ACA to expand Medicaid eligibility. If these states reverse their decisions, their Medicaid programs might not enroll a population that is sicker than their pre-ACA enrollees. By expanding Medicaid eligibility, states could provide coverage to millions of healthier adults as well as to millions who have chronic conditions and who need care. © 2014 Project HOPE-The People-to-People Health Foundation, Inc.


Menke A.,Social and Scientific Systems | Rust K.F.,650 Research Boulevard | Fradkin J.,U.S. National Institute of Diabetes and Digestive and Kidney Diseases | Cheng Y.J.,Centers for Disease Control and Prevention | Cowie C.C.,U.S. National Institute of Diabetes and Digestive and Kidney Diseases
Annals of Internal Medicine | Year: 2014

Background: The increase in the prevalence of diabetes over the past few decades has coincided with an increase in certain risk factors for diabetes, such as a changing race/ethnicity distribution, an aging population, and a rising obesity prevalence. Objective: To determine the extent to which the increase in diabetes prevalence is explained by changing distributions of race/ethnicity, age, and obesity prevalence in U.S. adults. Design: Cross-sectional, using data from 5 NHANES (National Health and Nutrition Examination Surveys): NHANES II (1976-1980), NHANES III (1988-1994), and the continuous NHANES 1999-2002, 2003-2006, and 2007-2010. Setting: Nationally representative samples of the U.S. noninstitutionalized civilian population. Patients: 23 932 participants aged 20 to 74 years. Measurements: Diabetes was defined as a self-reported diagnosis or fasting plasma glucose level of 7.0 mmol/L (126 mg/dL) or more. Results: Between 1976 to 1980 and 2007 to 2010, diabetes prevalence increased from 4.7% to 11.2% in men and from 5.7% to 8.7% in women (P for trends for both groups < 0.001). After adjustment for age, race/ethnicity, and body mass index, diabetes prevalence increased in men (6.2% to 9.6%; P for trend < 0.001) but not women (7.6% to 7.5%; P for trend < 0.69). Body mass index was the greatest contributor among the 3 covariates to the change in prevalence estimates after adjustment. Limitation: Some possible risk factors, such as physical activity, waist circumference, and mortality, could not be studied because data on these variables were not collected in all surveys. Conclusion: The increase in the prevalence of diabetes was greater in men than in women in the U.S. population between 1976 to 1980 and 2007 to 2010. After changes in age, race/ethnicity, and body mass index were controlled for, the increase in diabetes prevalence over time was approximately halved in men and diabetes prevalence was no longer increased in women.


Bainbridge K.E.,Social and Scientific Systems | Cheng Y.J.,Centers for Disease Control and Prevention | Cowie C.C.,U.S. National Institute of Diabetes and Digestive and Kidney Diseases
Diabetes Care | Year: 2010

OBJECTIVE - We examined potential mediators of the reported association between diabetes and hearing impairment. RESEARCH DESIGN AND METHODS - Data come from 1,508 participants, aged 40-69 years, who completed audiometric testing during 1999-2004 in the National Health and Nutrition Examination Survey (NHANES). We defined hearing impairment as the pure-tone average >25 decibels hearing level of pure-tone thresholds at low/mid (500, 1,000, and 2,000 Hz) and high (3,000, 4,000, 6,000, and 8,000 Hz) frequencies. Using logistic regression, we examined whether controlling for vascular or neuropathic conditions, cardiovascular risk factors, glycemia, or inflammation diminished the association between diabetes and hearing impairment. RESULTS - Diabetes was associated with a 100% increased odds of low/mid-frequency hearing impairment (odds ratio 2.03 [95% CI 1.32-3.10]) and a 67% increased odds of high-frequency hearing impairment (1.67 [1.14-2.44]) in preliminary models after controlling for age, sex, race/ethnicity, education, smoking, and occupational noise exposure. Adjusting for peripheral neuropathy attenuated the association with low/mid-frequency hearing impairment (1.70 [1.02-2.82]). Adjusting for albuminuria and C-reactive protein attenuated the association with high-frequency hearing impairment (1.54 [1.02-2.32] and 1.50 [1.01-2.23], respectively). Diabetes was not associated with high-frequency hearing impairment after controlling for A1C (1.09 [0.60-1.99]) but remained associated with low/mid-frequency impairment. We found no evidence suggesting that our observed relationship between diabetes and hearing impairment is due to hypertension or dyslipidemia. CONCLUSIONS - Mechanisms related to neuropathic or microvascular factors, inflammation, or hyperglycemia may be mediating the association of diabetes and hearing impairment. © 2010 by the American Diabetes Association.


