Racial and Ethnic Disparities in Insurance Coverage Among US Adults Aged 60 to 64 Years

Patterson, Anna; Robinson, Taylor; Roberts, Eric T.

doi:10.1001/jamanetworkopen.2022.9406

Cited by 4 publications

(2 citation statements)

References 3 publications

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“…Although insurance status was not shown to be predictive of missed appointments, its role in enabling access to health care and to protect families from high medical costs is also germane as patients from disadvantaged backgrounds have faced longstanding disparities in health coverage that contributes to differing barriers to access. While the Affordable Care Act created new health coverage options that helped to narrow these disparities, studies have shown that Black and Latino individuals continued to lag with respect to health insurance coverage compared to their Caucasian counterparts ( 19 ). The higher rates of uninsured among these groups largely reflects more limited rates of private coverage among these groups which was consistent with what was seen.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic and demographic factors predictive of missed appointments in outpatient radiation oncology: an evaluation of access

Chen

2023

Front. Health Serv.

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PurposeWhile missed patient appointments reduce clinic efficiency and limit effective resource allocation, factors predictive of “no shows” are poorly understood in radiation oncology.Methods and materialsA prospective data registry of consecutive patients referred for initial consultation from October 2,018 to April 2022 was reviewed. Demographic characteristics recorded included age, gender, race, language preference, living situation, and insurance status. Zip code data linked to a patient’s residential address was used to determine socioeconomic status (SES) based on publicly available data on median household income. No show encounters were defined as all encounters where the patient failed to cancel their visit and did not sign-in to their scheduled appointment. Descriptive statistics were presented to identify factors predictive of missed appointments.ResultsA total of 9,241 consecutive patients were referred and logged into the database during the 4-year period, of which 5,755 were successfully scheduled and registered. A total of 523 patients (9%) failed to show for their appointments. Missed appointments were associated with low-income status, homeless living situation, and Black or Latino race (p < 0.05, for all). The proportion of White, Latino, Asian, and Black patients who missed appointments was 6%, 14%, 9%, and 12%, respectively (p < 0.001). Patient characteristics independently associated with higher odds of appointment non-adherence included low-income status ((OR) = 2.90, 95% CI (1.44–5.89) and Black or Latino race [(OR) = 3.31, 95% CI: 1.22–7.65].ConclusionsOur results highlight the influence of demographic, financial, and racial disparities on proper health care utilization among patients with cancer. Future interventions aimed at reducing appointment no shows could channel resources to the at risk-populations identified in this analysis, improving access to care, and optimize clinic efficiency.

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Section: Discussionmentioning

confidence: 99%

Socioeconomic and demographic factors predictive of missed appointments in outpatient radiation oncology: an evaluation of access

Chen

2023

Front. Health Serv.

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“…[14,15] Moreover, the COVID-19 pandemic has considerably impacted on household income due to premature deaths, workplace absenteeism, and reduced productivity, leading to unemployment. [16,17] It may result in economic problems, depression, and a subsequent increase in alcohol and substance consumption. [18,19]…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Exploring factors related to alcohol and substance use during the COVID-19 pandemic: a post-hoc analysis from the Korea youth risk behavior web-based survey

