Exploring the impacts of neighborhood disadvantage on Medicare beneficiaries' early COVID-19 vaccine uptake.

A variety of factors influenced the American public's experiences with the COVID-19 pandemic and initial availability and uptake of COVID-19 vaccines. To examine variation in early COVID-19 vaccine uptake based on neighborhood disadvantage along with individual sociodemographic and health characteristics, we used Spring 2021 data from the Medicare Current Beneficiary Survey (MCBS), a nationally representative, longitudinal survey of the Medicare population conducted by the Centers for Medicare & Medicaid Services. Bivariate analyses showed that beneficiaries in disadvantaged neighborhoods were less likely to have received at least one vaccine dose than those in less disadvantaged neighborhoods (49.7%, SE = 1.6 versus 66.6%, SE = 1.0, p < 0.0001). After accounting for individual characteristics, the relationship between neighborhood disadvantage and vaccine uptake was not statistically significant. However, interaction effects of neighborhood disadvantage by urbanicity showed a more complex picture, where those in disadvantaged urban areas had the lowest odds of vaccine uptake (p < 0.01). The relationship between neighborhood disadvantage and vaccination is multifaceted, requiring further research to inform future vaccination efforts targeting the most vulnerable beneficiaries.

Outpatient prescribing of opioids to adults diagnosed with mental disorders in the United States.

BACKGROUND: Adults with mood and anxiety disorders have an increased likelihood of being prescribed opioids. The influence of other mental disorders, such as psychotic and attention disorders, on opioid prescribing patterns is less known. METHODS: We studied a population-representative sample of 166,927 outpatient visits for adults with painful conditions from the 2002-2016 National Ambulatory Medical Care Survey and the 2002-2011 National Hospital Ambulatory Medical Care Survey. Logistic regression analyses examined the likelihood of opioid prescription among visits with specific mental disorder diagnoses (anxiety, attention, mood, psychotic, post-traumatic stress disorder (PTSD), opioid use, and non-opioid substance use), adjusted for covariates and weighted for the complex survey design. Secondary analyses stratified results by whether opioids were newly initiated or continued. RESULTS: Opioids were prescribed at 16.8 % of visits. Mood, anxiety, and non-opioid substance use disorders were associated with higher likelihoods of opioid prescriptions, particularly for continued rather than first-time prescriptions. Psychotic disorders were strongly negatively associated with opioid prescriptions (adjusted odds ratio 0.44, 95 % CI 0.22-0.86). Diagnoses of PTSD and attention disorders were not associated with opioid prescribing. CONCLUSIONS: Outpatient physicians are more likely to prescribe and refill opioids for adults with pain who present with mood, anxiety, and non-opioid substance use disorders, but not for those who present with PTSD or attention disorders. Patients with psychotic disorders and pain are markedly less likely to be prescribed opioids.