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Trends in Prediabetes Among Youths in the US From 1999 Through 2018

Liu, Junting; Li, Yan; Zhang, Donglan; Yi, Stella S; Liu, Junxiu
PMID: 35344013
ISSN: 2168-6211
CID: 5200902

Assessment of Changes in Rural and Urban Primary Care Workforce in the United States From 2009 to 2017

Zhang, Donglan; Son, Heejung; Shen, Ye; Chen, Zhuo; Rajbhandari-Thapa, Janani; Li, Yan; Eom, Heesun; Bu, Daniel; Mu, Lan; Li, Gang; Pagán, José A
Importance/UNASSIGNED:Access to primary care clinicians, including primary care physicians and nonphysician clinicians (nurse practitioners and physician assistants) is necessary to improving population health. However, rural-urban trends in primary care access in the US are not well studied. Objective/UNASSIGNED:To assess the rural-urban trends in the primary care workforce from 2009 to 2017 across all counties in the US. Design, Setting, and Participants/UNASSIGNED:In this cross-sectional study of US counties, county rural-urban status was defined according to the national rural-urban classification scheme for counties used by the National Center for Health Statistics at the Centers for Disease Control and Prevention. Trends in the county-level distribution of primary care clinicians from 2009 to 2017 were examined. Data were analyzed from November 12, 2019, to February 10, 2020. Main Outcomes and Measures/UNASSIGNED:Density of primary care clinicians measured as the number of primary care physicians, nurse practitioners, and physician assistants per 3500 population in each county. The average annual percentage change (APC) of the means of the density of primary care clinicians over time was calculated, and generalized estimating equations were used to adjust for county-level sociodemographic variables obtained from the American Community Survey. Results/UNASSIGNED:The study included data from 3143 US counties (1167 [37%] urban and 1976 [63%] rural). The number of primary care clinicians per 3500 people increased significantly in rural counties (2009 median density: 2.04; interquartile range [IQR], 1.43-2.76; and 2017 median density: 2.29; IQR, 1.57-3.23; P < .001) and urban counties (2009 median density: 2.26; IQR. 1.52-3.23; and 2017 median density: 2.66; IQR, 1.72-4.02; P < .001). The APC of the mean density of primary care physicians in rural counties was 1.70% (95% CI, 0.84%-2.57%), nurse practitioners was 8.37% (95% CI, 7.11%-9.63%), and physician assistants was 5.14% (95% CI, 3.91%-6.37%); the APC of the mean density of primary care physicians in urban counties was 2.40% (95% CI, 1.19%-3.61%), nurse practitioners was 8.64% (95% CI, 7.72%-9.55%), and physician assistants was 6.42% (95% CI, 5.34%-7.50%). Results from the generalized estimating equations model showed that the density of primary care clinicians in urban counties increased faster than in rural counties (β = 0.04; 95% CI, 0.03 to 0.05; P < .001). Conclusions and Relevance/UNASSIGNED:Although the density of primary care clinicians increased in both rural and urban counties during the 2009-2017 period, the increase was more pronounced in urban than in rural counties. Closing rural-urban gaps in access to primary care clinicians may require increasingly intensive efforts targeting rural areas.
PMID: 33112401
ISSN: 2574-3805
CID: 4717142

Antihypertensive Use and the Risk of Alzheimer's Disease and Related Dementias among Older Adults in the USA

Pan, Xi; Zhang, Donglan; Heo, Ji Haeng; Park, Chanhyun; Li, Gang; Dengler-Crish, Christine M; Li, Yan; Gu, Yian; Young, Henry N; Lavender, Devin L; Shi, Lu
BACKGROUND:Epidemiological evidence on different classes of antihypertensives and risks of Alzheimer's disease and related dementias (ADRD) is inconclusive and limited. This study examined the association between antihypertensive use (including therapy type and antihypertensive class) and ADRD diagnoses among older adults with hypertension. METHODS:A retrospective, cross-sectional study was conducted, involving 539 individuals aged ≥ 65 years who used antihypertensives and had ADRD diagnosis selected from 2013 to 2018 Medical Expenditure Panel Survey (MEPS) data. The predictors were therapy type (monotherapy or polytherapy) and class of antihypertensives defined using Multum Lexicon therapeutic classification (with calcium channel blockers [CCBs] as the reference group). Weighted logistic regression was used to assess the relationships of therapy type and class of antihypertensives use with ADRD diagnosis, adjusting for sociodemographic characteristics and health status. RESULTS:We found no significant difference between monotherapy and polytherapy on the odds of ADRD diagnosis. As to monotherapy, those who used angiotensin-converting enzyme inhibitors (ACEIs) had significantly lower odds of developing AD compared to those who used CCBs (OR 0.36, 95 % CI 0.13-0.99). CONCLUSIONS:Findings of the study suggest the need for evidence-based drug therapy to manage hypertension in later adulthood and warrant further investigation into the mechanism underlying the protective effect of antihypertensives, particularly ACEIs, against the development of AD among older adults with hypertension.
PMID: 36251143
ISSN: 1179-1969
CID: 5352362