Fwu C.-W.,Social and Scientific Systems | Eggers P.W.,Urologic | Kimmel P.L.,Urologic | Kusek J.W.,Urologic | Kirkali Z.,Urologic
Kidney International | Year: 2013

The occurrence of urolithiasis in the United States has increased; however, information on long-term trends, including recurrence rates, is lacking. Here we describe national trends in rates of emergency department visits, use of imaging, and drug treatment, primarily using the National Hospital Ambulatory Medical Care Survey to describe trends and the National Health and Nutrition Examination Survey to determine the frequency of lifetime passage of kidney stones. Emergency department visit rates for urolithiasis increased from 178 to 340 visits per 100,000 individuals from 1992 to 2009. Increases in visit rates were greater in women, Caucasians, and in those aged 25-44 years. The use of computed tomography in urolithiasis patients more than tripled, from 21 to 71%. Medical expulsive therapy was used in 14% of the patients with a urolithiasis diagnosis in 2007-2009. Among National Health and Nutrition Examination Survey participants who reported a history of kidney stones, 22.4% had passed three or more stones. Hence, emergency department urolithiasis visit rates have increased significantly, as has the use of computed tomography in the United States. Further research is necessary to determine whether recurrent stone formers receive unnecessary radiation exposure during diagnostic evaluation in the emergency department and allow development of corresponding evidence-based guidelines. © 2012 International Society of Nephrology.


Abdus S.,Social and Scientific Systems | Selden T.M.,Agency for Healthcare Research and Quality
Medical Care | Year: 2013

Background: A large literature documents cross-sectional differences in adult preventive services across population subgroups. Less is known, however, about how these differences have changed over time. Objectives: This study tracks changes over time in the distribution of preventive services use across groups defined by poverty status, race/ethnicity, insurance coverage, Census region, and urbanicity. Methods: Data from the 1996-2008 Medical Expenditure Panel Survey are used to examine 5 preventive services: general checkups, blood pressure screening, blood cholesterol screening, Pap smears, and mammograms. Multivariate logistic regression models of preventive services use are used to compute adjusted utilization for each subgroup of adults aged 19-64 in 1996/1998, 2002/2003, and 2007/2008. We then examine the extent to which percentage point gaps in utilization rates across subgroups have changed between 1996/1998 and 2007/2008. Results: Our analysis of utilization rates across subgroups and over time identified only rare cases in which subgroup differences narrowed or widened between 1996/1998 and 2007/2008. Rather, differences across subgroups tended to persist over time. Some of the largest (adjusted) gaps are between adults with and without coverage, and only for blood cholesterol screening do we observe significant narrowing of the gap between the uninsured and the privately insured. Regional differences persisted or widened over the study period. Conclusions: On the eve of health reform implementation, a key challenge facing the Affordable Care Act will be to address persistent differences in preventive services use within the US population. © 2013 by Lippincott Williams and Wilkins.


Hudson J.L.,Agency for Healthcare Research and Quality | Abdus S.,Social and Scientific Systems
Health Affairs | Year: 2015

Public health insurance for low-income children in the United States is primarily available through Medicaid and the Childrenâ™s Health Insurance Program (CHIP). Mixed eligibility occurs when there is a mix of either âœMedicaid- and CHIP-eligibleâ children or a mix of âœeligible (for public insurance) and ineligible (for public insurance)â children in the family.We used data from the Medical Expenditure Panel Survey (MEPS) Household Component for 2001â"12 to examine insurance coverage, access to care, and health care use for eligible children in families with mixedeligible siblings compared to those in families where all siblings were eligible for one program.We found that mixed eligibility has a significant dampening effect for eligible children in families with a mix of eligible and ineligible siblings. These children were more likely to be uninsured and less likely to have a usual source of care, less likely to have any preventive dental or well-child visits during the year, and less likely to fully adhere to recommended preventive dental and well-child visits than eligible children with all-Medicaid- or all-CHIP-eligible siblings. We found no significant impact for eligible children living in Medicaid-CHIP-mixed families. © 2015 Project HOPE- The People-to-People Health Foundation, Inc.


