Health Aff (Millwood). 2024 Nov;43(11):1502-1507. doi: 10.1377/hlthaff.2024.00295.
ABSTRACT
We compared the generosity of Medicare plans in terms of out-of-pocket costs attributable to cost sharing and premiums, including both basic and supplemental services. From 2014 through 2019, projected out-of-pocket costs for a typical enrollee were 18-24 percent lower in Medicare Advantage than traditional fee-for-service Medicare.
PMID:39496086 | DOI:10.1377/hlthaff.2024.00295
Health Aff (Millwood). 2024 Nov;43(11):1587-1596. doi: 10.1377/hlthaff.2024.00307.
ABSTRACT
The Affordable Care Act Marketplaces may improve access to dental insurance, but little is known about the availability of such coverage. We used data from state and federal Marketplace sources to describe the availability of adult dental plans, including Stand-alone Dental Plans and those embedded in medical plans. We also examined the characteristics of counties with limited dental insurer participation and those that experienced a net loss of Stand-alone Dental Plan insurers between 2016 and 2023. We found that in 2023, at least one Stand-alone Dental Plan was offered in every state, and thirty-six states offered embedded dental plans. Most counties (63.6 percent) had access to more than five insurers offering adult dental plans, whereas approximately 4 percent had only one insurer offering adult dental plans. Counties in state-based Marketplaces, rural areas, and dentist shortage areas were more likely to be counties with limited dental insurer participation. The net loss of Stand-alone Dental Plans between 2016 and 2023 was more common in state-based Marketplaces and disadvantaged counties. Our findings can inform future policies to improve the dental insurance Marketplace and access to affordable dental care.
PMID:39496084 | DOI:10.1377/hlthaff.2024.00307
Health Aff (Millwood). 2024 Nov;43(11):1528-1537. doi: 10.1377/hlthaff.2024.00204.
ABSTRACT
Some noncitizens in the US are not eligible for public health insurance, potentially reducing access to preconception, prenatal, and postpartum care. We compared insurance coverage and health care use from the preconception period to the postpartum period by immigration status, using representative survey data collected from six US states between 2020 and 2022. Respondents were surveyed at two to six months postpartum and at twelve to fourteen months postpartum. Immigration status was classified in three categories: US citizen, permanent resident, and people who were neither citizens nor permanent residents. Compared with US citizens, fewer permanent residents had late postpartum insurance coverage, but coverage rates were otherwise similar. Coverage was lower among noncitizens/non-permanent residents compared with US citizens at every time point except pregnancy, with the largest differences at preconception (50.5 percent and 90.5 percent, respectively) and late postpartum (53.2 percent and 95.1 percent, respectively). Fewer permanent residents had health care visits before pregnancy compared with US citizens, but health care use was otherwise similar. Noncitizens/non-permanent residents had substantially lower rates of preconception health care, early and adequate prenatal care, postpartum visits, and having a usual source of care at one year postpartum. Expansion of public insurance to cover immigrants is needed to reduce large inequities in perinatal health insurance and health care use by immigration status.
PMID:39496082 | DOI:10.1377/hlthaff.2024.00204
Health Aff (Millwood). 2024 Nov;43(11):1508-1517. doi: 10.1377/hlthaff.2024.00302.
ABSTRACT
Medicare Advantage (MA) plans are increasingly enrolling veterans. Because MA plans receive full capitated payments regardless of whether or not veterans use Medicare services, the federal government can incur substantial duplicative, wasteful spending if veterans in MA plans predominantly seek care through the Veterans Health Administration (VHA) system. The recent growth of MA plans that disproportionately enroll veterans could further exacerbate such wasteful spending. Using national data, we found that veterans increasingly enrolled in MA between 2016 and 2022, including in a growing number of MA plans in which 20 percent or more of the enrollees were veterans. Notably, about one in five VHA enrollees in these high-veteran MA plans did not incur any Medicare services paid by MA within a given year-a rate 2.5 times that of VHA enrollees in other MA plans and 5.7 times that of the general MA population. Meanwhile, VHA enrollees in high-veteran MA plans were significantly more likely to receive VHA-funded care. In 2020, the Centers for Medicare and Medicaid Services paid more than $1.32 billion to MA plans for VHA enrollees who did not use any Medicare services, with 19.1 percent going to high-veteran MA plans.
