Category: Statistics

West Afr J Med. 2025 May 30;42(5):405-412.

ABSTRACT

BACKGROUND: Good quality sleep is critical to human functioning as decline in sleep quality has been linked with health issues. One of the factors that has been identified with decline in sleep quality is increasing age, making older persons at risk of significant deleterious consequences on their physical, social, and mental spheres of well-being when they have poor sleep quality.

OBJECTIVES: This study aimed at determining the predictors of sleep quality among older persons aged 60 years and above attending the outpatient clinics of a tertiary hospital in Uyo, South-South Nigeria with a view to suggesting appropriate recommendations for health improvement of participants and clinical practice, where necessary.

METHODOLOGY AND METHODS: This was a cross-sectional study involving two hundred and fourteen (214) respondents. Those who met the inclusion criteria were interviewed with the aid of a semi- structured questionnaire containing items on socio-demographic characteristics, clinical data, and items from the Pittsburgh sleep quality index. Data was analysed using Epi info® version 3.5.1.

RESULTS: Of the 214 respondents recruited, the prevalence of good sleep quality was 63.1% with a higher rate of poor sleep quality observed in males (57%). Factors affecting sleep quality after bivariate analysis in this study were age group (70-74 years), polygamous family type, significant stress, sleep problems, chronic medical illness, routine medication, high blood pressure, overweight and obesity. However, when multiple logistic regression was done on these factors, family type, sleep problems, and chronic medical illness were still statistically significant.

CONCLUSIONS: More than one-third of the older persons had poor quality of sleep in this study, and the predictors of sleep quality were family type (polygamous), sleep problems, and chronic medical illness. Therefore, there is need for a careful routine assessment of sleep among older persons and this should include comprehensive sleep history as well as evaluation and treatment of various co-morbidities in order to improve sleep quality among them.

PMID:41052398

Health Aff (Millwood). 2025 Oct;44(10):1250-1255. doi: 10.1377/hlthaff.2025.00408.

ABSTRACT

Medicare Advantage (MA) provider prices are, on average, similar to those of traditional Medicare; however, prices may vary across hospitals or insurers. Using national data, we found that MA prices averaged 97 percent of traditional Medicare prices. Although only 39 percent of hospitals in our sample had average inpatient MA prices within 5 percent of traditional Medicare prices, MA prices varied far less than commercial or Medicaid prices.

PMID:41052396 | DOI:10.1377/hlthaff.2025.00408

Health Aff (Millwood). 2025 Oct;44(10):1298-1306. doi: 10.1377/hlthaff.2024.01641.

ABSTRACT

The 2021 expanded Child Tax Credit (ECTC) provided families with six monthly cash transfer payments disbursed between July and December 2021, with the goal of alleviating financial strain during the COVID-19 pandemic. These payments reduced child poverty and food insufficiency and may have had beneficial effects on child health. Using 2019-22 Pennsylvania birth certificate data, we examined the association between parental receipt of monthly ECTC payments during pregnancy and infant birth outcomes, exploiting quasi-random variation in ECTC payment amounts based on date of birth and number of siblings. For every $1,000 in ECTC payments received during pregnancy, we observed decreased odds of preterm birth, low birthweight, and very low birthweight among infants of Medicaid-insured pregnant people. Nondirected cash transfer programs such as the ECTC and other income support programs and policies targeting pregnancy may lead to improved birth outcomes.

PMID:41052394 | DOI:10.1377/hlthaff.2024.01641

Health Aff (Millwood). 2025 Oct;44(10):1273-1280. doi: 10.1377/hlthaff.2024.01289.

ABSTRACT

The Affordable Care Act (ACA) enabled states to expand Medicaid to low-income adults and required expansion programs to cover substance use disorder (SUD) treatment. Extending prior research, we analyzed more recent effects of ACA Medicaid expansions on specialty SUD treatment, using 2010-22 all-payer data on treatment episodes. This period coincides with the worsening national drug overdose epidemic, as well as changes to Medicaid policy through program redesign and under the COVID-19 public health emergency. Using difference-in-differences methods, we found that after expansion, episodes to specialty treatment increased by 28 percent in expansion states compared with nonexpansion states. Financial protection through Medicaid as a source of insurance and payment for services also increased significantly in expansion states compared with nonexpansion states. Medicaid expansion is an important program for increasing access to SUD care for a population with high levels of need.

PMID:41052393 | DOI:10.1377/hlthaff.2024.01289

Health Aff (Millwood). 2025 Oct;44(10):1307-1316. doi: 10.1377/hlthaff.2025.00375.

ABSTRACT

Many Latino immigrants avoid public benefits because of fears about their immigration status or that of family members, which is heightened by anti-immigration rhetoric. This study used data from the Latino Youth Health Study and the 2021-22 California Health Interview Survey to examine decisions not to apply for noncash public benefits, such as Medicaid, food assistance, and housing subsidies, as well as safety perceptions among income-eligible Latino families in California. We also analyzed differences by parental citizenship and household language. Compared to families with two US citizen parents, families with one or both noncitizen parents were more likely (by 38.4 and 46.7 percentage points, respectively) to avoid applying for benefits because of immigration-related concerns, and such families were also more likely to fear deportation for themselves or a family member or close friend. Spanish-only and bilingual households showed similar patterns. These findings underscore the need for accurate information on public benefit eligibility and immigration policies to ensure that immigrant families can access health care and resources to which they are legally entitled.