Were Women Staying on Track with Intermittent Preventive Treatment for Malaria in Antenatal Care Settings? A Cross-Sectional Study in Senegal

Zhang, Karen; Liang, Di; Zhang, Donglan; Cao, Jun; Huang, Jiayan
A significant gap exists between high rates of antenatal care attendance and low uptake of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) in Senegal. This study aims to investigate whether IPTp-SP is delivered per Senegal's national guidelines and to identify factors affecting the delivery of IPTp-SP at antenatal care visits. A secondary analysis was conducted using the 2014 and 2016 Senegal's Service Provision Assessment. The study sample consists of 1076 antenatal care across 369 health facilities. Multiple logit regression models were used to estimate the probability of receiving IPTp-SP during the antenatal care visit based on prior receipt of IPTp-SP and gestational age during the current pregnancy. At an antenatal care visit, the probability of receiving IPTp-SP is 84% (95% CI = [83%, 86%]) among women with no IPTp-SP history and 85% (95% CI = [79%, 92%]) among women with one prior dose. Women who visit a facility in the top quintile of the proportion of IPTp trained staff have a nearly 4-fold higher odds of receiving IPTp compared to those who visit a facility in the bottom quintile (95% CI = [1.54, 9.80]). The dose and timing of IPTp-SP provided in antenatal care settings in Senegal did not always conform with the national guideline. More training for providers and patient engagement is warranted to improve the uptake of IPTp-SP in antenatal care visits.
PMID: 36232166
ISSN: 1660-4601
CID: 5360002

Continuity of Care and Healthcare Costs among Patients with Chronic Disease: Evidence from Primary Care Settings in China

Liang, Di; Zhu, Wenjun; Qian, Yuling; Zhang, Donglan; Petersen, Jindong Ding; Zhang, Weijun; Huang, Jiayan; Dong, Yin
Background/UNASSIGNED:Though critical to primary care, continuity of care has rarely been examined in China. This study aims to assess the relationship between continuity of care and healthcare costs among patients with chronic diseases within primary care settings in China. Methods/UNASSIGNED:In this cross-sectional study, we used a social health insurance claims dataset of 1406 patients with hypertension and/or diabetes in Yuhuan City, Zhejiang Province collected in 2017-2019. We measured continuity of care using the Bice-Boxerman Continuity of Care (COC) Index, Herfindahl Index (HI), Sequential Continuity of Care (SECON) Index, Usual Provider of Care (UPC), and a binary variable indicating whether a patient's UPC was a primary care provider. We examined the associations between continuity of care and healthcare costs in the same period and the subsequent year, using ordinary least squares regression for the outpatient costs and two-part regression for the inpatient costs. Based on the regression coefficients, we predicted costs saved if each continuity measure was set to 1 from the status quo. Results/UNASSIGNED:When optimum continuity were to be achieved, 7.12-27.29% of total outpatient costs and 55.38-73.35% of total inpatient costs could be saved compared to the status quo during the two-year study period. If optimum continuity were to be achieved in the first year, 7.47%-21.78% of total outpatient costs and 8.84-40.22% of total inpatient costs could be saved in the second-year. Conclusions/UNASSIGNED:Care continuity indicators were consistently associated with reduced outpatient costs and hospitalization risks. Future health reform in China should further enhance continuity of care in primary care.
PMID: 36310688
ISSN: 1568-4156
CID: 5358362

Generation 1.5: Years in the United States and Other Factors Affecting Smoking Behaviors Among Asian Americans