Yon¹,

Park²,

Koyanagi³

et al. 2023

Life Cycle

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Despite the significance of the COVID-19 pandemic's effect on life, only a few previous studies have been conducted on youth substance use during the era of the COVID-19 pandemic. Thus, we aimed to determine the change in alcohol and substance use by the familial-, social-, and individual-associated risk factors among Korean adolescents, comparing the preand during COVID-19 pandemic period. Data on 1,109,776 Korean adolescents aged 13 to 18 years from 2005 to 2021 were obtained in a nationwide, large-scale, and serial study. This study was conducted to compare the risk factors of alcohol and substance use for overall years and the transitional effect of the COVID-19 pandemic. Among one million adolescents during the pandemic (2019 versus 2021), lower school grades (ratio of odds ratio [ROR], 1.172; 95% CI, 1.075-1.279), male (ROR, 1.098; 95% CI, 1.008-1.197), lower educational levels of parents (ROR, 1.116; 95% CI, 1.002-1.215), and lower economic levels (ROR, 1.341; 95% CI, 1.026-1.754) were more pronounced and significant among alcohol users compared to the prepandemic period (2019 versus 2021). During the pandemic, higher school grades (ROR, 1.561; 95% CI, 1.166-2.090) and former smoking (ROR, 1.969; 95% CI, 1.290-3.003) were more pronounced and significant among substance users than in the pre-pandemic period. Over a million adolescents' national data were used in this study to investigate changes in alcohol and drug use according to risk factors. Moreover, we compared how they were affected by the COVID-19 pandemic by comparing the change in risk factors in the pre-pandemic (2019) and pandemic periods (2021). The outcomes of this study suggest a complex interaction between a multitude of factors that influence adolescent alcohol and substance use.

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Insurance-Related Disparities in Withdrawal of Life Support and Mortality After Spinal Cord Injury

Shakil,

Essa,

Malhotra

et al. 2024

JAMA Surg

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ImportanceIdentifying disparities in health outcomes related to modifiable patient factors can improve patient care.ObjectiveTo compare likelihood of withdrawal of life-supporting treatment (WLST) and mortality in patients with complete cervical spinal cord injury (SCI) with different types of insurance.Design, Setting, and ParticipantsThis retrospective cohort study collected data between 2013 and 2020 from 498 trauma centers participating in the Trauma Quality Improvement Program. Participants included adult patients (older than 16 years) with complete cervical SCI. Data were analyzed from November 1, 2023, through May 18, 2024.ExposureUninsured or public insurance compared with private insurance.Main Outcomes and MeasuresCoprimary outcomes were WLST and mortality. The adjusted odds ratio (aOR) of each outcome was estimated using hierarchical logistic regression. Propensity score matching was used as an alternative analysis to compare public and privately insured patients. Process of care outcomes, including the occurrence of a hospital complication and length of stay, were compared between matched patients.ResultsThe study included 8421 patients with complete cervical SCI treated across 498 trauma centers (mean [SD] age, 49.1 [20.2] years; 6742 male [80.1%]). Among the 3524 patients with private insurance, 503 had WLST (14.3%) and 756 died (21.5%). Among the 3957 patients with public insurance, 906 had WLST (22.2%) and 1209 died (30.6%). Among the 940 uninsured patients, 156 had WLST (16.6%) and 318 died (33.8%). A significant difference was found between uninsured and privately insured patients in the adjusted odds of WLST (aOR, 1.49; 95% CI, 1.11-2.01) and mortality (aOR, 1.98; 95% CI, 1.50-2.60). Similar results were found in subgroup analyses. Matched public compared with private insurance patients were found to have significantly greater odds of hospital complications (odds ratio, 1.27; 95% CI, 1.14-1.42) and longer hospital stay (mean difference 5.90 days; 95% CI, 4.64-7.20), which was redemonstrated on subgroup analyses.Conclusions and RelevanceHealth insurance type was associated with significant differences in the odds of WLST, mortality, hospital complications, and days in hospital among patients with complete cervical SCI in this study. Future work is needed to incorporate patient perspectives and identify strategies to close the quality gap for the large number of patients without private insurance.

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Racial and Ethnic Disparities in Insurance Coverage Among US Adults Aged 60 to 64 Years

Cited by 4 publications

References 3 publications

Socioeconomic and demographic factors predictive of missed appointments in outpatient radiation oncology: an evaluation of access

Socioeconomic and demographic factors predictive of missed appointments in outpatient radiation oncology: an evaluation of access

Exploring factors related to alcohol and substance use during the COVID-19 pandemic: a post-hoc analysis from the Korea youth risk behavior web-based survey

Insurance-Related Disparities in Withdrawal of Life Support and Mortality After Spinal Cord Injury

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