PMID:39496081 | DOI:10.1377/hlthaff.2024.00302
Urol Res Pract. 2024 Oct 21;50(3):148-153. doi: 10.5152/tud.2024.24024.
ABSTRACT
OBJECTIVE: Transforming growth factor beta (TGF-β) is a member of the growth factor superfamily that clinical studies address its association with bladder cancer invasion, progression, and metastasis. The present systematic review and meta-analysis aimed to explore the prognostic significance of TGF-β expression in bladder cancer patients.
MATERIALS AND METHODS: The major international databases, including PubMed, Web of Science, Embase, and Scopus, were searched for full-text literature citations. The hazard ratio (HR) with a 95% CI as the effect size was applied as the appropriate summarized statistic. We used a random-effects model using the DerSimonian and Laird method to estimate the pooled effect size. To assess the heterogeneity among trials, the I-square (I 2 ) statistic and Cochran’s Q test were used. Forest and funnel plots were drawn to respectively demonstrate the findings and detect any existing publication bias.
RESULTS: This meta-analysis included 3 studies that met the criteria and included 535 patients. The combined HR for the selected studies was 2.250 (95% CI=(1.411, 3.586), P< .001) and no significant heterogeneity was detected between trials (I 2=58.63, P=.089). Furthermore, no severe asymmetry was seen within the funnel plot, indicating a lack of potential publication bias.
CONCLUSION: Our findings suggest that TGF-β expression can remarkably predict a worse prognosis in patients with bladder cancer. The results of the present meta-analysis may be validated through further updated reviews and additional relevant investigations in future studies.
PMID:39495544 | DOI:10.5152/tud.2024.24024
J Craniofac Surg. 2024 Nov 4. doi: 10.1097/SCS.0000000000010840. Online ahead of print.
ABSTRACT
OBJECTIVE: Facial feminization surgery (FFS) treats gender dysphoria in transfeminine patients by addressing the facial bony and soft tissue components. Individuals seeking FFS may be taking gender-affirming hormone replacement therapy [gender-affirming hormone therapy (GAHT)]. This study aims to better characterize the GAHT’s impact on venous thromboembolism (VTE) risk, surgical planning, and outcomes.
METHODS: A systematic review and meta-analysis of the literature were carried out to assess the effect of perioperative GAHT continuation on VTE. Cochrane Q and I2 statistics measured study heterogeneity with the following meta-regression exploring these results. Simultaneously, a retrospective review of the senior author’s FFS cohort was conducted to investigate GAHT duration’s impact on FFS revision rate, complication incidence, and facial structures operated on.
RESULTS: Eleven articles were included: 602 patients stopped GAHT, of whom 3 VTEs were recorded (0.49%). This is compared with one episode among the 925 who continued GAHT perioperatively (0.11%). Study heterogeneity was low (0%), but limited VTE sample size precluded meta-analytic conclusions. Gender-affirming hormone therapy duration does not impact the incidence of all-cause complications (P = 0.478), wound infection (P = 0.283), hematoma (P = 0.283), or VTE (P = 1). The only procedures significantly less associated with higher GAHT were tracheal shaving (P = 0.002) and mandibuloplasty (P = 0.003). Finally, the FFS revision rate was not associated with GAHT duration (P = 0.06).
CONCLUSION: There is a paucity of data to assess the safety or harm of continuing GAHT in the FFS perioperative period. Thus, a shared provider-patient decision-making process examining the risks and benefits of GAHT perioperative continuation is warranted. As patients seeking gender-affirming care are diverse, a “one-protocol-fits-all” is not appropriate.
