Reduced Access to Preventive Care Due to the COVID-19 Pandemic, by Chronic Disease Status and Race and Hispanic Origin, United States, 2020-2021

OBJECTIVES

The COVID-19 pandemic has disproportionately affected racial and ethnic minority populations in the United States. The National Center for Health Statistics adapted the Research and Development Survey (RANDS), a commercial panel survey, to track selected health outcomes during the pandemic using the series RANDS during COVID-19 (RC-19). We examined access to preventive care among adults by chronic condition status, race, and Hispanic origin.

METHODS

NORC at the University of Chicago conducted RC-19 among US adults in 3 rounds (June-July 2020 [round 1, N = 6800], August 2020 [round 2, N = 5981], and May-June 2021 [round 3, N = 5458]) via online survey and telephone. We evaluated reduced access to ≥1 type of preventive care due to the pandemic in the past 2 months for each round by using logistic regression analysis stratified by chronic condition status and race and Hispanic origin, adjusting for sociodemographic and health variables.

RESULTS

Overall, 35.8% of US adults reported missing ≥1 type of preventive care in the previous 2 months in round 1, 26.0% in round 2, and 11.2% in round 3. Reduced access to preventive care was significantly higher among adults with ≥1 chronic condition (vs no chronic conditions) in rounds 1 and 2 (adjusted odds ratios [aOR)] = 1.5 and 1.4, respectively). Compared with non-Hispanic White adults, non-Hispanic Black adults reported significantly lower reduced access to preventive care in round 1 (aOR = 0.7), and non-Hispanic Other adults reported significantly higher reduced access to preventive care in round 2 (aOR = 1.5).

CONCLUSIONS

Our findings may inform policies and programs for people at risk of reduced access to preventive care.

Social Determinants of Health and Race Disparities in Kidney Transplant

BACKGROUND AND OBJECTIVES

Black patients have a higher incidence of kidney failure but lower rate of deceased- and living-donor kidney transplantation compared with White patients, even after taking differences in comorbidities into account. We assessed whether social determinants of health (e.g., demographics, cultural, psychosocial, knowledge factors) could account for race differences in receiving deceased- and living-donor kidney transplantation.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Via medical record review, we prospectively followed 1056 patients referred for kidney transplant (2010-2012), who completed an interview soon after kidney transplant evaluation, until their kidney transplant. We used multivariable competing risk models to estimate the cumulative incidence of receipt of any kidney transplant, deceased-donor transplant, or living-donor transplant, and the factors associated with each outcome.

RESULTS

Even after accounting for social determinants of health, Black patients had a lower likelihood of kidney transplant (subdistribution hazard ratio, 0.74; 95% confidence interval, 0.55 to 0.99) and living-donor transplant (subdistribution hazard ratio, 0.49; 95% confidence interval, 0.26 to 0.95), but not deceased-donor transplant (subdistribution hazard ratio, 0.92; 95% confidence interval, 0.67 to 1.26). Black race, older age, lower income, public insurance, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, less transplant knowledge, and fewer learning activities were each associated with a lower probability of any kidney transplant. Older age, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, and fewer learning activities were each associated with a lower probability of deceased-donor transplant. Black race, older age, lower income, public insurance, higher body mass index, dialysis before kidney transplant, not presenting with a potential living donor, religious objection to living-donor transplant, and less transplant knowledge were each associated with a lower probability of living-donor transplant.

CONCLUSIONS

Race and social determinants of health are associated with the likelihood of undergoing kidney transplant.

Effect of Dual Use of Veterans Affairs and Medicare Part D Drug Benefits on Antihypertensive Medication Supply in a National Cohort of Veterans with Dementia

OBJECTIVE

To evaluate the effect of dual use of VA/Medicare Part D drug benefits on antihypertensive medication supply in older Veterans with dementia.

DATA SOURCES/STUDY SETTING

National, linked 2007-2010 Veterans Affairs (VA) and Medicare utilization and prescription records for 50,763 dementia patients with hypertension.

STUDY DESIGN

We used inverse probability of treatment (IPT)-weighted multinomial logistic regression to examine the association of dual prescription use with undersupply and oversupply of antihypertensives.

DATA COLLECTION/EXTRACTION METHODS

Veterans Affairs and Part D prescription records were used to classify patients as VA-only, Part D-only, or dual VA/Part D users of antihypertensives and summarize their antihypertensive medication supply in 2010: (1) appropriate supply of all prescribed antihypertensive classes, (2) undersupply of ≥1 class with no oversupply of another class, (3) oversupply of ≥1 class with no undersupply, or (4) both undersupply and oversupply.

