BackgroundDue to preexisting conditions, older adults are at higher risk of COVID-19 related severe complications. Current evidence is limited on access to care for older adults during the COVID-19 pandemic.ObjectivesTo examine the extent of reduced access to care among older American adults during the COVID-19 pandemic, identify predictors and reasons of reduced access.Materials and methodsUsing publicly available data from the COVID-19 module (interim release) of the Health and Retirement Study, we undertook descriptive analyses of older adults stratified by sex, age group, race, education, marital status, employment, receipt of social security benefits, health insurance, number of limitations in activities of daily living and pre-existing conditions. Associations between reduced access to care and predictors were estimated using a multivariable logistic regression model.ResultsAbout 30% of respondents delayed or avoided care during the pandemic. Reduced access was more likely to be reported by respondents that were female, younger, educated, not receiving social security benefits, with limitations in daily activities and three preexisting conditions. In terms of the reasons, the majority of the respondents (45.9%) reported that their visit was either cancelled or rescheduled by the provider; 13.9% thought they could wait, 10.9% could not get an appointment, 9.1% found it unaffordable, and 7.4% were afraid to visit the provider. Respondents reported of reduced access to doctor’s visits, surgery, prescription filling, and dental care.ConclusionsWe suggest urgent attention on improving access to care for older adults during the pandemic. For nonemergency conditions and routine care that can be delivered virtually, telehealth services can be strengthened. Additionally, health messaging can reemphasize that neglecting medical care might lead to increased morbidity and mortality among older adults from preexisting illnesses.

Background: Acute myeloid leukemia (AML) accounts for a fifth of childhood leukemia. Although survival rates for AML have greatly improved over the past few decades, they vary depending on demographic and AML type factors. Objectives: To predict the five-year survival among pediatric AML patients using machine learning algorithms and deploy the best performing algorithm as an online survival prediction tool. Materials and methods: Pediatric patients (0 to 14 years) with a microscopically confirmed AML were extracted from the Surveillance Epidemiology and End Results (SEER) database (2000-2016) and split into training and test datasets (80/20 ratio). Four machine learning algorithms (logistic regression, support vector machine, gradient boosting and K nearest neighbor) and a deep neural network algorithm were trained on features to predict five-year survival. Performances of the algorithms were compared and the best performing algorithm was deployed as an online prediction tool. Results: A total of 2,140 patients met our inclusion criteria. The gradient boosting algorithm was the best performer in terms of discrimination and predictive ability. It was deployed as the online survival prediction tool named OSPAM-C (https://ashis-das.shinyapps.io/ospam/). Conclusions: Our study provides a framework for the development and deployment of an online survival prediction tool for pediatric patients with AML. While external validation is needed, our survival prediction tool presents an opportunity to inform clinical decision-making for AML patients.

Background: Reduced access to routine care can lead to higher morbidity and mortality among older adults. We assessed the extent of reduced access to care among older American adults during the COVID-19 pandemic, identified predictors and reasons for reduced access. Materials and methods: Using publicly available data from the COVID-19 module (interim release) of the Health and Retirement Study, we undertook descriptive analyses of older adults stratified by socio-demographic characteristics. Associations between reduced access to care and predictors were estimated using a multivariable logistic regression model. Results: 30.2% of respondents delayed or avoided care during the pandemic. Reduced access was more likely to be reported by respondents that were female, younger, educated, not receiving social security benefits, with limitations in daily activities and three preexisting conditions. In terms of the reasons, the majority of the respondents (45.9%) reported that their visit was either cancelled or rescheduled by the provider; 13.9% thought they could wait, 10.9% could not get an appointment, 9.1% found it unaffordable, and 7.4% were afraid to visit the provider. Respondents reported of reduced access to doctor’s visits, surgery, prescription filling, and dental care. Conclusions: We suggest urgent attention on improving access to care for older adults during the pandemic. For nonemergency conditions and routine care that can be delivered virtually, telehealth services can be strengthened. Additionally, health messaging can reemphasize that neglecting medical care might lead to increased morbidity and mortality among older adults from preexisting illnesses. Keywords: Older adults; Access to care; COVID-19; Health and retirement study

BackgroundInfluenza could be associated with illnesses, severe complications, hospitalizations, and deaths among adults with high-risk medical conditions. Influenza vaccination reduces the risks and complications associated with influenza infection in high-risk conditions. We assessed the prevalence and predictors of influenza vaccination in a national sample of adults with high-risk medical conditions.MethodsUsing the nationally representative National Health Interview Survey of 2019, we estimated the prevalence of influenza vaccination among adults with high-risk conditions. We tested the associations between receipt of vaccination and sociodemographic predictors with adjusted multivariable logistic regression.ResultsOut of 15,258 adults with high-risk conditions, 56% reported receiving an influenza vaccine over the previous 12 months. Multivariable regressions show that respondents from older age groups, females, other race/ethnic group, married, higher annual family income, having a health insurance and those with more than two high-risk conditions are more likely to receive the influenza vaccine. However, adults from non-Hispanic Black race/ethnicity and living in the Southern census region are less likely to receive the vaccination. Education levels and living in a metro show no associations with vaccination status.ConclusionState authorities, primary physicians, specialists, and pharmacists have important roles in sensitizing and reminding individuals with high-risk conditions to receive timely vaccination. Similarly, affordability needs to be enhanced for influenza vaccination including better insurance coverage and reduced co-payment.

Introduction: Influenza could be associated with illnesses, severe complications, hospitalizations, and deaths among adults with high-risk medical conditions. Influenza vaccination reduces the risks and complications associated with influenza infection in high-risk conditions. We assessed the prevalence and predictors of influenza vaccination in a national sample of adults with high-risk medical conditions in the United States. Methods: Using the nationally representative National Health Interview Survey of 2019, we estimated the prevalence of influenza vaccination among adults with high-risk conditions. We tested the associations between receipt of vaccination and socio-demographic predictors. Results: Out of 15,258 adults with high-risk conditions, 56% reported receiving an influenza vaccine over the previous 12 months. Multivariable regressions show that respondents from older age groups, females, married, higher annual family income, having health insurance and those with more than two high-risk conditions are more likely to receive the vaccine. However, adults from non-Hispanic Black race/ethnicity and living in the Southern census region are less likely to receive the vaccination. Education levels and living in a metro show no associations with vaccination status. Conclusions: State authorities and providers have important roles in sensitizing and reminding individuals with high-risk conditions to receive timely vaccination. Affordability needs to be enhanced for influenza vaccination including better insurance coverage and reduced co-payment.