Yearly Treatment Patterns for Patients with Recently Diagnosed Diabetic Macular Edema.

PURPOSE: To describe the treatment patterns and the predictors of different treatment standards in recently diagnosed diabetic macular edema (DME) patients in a nationally representative sample. DESIGN: A retrospective cohort study using administrative claims data from January 1, 2007, through March 31, 2015. Patients were grouped into yearly cohorts. PARTICIPANTS: A total of 96 316 patients were included. METHODS: Patients with a diagnosis of DME were identified using International Classification of Diseases, Ninth Edition, Clinical Modification, codes. Predictors of anti-vascular endothelial growth factor (VEGF) use and number of anti-VEGF injections per patient were assessed using generalized linear regression (logistic and negative binomial, respectively), and yearly trends in different treatments were analyzed with Mann-Kendall tests. MAIN OUTCOME MEASURES: Predictors of anti-VEGF treatment and of anti-VEGF injections per patient and the changes in relative use of DME therapies per cohort. RESULTS: Among those with any treatment, the odds of being prescribed anti-VEGF therapy increased by 700% from 2009 to 2014 and by 154% for those seen by a retina specialist. Those in the cohort of year 2014 received 3.5 times more injections than those in 2009, whereas those covered by Managed Medicare, Medicaid, and Medicare received 31%, 24%, and 11% less injections. Anti-VEGF were 11.6% of all DME treatments in 2009 increasing to 61.9% in 2014, while corticosteroids and focal laser procedures dropped from 6.1% to 3% and 75% to 24%, respectively. Procedures per patient (PPP) were much lower than those observed in clinical trials of anti-VEGF. Procedures per patient increased in the cases of aflibercept (from 1 in 2011 to 2.20 in 2014), bevacizumab (from 1.84 in 2009 to 3.40 in 2014), and ranibizumab (from 3.11 in 2009 to 4.48 in 2014), whereas applications of laser procedures and corticosteroids per patient remained roughly stable. CONCLUSIONS: Year of diagnosis and being seen by a retina specialist were important predictors of receiving anti-VEGF therapy, and after one received such therapy, the number of additional injections was smaller for those with government-provided insurance. Anti-VEGF therapy has become a mainstay in DME treatment, with PPP, although relatively low, also increasing.

Correlates of health information seeking between adults diagnosed with and without cancer.

PURPOSE: To examine predictors of information seeking behavior among individuals diagnosed with cancer versus those without. METHODS: Cross-sectional data from the Health Information National Trends Survey 4 Cycles 1-3 (October 2011 to November 2013) were analyzed for 10,774 survey respondents aged ≥18 years. Binary logistic regression was used to examine the effect of socio-demographic and behavioral factors on health information seeking. RESULTS: Cancer diagnosis did not predict health information seeking. However, respondents diagnosed with cancer were more likely to seek health information from a healthcare practitioner. Compared to males, females were more likely to seek health information irrespective of cancer diagnosis. Regardless of cancer diagnosis, those without a regular healthcare provider were less likely to seek health information. Likelihood of seeking health information declined across education strata, and significantly worsened among respondents without high school diplomas irrespective of cancer diagnosis. CONCLUSIONS: Respondents sought health information irrespective of cancer diagnosis. However, the source of health information sought differed by cancer diagnosis. Gender, education, and having a regular healthcare provider were predictors of health information seeking. Future health communication interventions targeting cancer patients and the general public should consider these findings for tailored interventions to achieve optimal results.

Foreign-born blacks no different from whites for odds of stroke.

BACKGROUND: Blacks have higher risk for stroke than whites. However, combining foreign-born and US-born blacks could mask important health differences. We examined the relationship between nativity and stroke risk in US adults. METHODS: Data were obtained from the National Health Interview Survey, 2006-2014. Study population (n=189, 409) included non-Hispanic whites and non-Hispanic blacks born in the Caribbean, and non-Hispanic blacks born in Africa. Logistic regression models were used to assess the association between stroke and race/nativity, adjusting for covariates such as insurance status, hypertension, age and duration of US residence. RESULTS: Foreign-born blacks had similar odds of stroke (95% CI 0.58 to 1.60 for non-Hispanic blacks from the Caribbean, and 95% CI 0.17 to 1.10 for blacks from Africa), while US-born blacks had increased odds of stroke (95% CI 1.22 to 1.46) compared with non-Hispanic whites. When compared with US-born blacks, both non-Hispanic blacks from the Caribbean and Africa showed reduced odds of stroke: 95% CI 0.50 to 0.94 and 95% CI 0.21 to 0.75, respectively. After adding a race/nativity × age interaction term to the model however, compared with non-Hispanic whites, blacks from Africa aged <65 years had lower odds of stroke (95% CI 0.13 to 0.72) while blacks from the Caribbean had similar odds of stroke at all ages. CONCLUSIONS: Homogenising 'Blacks' may mask important differences based on nativity. Public health prevention efforts should consider the heightened risk of stroke among younger US-born blacks and focus on primary prevention for immigrant blacks. Also, national surveys should incorporate more ethnicity-related variables.

Race is a Strong Predictor of Receipt of a Written Survivorship Care Plan: Results from the National Health Interview Survey.

The purpose of this study is to investigate the prevalence of receipt of written documentation of follow up care and of cancer treatments and to examine the predictors of receipt of such written documentation. Data from the 2010 National Health Interview Survey was used to identify individuals 18 years or older with a history of cancer. Binary and multinomial logistic regression were used to investigate patient-level variables associated with receipt of written documentation of cancer treatment, written advice about follow-up care, or both written documents. Patient-level variables included in the analysis were age, gender, region of residence, race/ethnicity, marital status, education level, insurance coverage, cancer type, employment status, and psychosocial support. Of the 1185 responses to the questions used to access receipt of a SCP, the prevalence of any receipt of a written documentation was 68%, where 30% obtained written advice only and 8% were provided a written treatment summary only; only 31% received both. Non-white race, cancer type, and psychosocial services were associated with increased odds of receiving written documentation. Patient-level characteristics are associated with receipt of care plan documentation. Further work needs to investigate the interaction of provider and patient-level characteristics. Understanding patient-level characteristics associated with receipt of written documentation may help uncover strategies for improved survivorship care plan implementation.