PMID:41052391 | DOI:10.1377/hlthaff.2025.00375

Health Aff (Millwood). 2025 Oct;44(10):1291-1297. doi: 10.1377/hlthaff.2025.00297.

ABSTRACT

Site neutrality in payment practices has become a salient issue in the US health care debate, as rising prices have brought increased pressure for policy action. Although Medicare has received disproportionate attention, these policies could also apply to commercial insurers, particularly to address payment differentials between hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs). Using 2024 Transparency in Coverage data provided by Clarify Health on commercial prices for three insurers (UnitedHealthcare, Cigna, and BlueCross BlueShield), we compared payments for thirteen common procedures across settings. Overall, in 2024, commercial prices were $1,489 (78 percent) higher in HOPDs than in ASCs, whereas Medicare prices were $633 (97 percent) higher. However, site payment differentials varied substantially across payers: Cigna had the lowest differentials between HOPDs and ASCs ($327), whereas United had the highest ($1,673). Cigna achieved this through provider selection, contracting with only 14 percent of HOPDs in applicable markets compared with an average of 76 percent for United and BlueCross BlueShield. If United and BlueCross BlueShield paid Cigna’s average HOPD rates for these procedures, together they would save approximately $1.4 billion a year. Our results suggest that payers can reduce site differentials through provider selection; they also imply that larger insurers with broader networks may continue to reimburse different sites differently in the absence of either government action or a shift in market dynamics.

PMID:41052389 | DOI:10.1377/hlthaff.2025.00297

Health Aff (Millwood). 2025 Oct;44(10):1256-1265. doi: 10.1377/hlthaff.2025.00330.

ABSTRACT

Medicare-Medicaid dual enrollees accounted for roughly a third of those programs’ spending but less than 20 percent of enrollment in 2021. Policy makers have responded to dual enrollees’ high levels of spending by encouraging their enrollment in private Medicare plans. However, assessing plans’ impact on spending is complicated by favorable selection, in which healthier people prefer private plans to Medicare fee-for-service. We tested for selection into Medicare plans among dual enrollees, using linked Medicaid-Medicare claims data from the period 2017-22. We tracked people transitioning from Medicaid to dual enrollment and compared their pre-dual enrollment spending among Medicare plan choices. We found evidence of favorable selection. After adjustment for for beneficiary characteristics, a 1 percent increase in medical spending reduced beneficiaries’ probability of enrolling in private plans by 1 percentage point (2.3 percent). The effects were driven by the highest-spending beneficiaries, who were 11 percentage points (25 percent) less likely to enroll in private plans. Selection appeared to be stronger among unintegrated plans (which cover Medicare but not Medicaid benefits), although higher spending on long-term services and supports reduced enrollment in all plan types. These findings highlight the need for researchers to control for underlying health status when evaluating health or spending outcomes in private plans.

PMID:41052388 | DOI:10.1377/hlthaff.2025.00330

Health Aff (Millwood). 2025 Oct;44(10):1266-1272. doi: 10.1377/hlthaff.2025.00211.

ABSTRACT

Although its availability has grown during the past decade, pre-exposure prophylaxis (PrEP) remains underused in the US. We evaluated the impact of Medicaid expansion on state-level PrEP prescribing outcomes, using HIV surveillance data from all fifty states and Washington, D.C., from the period 2012-23, using a staggered diffeence-in-differences approach. PrEP coverage (prescriptions per 100,000 population) increased over time but was not statistically significantly associated with Medicaid expansion. There were, however, significant increases in the PrEP-to-need ratio (4.44 PrEP prescriptions per new HIV diagnosis) that were attributable to Medicaid expansion, with the strength of effects increasing over time. Medicaid expansion was associated with significant increases in PrEP-to-need ratios across all subgroups. Although Medicaid expansion effectively increased PrEP access relative to HIV diagnoses, differential impacts by race and ethnicity may suggest widening racial and ethnic disparities.

PMID:41052386 | DOI:10.1377/hlthaff.2025.00211

Health Aff (Millwood). 2025 Oct;44(10):1281-1284. doi: 10.1377/hlthaff.2025.00105.

ABSTRACT

Registered nurses (RNs) represent the largest clinical workforce in the US. We examined RN wages relative to wages for other health care occupations for the period 2012-23. Although annual inflation-adjusted wages increased across all health care occupations, RNs experienced the smallest growth (0.51 percent), and nursing assistants experienced the greatest (1.48 percent). Comparing 2012 to 2023, wage gaps between RNs narrowed compared with some professions and widened compared with others.

PMID:41052382 | DOI:10.1377/hlthaff.2025.00105

Health Aff (Millwood). 2025 Oct;44(10):1244-1249. doi: 10.1377/hlthaff.2025.00119.

ABSTRACT

Medicare Advantage (MA) enrollment has grown rapidly over recent years, and enrollees may now choose from among a large number of MA plans. However, the market remains highly concentrated, with a few very large insurers. Using MA administrative data, we analyzed trends in insurer concentration during the period 2013-23 and its relation to MA payments and plan characteristics. We documented a significant shift toward less concentration, but concentration remained high. The average number of insurers per county increased, and the Herfindahl-Hirschman Index measure of market concentration declined. Reduced concentration was associated with lower Medicare payments and individual premiums, higher plan rebates, and less enrollee cost sharing. The estimated effects, however, were quantitatively small. Our findings suggest that further reductions in MA insurer concentration may yield only modest benefits for Medicare beneficiaries and the program unless concentration falls well below current levels.

PMID:41052381 | DOI:10.1377/hlthaff.2025.00119