Shi, Lu; Mayorga, Maria; Su, Dejun; Li, Yan; Martin, Emily; Zhang, Donglan
Introduction/UNASSIGNED:Generation 1.5, immigrants who moved to a different country before adulthood, are hypothesized to have unique cognitive and behavioral patterns. We examined the possible differences in cigarette smoking between Asian subpopulations who arrived in the United States at different life stages. Methods/UNASSIGNED:Using the Asian subsample of the 2015 Tobacco Use Supplement to the Current Population Survey, we tested this Generation 1.5 hypothesis with their smoking behavior. This dataset was chosen because its large sample size allowed for a national-level analysis of the Asian subsamples by sex, while other national datasets might not have adequate sample sizes for analysis of these subpopulations. The outcome variable was defined as whether the survey respondent had ever smoked 100 cigarettes or more, with the key independent variable operationalized as whether the respondent was: 1) born in the United States; 2) entered the United States before 12; 3) entered between 12 and 19; and 4) entered after 19. Logistic regressions were run to examine the associations with covariates including the respondent's age, educational attainment, and household income. Results/UNASSIGNED:Asian men who entered before 12 were less likely to have ever smoked 100 cigarettes than those who immigrated after 19; for Asian women, three groups (born in the United States, entered before 12, entered between 12 and 19) were more likely to have smoked 100 cigarettes than those who immigrated after 19. Conclusions/UNASSIGNED:While Asian men who came to the United States before 12 were less at risk for cigarette smoking than those who immigrated in adulthood, the pattern was the opposite among Asian women. Those who spent their childhood in the United States were more likely to smoke than those who came to the United States in adulthood. These patterns might result from the cultural differences between US and Asian countries, and bear policy relevance for the tobacco control efforts among Asian Americans.
PMID: 35497393
ISSN: 1945-0826
CID: 5215812

Discrimination in Medical Settings across Populations: Evidence from the All of Us Research Program

Wang, Vivian Hsing-Chun; Cuevas, Adolfo G; Osokpo, Onome Henry; Chang, Ji Eun; Zhang, Donglan; Hu, Anqing; Yun, Jeongwook; Lee, Adaora; Du, Shilei; Williams, David R; Pagán, José A
INTRODUCTION/BACKGROUND:Discrimination in medical settings (DMS) contributes to health care disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations. METHODS:Survey data from 41,875 adults participating in the All of Us Research Program collected in 2021-2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a health care provider within the past 12 months. Statistical analysis was performed in 2023-2024. RESULTS:About 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, p<0.05. CONCLUSIONS:The findings indicate a high prevalence of DMS, particularly among some population groups. Characterizing DMS may be a valuable tool for identifying populations at risk within the health care system and optimizing the overall patient care experience. Implementing relevant policies remains an essential strategy for mitigating the prevalence of DMS and reducing health care disparities.
PMID: 38844146
ISSN: 1873-2607
CID: 5665712

Changes in home environment, lifestyles, and mental health among preschoolers who experienced lockdown during the first wave of COVID-19 in Shanghai

Zhang, Yunting; Zhao, Jin; Yu, Zhangsheng; Zhang, Donglan; Wu, Saishuang; Zhang, Yue; Chen, Xi; Wang, Guanghai; Zhang, Jun; Jiang, Fan
From January 24, 2020, to March 24, 2020, during the first wave of the COVID-19 pandemic, Shanghai implemented lockdown measures to stop transmission of the virus. Over 26 million residents, including 0.8 million children aged 3"“6, were confined at home. The present study leveraged a city-wide cohort study of preschool children in Shanghai"”the Shanghai Children's Health, Education and Lifestyle Evaluation, Preschool (SCHEDULE-P) study"”and used a quasi-experimental design to study the impact of lockdown on preschool children's mental health and changes in their home environment and lifestyles. Two cohorts"”the pre-pandemic cohort and the pandemic cohort"”were investigated and compared using the difference-in-differences estimation framework. The Strengths and Difficulties Questionnaire was used to screen children who were at risk for mental health distress. The Index of Child Care Environment questionnaire was used to evaluate the quality and quantity of stimulation and support available to children in their family environment. Children's screen time, sleep duration, and household socioeconomic status were also queried. All measures were reported by parents. The results showed that having experienced lockdown and home confinement was associated with a 3.1% (95% confidence interval [CI]: 1.9% to 4.4%) increase in the percentage of children at risk for mental health distress, was associated with longer screen time (21.2 min/day, 95% CI: 17.8"“24.6), longer sleep duration (15.7 min/day, 95% CI: 14.0, 17.4), and a less favorable family environment. Children of parents with lower levels of education were more likely to experience mental health challenges associated with the lockdown. The study was limited by relying on parents as informants for measuring the key variables. Since both parents and children experienced lockdown, this hindered our ability to isolate the impact of lockdowns solely on children. In summary, the study provides evidence on the influence of lockdown measures on mental health and well-being among young children. Authorities need to manage the risks and consider long-term consequences when issuing measures to contain COVID-19 transmission.
ISSN: 0190-7409
CID: 5659532