PMID:39495542 | DOI:10.1097/SCS.0000000000010840
JAMA Pediatr. 2024 Nov 4. doi: 10.1001/jamapediatrics.2024.4361. Online ahead of print.
ABSTRACT
IMPORTANCE: A meta-analysis published in 2001 suggested that exposure to infections measured by day care attendance may be important in the pathogenesis of type 1 diabetes. Several new studies on the topic have since been published.
OBJECTIVE: To investigate the association between day care attendance and risk of type 1 diabetes and to include all available literature up to March 10, 2024.
DATA SOURCES: Data from PubMed and Web of Science were used and supplemented by bibliographies of the retrieved articles and searched for studies assessing the association between day care attendance and risk of type 1 diabetes.
STUDY SELECTION: Studies that reported a measure of association between day care attendance and risk of type 1 diabetes were included.
DATA EXTRACTION AND SYNTHESIS: Details, including exposure and outcome assessment and adjustment for confounders, were extracted from the included studies. The multivariable association with the highest number of covariates, lowest number of covariates, and unadjusted estimates and corresponding 95% CIs were extracted. DerSimonian and Laird random-effects meta-analyses were performed and yielded conservative confidence intervals around relative risks.
MAIN OUTCOMES AND MEASURES: The principal association measure was day care attendance vs no day care attendance and risk of type 1 diabetes.
RESULTS: Seventeen articles including 22 observational studies of 100 575 participants were included in the meta-analysis. Among the participants, 3693 had type 1 diabetes and 96 882 were controls. An inverse association between day care attendance and risk of type 1 diabetes was found (combined odds ratio, 0.68; 95% CI, 0.58-0.79; P < .001; adjusted for all available confounders). When the 3 cohort studies included were analyzed separately, the risk of type 1 diabetes was 15% lower in the group attending day care; however, the difference was not statistically significant (odds ratio, 0.85; 95% CI, 0.59-1.12; P = .37).
CONCLUSIONS AND RELEVANCE: These results demonstrated that day care attendance appears to be associated with a reduced risk of type 1 diabetes. Increased contacts with microbes in children attending day care compared with children who do not attend day care may explain these findings. However, further prospective cohort studies are needed to confirm the proposed association.
PMID:39495535 | DOI:10.1001/jamapediatrics.2024.4361
JAMA Intern Med. 2024 Nov 4. doi: 10.1001/jamainternmed.2024.5932. Online ahead of print.
ABSTRACT
IMPORTANCE: Work requirements are a controversial feature of US safety-net programs, with some policymakers seeking to expand their use. Little is known about the demographic, clinical, and socioeconomic characteristics of individuals most likely to be negatively impacted by work requirements.
OBJECTIVE: To examine the association between work requirements and safety-net program enrollment.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included Medicaid and Supplemental Nutrition Assistance Program (SNAP) enrollees in Connecticut. The impact of SNAP work requirements for able-bodied adults without dependents-the target population-was estimated using a triple-differences research design comparing outcomes before and after the policy (first difference) in affected and exempted towns (second difference) between the targeted population and untargeted parents and caregivers (third difference). SNAP and Medicaid enrollment trends were assessed for a 24-month period, and the characteristics of individuals most likely to lose coverage were examined. Data were collected from August 2015 to April 2018, and data were analyzed from August 2022 to September 2024.
EXPOSURES: The reintroduction of SNAP work requirements in 2016.
MAIN OUTCOMES AND MEASURES: Proportion of enrollees disenrolled from SNAP and Medicaid.