PRINCIPAL FINDINGS

Dual prescription users were more likely than VA-only users to have undersupply only (aOR = 1.28; 95 percent CI = 1.18-1.39), oversupply only (aOR = 2.38; 95 percent CI = 2.15-2.64), and concurrent under- and oversupply (aOR = 2.89; 95 percent CI = 2.53-3.29), versus appropriate supply of all classes.

CONCLUSIONS

Obtaining antihypertensives through both VA and Part D was associated with increased antihypertensive under- and oversupply. Efforts to understand how best to coordinate dual-system prescription use are critically needed.

Characteristics of dual drug benefit use among veterans with dementia enrolled in the Veterans Health Administration and Medicare Part D

BACKGROUND

Obtaining prescription medications from multiple health systems may complicate coordination of care. Older Veterans who obtain medications concurrently through Veterans Affairs (VA) benefits and Medicare Part D benefits (dual users) are at higher risk of unintended negative outcomes.

OBJECTIVE

To explore characteristics predicting dual drug benefit use from both VA and Medicare Part D in a national sample of older Veterans with dementia.

METHODS

Administrative data were obtained from the VA and Medicare for a national sample of 110,828 Veterans with dementia ages 68 and older in 2010. Veterans were classified into three drug benefit user groups based on the source of all prescription medications they obtained in 2010: VA-only, Part D-only, and Dual Use. Multinomial logistic regression was used to examine predictors of drug benefit user group. The source of prescriptions was described for each of the ten most frequently used drug classes and opioids.

RESULTS

Fifty-six percent of Veterans received all of their prescription medications from VA-only, 28% from Part D-only, and 16% from both VA and Part D. Veterans who were eligible for Medicaid or who had a priority group score conferring less generous drug benefits within the VA were more likely to be Part D-only or dual users. Nearly one fourth of Veterans taking opioids concurrently received opioid prescriptions from dual sources (24.7%).

CONCLUSIONS

Medicaid eligibility and Veteran priority group status, which largely decrease copayments for drugs obtained outside versus within the VA, respectively, were the main factors predicting drug user benefit group. Policies to encourage single-system prescribing and enhance communication across health systems are crucial to preventing negative health outcomes related to care fragmentation.

Dual Health Care System Use and High-Risk Prescribing in Patients With Dementia: A National Cohort Study

BACKGROUND

Recent federal policy changes attempt to expand veterans' access to providers outside the Department of Veterans Affairs (VA). Receipt of prescription medications across unconnected systems of care may increase the risk for unsafe prescribing, particularly in persons with dementia.

OBJECTIVE

To investigate the association between dual health care system use and potentially unsafe medication (PUM) prescribing.

DESIGN

Retrospective cohort study.

SETTING

National VA outpatient care facilities in 2010.

PARTICIPANTS

75 829 veterans with dementia who were continuously enrolled in Medicare from 2007 to 2010; 80% were VA-only users, and 20% were VA-Medicare Part D (dual) users.

MEASUREMENTS

Augmented inverse propensity weighting was used to estimate the effect of dual-system versus VA-only prescribing on 4 indicators of PUM prescribing in 2010: any exposure to Healthcare Effectiveness Data and Information Set (HEDIS) high-risk medication in older adults (PUM-HEDIS), any daily exposure to prescriptions with a cumulative Anticholinergic Cognitive Burden (ACB) score of 3 or higher (PUM-ACB), any antipsychotic prescription (PUM-antipsychotic), and any PUM exposure (any-PUM). The annual number of days of each PUM exposure was also examined.

RESULTS

Compared with VA-only users, dual users had more than double the odds of exposure to any-PUM (odds ratio [OR], 2.2 [95% CI, 2.2 to 2.3]), PUM-HEDIS (OR, 2.4 [CI, 2.2 to 2.8]), and PUM-ACB (OR, 2.1 [CI, 2.0 to 2.2]). The odds of PUM-antipsychotic exposure were also greater in dual users (OR, 1.5 [CI, 1.4 to 1.6]). Dual users had an adjusted average of 44.1 additional days of any-PUM exposure (CI, 37.2 to 45.0 days).

LIMITATION

Observational study design of veteran outpatients only.

CONCLUSION

Among veterans with dementia, rates of PUM prescribing are significantly higher among dual-system users than with VA-only users.

