Preventive medicine
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Preventive medicine · Dec 2019
Financial hardship among rural cancer survivors: An analysis of the Medical Expenditure Panel Survey.
Some cancer survivors report spending 20% of their annual income on medical care. Undue financial burden that patients face related to the cost of care is referred to as financial hardship, which may be more prevalent among rural cancer survivors. This study examined contrasts in financial hardship among 1419 rural and urban cancer survivors using the 2011 Medical Expenditure Panel Survey supplement - The Effects of Cancer and Its Treatment on Finances. ⋯ Average adjusted predicted probabilities of financial hardship were 18.6% for urban survivors (Confidence Interval [CI]: 11.9%-27.5%) and 24.2% for rural survivors (CI: 15.0%-36.2%). For financial worry, average adjusted predicted probabilities were 19.9% for urban survivors (CI: 12.0%-31.0%) and 18.8% for rural survivors (CI: 12.1%-28.0%). Improving patient-provider communication through decision aids and/or patient navigators may be helpful to reduce financial hardship and worry regardless of rural-urban status.
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Preventive medicine · Dec 2019
Integrating local health departments to reduce suicide-related emergency department visits among people with substance use disorders - Evidence from the state of Maryland.
Individuals with a substance use disorder (SUD) are six times as likely than those without a SUD to attempt suicide, however just 18% of the SUD population has received treatment. One of the barriers to treatment is appropriate and timely mental health services. This resulted in a substantial increase in emergency department (ED) visits related to SUD and suicide. ⋯ After adjusting for the endogeneity of LHDs' activity measures and controlling for individual-, hospital-, LHD-, and county-level characteristics, results demonstrated patients with a SUD experienced a 6% and 5% reduction in suicide-related ED visits when their LHD directly provided primary prevention for mental illness and mental health services, respectively. The results are small but significant, with robust standard errors. This study suggests LHDs may be key players in preventing suicide-related ED visits among the SUD population.
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Preventive medicine · Dec 2019
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: A population-level simulation analysis.
Although screening is effective in reducing incidence, mortality, and costs of treating colorectal cancer (CRC), it remains underutilized, in part due to limited insurance access. We used microsimulation to estimate the health and financial effects of insurance expansion and reduction scenarios in North Carolina (NC). We simulated the full lifetime of a simulated population of 3,298,265 residents age-eligible for CRC screening (ages 50-75) during a 5-year period starting January 1, 2018, including polyp incidence and progression and CRC screening, diagnosis, treatment, and mortality. ⋯ Throughout these individuals' lifetimes, this change in CRC screening/testing results in an estimated 498 CRC cases averted with Medicaid expansion and 6031 averted with Medicare-for-all, and an additional 1782 cases if health insurance gains associated with ACA are lost. Estimated cost savings - balancing increased CRC screening/testing costs against decreased cancer treatment costs - are approximately $30 M and $970 M for Medicaid expansion and Medicare-for-all scenarios, respectively, compared to status quo. Insurance expansion is likely to improve CRC screening both overall and in underserved populations while saving money, with the largest savings realized by Medicare.
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Preventive medicine · Dec 2019
Challenges of using nationally representative, population-based surveys to assess rural cancer disparities.
Population-based surveys provide important information about cancer-related health behaviors across the cancer care continuum, from prevention to survivorship, to inform cancer control efforts. These surveys can illuminate cancer disparities among specific populations, including rural communities. However, due to small rural sample sizes, varying sampling methods, and/or other study design or analytical concerns, there are challenges in using population-based surveys for rural cancer control research and practice. ⋯ Survey data have become restricted based on small numbers (i.e., BRFSS) and have made rural-urban measures only available for analysis at Research Data Centers (i.e., NHIS and MEPS). Additionally, studies that used these surveys reported varying proportions of rural participants with noted limitations in sufficient representation of rural minorities and/or cancer survivors. In order to mitigate these challenges, we propose two solutions: 1) make rural-urban measures more accessible to non-federal researchers and 2) implement sampling approaches to oversample rural populations.
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Preventive medicine · Dec 2019
Examining mass shootings from a neighborhood perspective: An analysis of multiple-casualty events and media reporting in Philadelphia, United States.
Identifying the people and places affected by mass shootings depends on how "mass shooting" is defined. From the perspective of urban neighborhoods, it is likely the number of people injured within a proximate time and space, which determines the event's impact on perceptions of safety and social cohesion. We aimed to describe the incidence of "neighborhood" mass shootings in one US city and to determine how these events were communicated to the public through news media. ⋯ Only one event was named a "mass shooting" in any associated headline. In Philadelphia, neighborhood mass shootings occur multiple times per year but receive limited media coverage. The population health impact of these events is likely under-appreciated by the public and policymakers.