Medical financial hardship between young adult cancer survivors and matched non-cancer individuals in the United States

Li, Lihua; Zhang, Donglan; Li, Yan; Jain, Mayuri; Lin, Xingyu; Hu, Rebecca; Liu, Junxiu; Thapa, Janani; Mu, Lan; Chen, Zhuo; Liu, Bian; Pagán, José A
BACKGROUND:Young adult cancer survivors face medical financial hardships that may lead to delaying or forgoing medical care. This study describes the medical financial difficulties experienced by young adult cancer survivors in the United States in the post Affordable Care Act (ACA) period. METHOD/METHODS:We identified 1,009 cancer survivors aged 18-39 years from the National Health Interview Survey 2015-2022 and matched 963 (95%) cancer survivors to 2,733 controls using nearest neighbor matching. We used conditional logistic regression to examine the association between cancer history and medical financial hardship and assess whether this association varied by age, sex, race/ethnicity, and region of residence. RESULTS:Compared to those without a cancer history, young adult cancer survivors were more likely to report material financial hardship (22.8% vs 15.2%; odds ratio (OR) 1.65, 95% confidence interval (CI):1.50-1.81) and behavioral medical financial hardship (34.3% vs 24.4%; OR 1.62, 95% CI: 1.49-1.76), but not psychological financial hardship (526% vs 50.9%; OR 1.07, 95% CI: 0.99-1.16). Young adult cancer survivors who were Hispanic, or lived in the Midwest and South were more likely to report psychological financial hardship than their counterparts. CONCLUSIONS:We found that young adult cancer survivors were more likely to experience material and behavioral medical financial hardship than young adults without a cancer history. We also identified specific subgroups of young adult cancer survivors that may benefit from targeted policies and interventions to alleviate medical financial hardship.
PMID: 38366027
ISSN: 2515-5091
CID: 5636102

Association of Economic Policies With Hypertension Management and Control: A Systematic Review

Zhang, Donglan; Lee, Jun Soo; Pollack, Lisa M; Dong, Xiaobei; Taliano, Joanna M; Rajan, Anand; Therrien, Nicole L; Jackson, Sandra L; Popoola, Adebola; Luo, Feijun
IMPORTANCE/UNASSIGNED:Economic policies have the potential to impact management and control of hypertension. OBJECTIVES/UNASSIGNED:To review the evidence on the association between economic policies and hypertension management and control among adults with hypertension in the US. EVIDENCE REVIEW/UNASSIGNED:A search was carried out of PubMed/MEDLINE, Cochrane Library, Embase, PsycINFO, CINAHL, EconLit, Sociological Abstracts, and Scopus from January 1, 2000, through November 1, 2023. Included were randomized clinical trials, difference-in-differences, and interrupted time series studies that evaluated the association of economic policies with hypertension management. Economic policies were grouped into 3 categories: insurance coverage expansion such as Medicaid expansion, cost sharing in health care such as increased drug copayments, and financial incentives for quality such as pay-for-performance. Antihypertensive treatment was measured as taking antihypertensive medications or medication adherence among those who have a hypertension diagnosis; and hypertension control, measured as blood pressure (BP) lower than  140/90 mm Hg or a reduction in BP. Evidence was extracted and synthesized through dual review of titles, abstracts, full-text articles, study quality, and policy effects. FINDINGS/UNASSIGNED:In total, 31 articles were included. None of the studies examined economic policies outside of the health care system. Of these, 16 (52%) assessed policies for insurance coverage expansion, 8 (26%) evaluated policies related to patient cost sharing for prescription drugs, and 7 (22%) evaluated financial incentive programs for improving health care quality. Of the 16 studies that evaluated coverage expansion policies, all but 1 found that policies such as Medicare Part D and Medicaid expansion were associated with significant improvement in antihypertensive treatment and BP control. Among the 8 studies that examined patient cost sharing, 4 found that measures such as prior authorization and increased copayments were associated with decreased adherence to antihypertensive medication. Finally, all 7 studies evaluating financial incentives aimed at improving quality found that they were associated with improved antihypertensive treatment and BP control. Overall, most studies had a moderate or low risk of bias in their policy evaluation. CONCLUSIONS AND RELEVANCE/UNASSIGNED:The findings of this systematic review suggest that economic policies aimed at expanding insurance coverage or improving health care quality successfully improved medication use and BP control among US adults with hypertension. Future research is needed to investigate the potential effects of non-health care economic policies on hypertension control.
PMID: 38334993
ISSN: 2689-0186
CID: 5631992