RESULTS: Of 81 888 Medicaid enrollees in Connecticut, 46 872 (57.2%) were female, and the mean (SD) age was 36.6 (7.0) years. Of these, 38 344 were able-bodied adults without dependents, of which 19 172 were exposed to SNAP work requirements, and 43 544 were parents or caregivers exempted from SNAP work requirements. SNAP coverage declined 5.9 percentage points (95% CI, 5.1-6.7), or 25%, following work requirements. There were no statistically significant changes in Medicaid coverage (0.2 percentage points; 95% CI, -1.4 to 1.0). Work requirements disproportionately affected individuals with more chronic illnesses, targeted beneficiaries who were older, and beneficiaries with lower incomes. Individuals with diabetes were 5 percentage points (95% CI, 0.8-9.3), or 91%, likelier to lose SNAP coverage than those with no chronic conditions; older SNAP beneficiaries (aged 40 to 49 years) with multiple comorbidities were 7.3 percentage points (95% CI, 4.3-11.3), or 553%, likelier to disenroll than younger beneficiaries (aged 25 to 29 years) without chronic conditions; and households with the lowest incomes were 18.6 percentage points (95% CI, 11.8-25.4), or 204%, likelier to lose coverage than the highest income SNAP beneficiaries.
CONCLUSIONS AND RELEVANCE: In this cohort study, SNAP work requirements led to substantial reductions in SNAP coverage, especially for the most clinically and socioeconomically vulnerable. Work requirements had little effect on Medicaid coverage, suggesting they did not lead to sufficient increases in employment to transition beneficiaries off the broader safety net.
PMID:39495527 | DOI:10.1001/jamainternmed.2024.5932
Mil Psychol. 2024 Nov 4:1-9. doi: 10.1080/08995605.2024.2423110. Online ahead of print.
ABSTRACT
Linkages among psychological health problems, intimate relationship distress, and suicide risk have been widely studied, but less is known about how these factors interact, especially in military populations. With steady increases in suicide rates among active military and post-service members (SMs), it is critical to better understand the relation among known risk factors. The current study addresses this gap by testing a model hypothesizing that the association between intimate-relationship problems and suicidal ideation is mediated by individual mental health symptoms. We tested this model on a sample of 862 active-duty Air Force members in committed relationships. The sample consisted of 35.0% women and 64.8% men, with an average age of 21.9 years and a mean relationship length of 2.8 years. Findings supported the hypothesized statistical mediation model. Results indicated that relationship problems contribute to psychological health problems, which, in turn, are related to suicidal ideation. These findings may help direct suicide intervention and prevention protocols that consider intimate relationship distress as a significant risk factor. Limitations and further implications for policies regarding suicide prevention in the armed forces are discussed.
PMID:39495505 | DOI:10.1080/08995605.2024.2423110
Eur J Epidemiol. 2024 Nov 4. doi: 10.1007/s10654-024-01166-w. Online ahead of print.
ABSTRACT
The mechanism underlying the co-occurrence of major depressive disorder (MDD) and gynecological diseases remains unclear. This study aimed to investigate the familial co-aggregation and shared genetic loading between MDD and gynecological diseases, namely dysmenorrhea, endometriosis, uterine leiomyomas (UL), and polycystic ovary syndrome (PCOS). Overall, 2,121,632 females born 1970-1999 with parental information were enrolled from the Taiwan National Health Insurance Research Database (NHIRD); 25,142 same-sex twins and 951,779 persons with full-sibling(s) were selected. Genome-wide genotyping data were available for 67,882 unrelated female participants from the Taiwan Biobank linked to the NHIRD. A generalized linear model with a logistic link function was used to examine the associations of individual history, family history in parents/full-siblings/same-sex twins, and polygenic risk scores (PRS) for MDD with the risk of gynecological diseases; generalized estimating equations were used to consider the non-independence of data. Both parents affected with MDD was associated with four gynecological diseases, and its magnitude of association was higher than either affected parent; maternal MDD showed a higher magnitude of association than paternal MDD. Full-siblings of patients with MDD had a higher risk of four gynecological diseases; same-sex twins of patients with MDD had a greater association with dysmenorrhea and PCOS. PRS for MDD was associated with dysmenorrhea and endometriosis. Familial co-aggregation was observed in the co-occurrence of MDD and four gynecological diseases. There exists a shared polygenic liability between MDD and dysmenorrhea and endometriosis. Individuals with MDD-affected relatives or a higher PRS for MDD should be monitored for gynecological diseases.
PMID:39495462 | DOI:10.1007/s10654-024-01166-w
