ABSTRACT
OBJECTIVE: Determine screening rates and examine socio-demographic characteristics of metabolic dysfunction-associated steatotic liver disease (MAFLD) screening in a large population of obese children. METHODS: We used Explorys (IBM) which contains aggregated population-level electronic health record data from approximately 360 hospitals and 317,000 providers across the United States to determine MAFLD screening rates. In children 10 to 14 years, obesity was determined based on body mass index ≥ 95%, or encounter with an international classification of disease obesity code. We determined screening rates by calculating the percentage of children with obesity who had an alanine aminotransferase tested, further analyzed by gender, race, and insurance. RESULTS: Of 3,558,420 children, 513,170 (14.4%) were obese. Of obese children, only 9.3% were screened for MAFLD. Females were more likely screened than males (odds ratio (OR) 1.09 (95% confidence intervals (CI): 1.07-1.12)); White children were more likely screened than non-White children (OR 1.21 (95% CI: 1.18-1.23)), and children with Medicaid more likely screened than children with non-Medicaid insurance (OR 1.34 (95% CI: 1.32-1.37)). CONCLUSIONS: The percentage of obese children receiving screening for MAFLD was low. Female gender, White race, and Medicaid insurance were associated with increased screening rates. These findings highlight the need to increase adherence to MAFLD screening. Reporting screening as a health quality measure may reduce implementation gaps in MAFLD screening.
Subject(s)
Alanine Transaminase , Mass Screening , Pediatric Obesity , Adolescent , Child , Female , Humans , Male , Alanine Transaminase/blood , Body Mass Index , Fatty Liver/diagnosis , Mass Screening/statistics & numerical data , Medicaid , Missed Diagnosis/statistics & numerical data , Non-alcoholic Fatty Liver Disease/diagnosis , Non-alcoholic Fatty Liver Disease/epidemiology , Pediatric Obesity/diagnosis , Pediatric Obesity/epidemiology , Practice Guidelines as Topic , Sex Factors , United StatesABSTRACT
Using a sample of 18,201 observations of working age respondents drawn from the Medical Expenditure Panel Survey, 1996-2018, this research examined the labor supply effects for younger family members of living with older persons needing assistance with activities of daily living. We report the effects for three labor supply outcomes of younger family members: working hours, full-time work, and occupational flexibility of working hours. Our results indicate that living with an older family member needing assistance significantly reduced younger women's working hours and the probability of working full-time among younger women, but increased both of these labor outcomes among younger men. In addition, living with an older family member needing help led younger women to work in occupations with significantly larger average variances in working hours. This suggests that these women occupied positions that allowed greater flexibility of working hours. We found little effect on flexibility of working hours for younger men. We conclude that the need for assistance among older family members has important effects on the labor market outcomes of younger family members.