Abdus S.,Social and Scientific Systems | Mistry K.B.,Agency for Healthcare Research and Quality | Selden T.M.,Agency for Healthcare Research and Quality
American Journal of Public Health | Year: 2015

Objectives: We examined prereform patterns in insurance coverage, access to care, and preventive services use by race/ethnicity in adults targeted by the coverage expansions of the Patient Protection and Affordable Care Act (ACA). Methods: We used pre-ACA household data from the Medical Expenditure Panel Survey to identify groups targeted by the coverage provisions of the Act (Medicaid expansions and subsidized Marketplace coverage). We examined racial/ethnic differences in coverage, access to care, and preventive service use, across and within ACA relevant subgroups from 2005 to 2010. The study took place at the Agency for Healthcare Research and Quality in Rockville, Maryland. Results: Minorities were disproportionately represented among those targeted by the coverage provisions of the ACA. Targeted groups had lower rates of coverage, access to care, and preventive services use, and racial/ethnic disparities were, in some cases, widest within these targeted groups. Conclusions: Our findings highlighted the opportunity of the ACA to not only to improve coverage, access, and use for all racial/ethnic groups, but also to narrow racial/ethnic disparities in these outcomes. Our results might have particular importance for states that are deciding whether to implement the ACA Medicaid expansions.


Liu R.,National Health Research Institute | Gao X.,Harvard University | Lu Y.,Social and Scientific Systems | Chen H.,National Health Research Institute
Neurology | Year: 2011

Objective: To assess the epidemiologic evidence on melanoma in relation to Parkinson disease (PD) via systematic review and meta-analysis. Methods: Epidemiologic studies on melanoma and PD were searched using PubMed, Web of Science, Scoups, and Embase (1965 through June 2010). Eligible studies were those that reported risk estimates of melanoma among patients with PD or vice versa. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Results: We identified 12 eligible publications on melanoma and PD: 8 had fewer than 10 cases with both PD and melanoma, and 7 provided gender-specific results. The pooled OR was 2.11 (95% CI 1.26-3.54) overall, 2.04 (1.55-2.69) for men, and 1.52 (0.85-2.75) for women. Analyses by temporal relationship found that melanoma occurrence was significantly higher after the diagnosis of PD (OR 3.61, 95% CI 1.49-8.77), but not before PD diagnosis (OR 1.07, 95% CI 0.62-1.84). Further analyses revealed that the lack of significance in the latter analysis was due to one study, which when excluded resulted in a significant association (OR 1.44, 95% CI 1.06-1.96). We also analyzed nonmelanoma skin cancers in relation to PD and found no significant relationship (OR 1.11, 95% CI 0.94-1.30). Conclusions: Collective epidemiologic evidence supports an association of PD with melanoma. Further research is needed to examine the nature and mechanisms of this relationship. Glossary: CI: confidence intervalMeSH: medical subject headingOR: odds ratioPD: Parkinson diseaseRR: relative riskSIR/SER: standardized incidence/event ratio. Copyright © 2011 by AAN Enterprises, Inc. All rights reserved.


Abdus S.,Social and Scientific Systems | Rangazas P.,Indiana University – Purdue University Indianapolis
Review of Economic Dynamics | Year: 2011

We provide microeconomic foundations for the commonly assumed subsistence constraint on consumption and demonstrate that the theory is consistent with several important features of development. In principle, subsistence is consistent with different combinations of food consumption, energy expenditure, body weight, and health. In practice, caloric intake has remained remarkably constant over the course of development, giving the appearance of a minimal subsistence constraint in consumption alone. We argue that the trendless nature of caloric intake results from a positive income effect on food consumption being offset by a reduction in the need for food as the energy requirements of work decrease with development. The theory helps explain the observed patterns in body mass, fertility, and economic growth rates for more than two centuries. © 2010 Elsevier Inc.


Abdus S.,Social and Scientific Systems
Medical Care | Year: 2014

BACKGROUND:: The association between uninsurance and reduced access to care is well known. Few studies, however, examine the relationship between the length of time without coverage and measures of access to care among adults. OBJECTIVES:: To examine the association between access to care and the length of time without coverage during a 12-month period among nonelderly adults. METHODS:: Multivariate logistic regression models of 15 measures of access to care are estimated, using data from the 2005-2010 Medical Expenditure Panel Survey. These models control for length of time without coverage and other factors. The study then examines how access to care varies by the length of time without coverage. RESULTS:: There were large differences in access to care between those with and without coverage for all 12 months. For most of the measures, those lacking coverage for 1-5 months also had less access to care compared with those covered all 12 months. Lastly, for most of the measures, those lacking coverage for all 12 months had less access to care compared with either those lacking coverage for 6-11 months, or those lacking coverage for 1-5 months. CONCLUSIONS:: The study shows the importance of considering the length of time without coverage when examining access to care of the uninsured. Even relatively short periods of uninsurance may be associated with some barriers to health care. In contrast, having some coverage during the year is associated with greater access to care than having no coverage at all. Copyright © 2014 by Lippincott Williams & Wilkins.

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