PRIMARY FUNDING SOURCE

U.S. Department of Veterans Affairs.

Summary health statistics for U.S. adults: National Health Interview Survey, 2009

OBJECTIVES

This report presents health statistics from the 2009 National Health Interview Survey (NHIS) for the civilian noninstitutionalized adult population, classified by sex, age, race and ethnicity, education, family income, poverty status, health insurance coverage, marital status, and place and region of residence. Estimates are presented for selected chronic conditions and mental health characteristics, functional limitations, health status, health behaviors, health care access and utilization, and human immunodeficiency virus testing. Percentages and percent distributions are presented in both age-adjusted and unadjusted versions.

DATA SOURCE

NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2009, data were collected on 27,731 adults in the Sample Adult questionnaire. The conditional response rate was 80.1%, and the final response rate was 65.4%. The health information for adults in this report was obtained from one randomly selected adult per family. In very rare instances where the sample adult was not able to respond for himself or herself, a proxy was used.

HIGHLIGHTS

In 2009, 61% of adults aged 18 years and over reported excellent or very good health. Fifty-five percent of adults had never participated in any type of vigorous leisure-time physical activity, and 17% of adults did not have a usual place of health care. Twelve percent of adults had been told by a doctor or health professional that they had heart disease, and 24% had been told on two or more visits that they had hypertension. Twenty-one percent of all adults were current smokers, and 21% were former smokers. Based on estimates of body mass index, 35% of adults were overweight, and 27% were obese.

Summary health statistics for U.S. adults: National Health Interview Survey, 2008

OBJECTIVES

This report presents health statistics from the 2008 National Health Interview Survey (NHIS) for the civilian noninstitutionalized adult population, classified by sex, age, race and ethnicity, education, family income, poverty status, health insurance coverage, marital status, and place and region of residence. Estimates are presented for selected chronic conditions and mental health characteristics, functional limitations, health status, health behaviors, health care access and utilization, and human immunodeficiency virus testing. Percentages and percent distributions are presented in both age-adjusted and unadjusted versions.

SOURCE OF DATA

NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2008, data were collected on 21,781 adults in the Sample Adult questionnaire. The conditional response rate was 74.2%, and the final response rate was 62.6%. The health information for adults in this report was obtained from one randomly selected adult per family. In very rare instances where the sample adult was not able to respond for himself or herself, a proxy was used.

HIGHLIGHTS

In 2008, 61% of adults 18 years of age or over reported excellent or very good health. Fifty-nine percent of adults had never participated in any type of vigorous leisure-time physical activity, and 16% of adults did not have a usual place of health care. Twelve percent of adults had been told by a doctor or health professional that they had heart disease, and 24% had been told on two or more visits that they had hypertension. Twenty-one percent of all adults were current smokers, and 21% were former smokers. Based on estimates of body mass index, 35% of adults were overweight and 27% were obese.

Summary health statistics for U.S. adults: National Health Interview Survey, 2007

OBJECTIVES

This report presents health statistics from the 2007 National Health Interview Survey (NHIS) for the civilian noninstitutionalized adult population, classified by sex, age, race and ethnicity, education, family income, poverty status, health insurance coverage, marital status, and place and region of residence. Estimates are presented for selected chronic conditions and mental health characteristics, functional limitations, health status, health behaviors, health care access and utilization, and human immunodeficiency virus testing. Percentages and percent distributions are presented in both age adjusted and unadjusted versions.

SOURCE OF DATA

NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2007, data were collected on 23,393 adults in the Sample Adult questionnaire. The conditional response rate was 78.3%, and the final response rate was 67.8%. The health information for adults in this report was obtained from one randomly selected adult per family. In very rare instances where the sample adult was not able to respond for him- or herself, a proxy was used.

HIGHLIGHTS

In 2007, 61% of adults 18 years of age or over reported excellent or very good health. Sixty-one percent of adults never participated in any type of vigorous leisure-time physical activity, and 15% of adults did not have a usual place of health care. Eleven percent of adults had been told by a doctor or health professional that they had heart disease, and 23% had been told on two or more visits that they had hypertension. Twenty percent of all adults were current smokers and 21% were former smokers. Based on estimates of body mass index, 35% of adults were overweight and 26% were obese.

A comparison of respiratory conditions between multiple race adults and their single race counterparts: an analysis based on American Indian/Alaska Native and white adults

CONTEXT

Multiple race data collection/reporting are relatively new among United States federal statistical systems. Not surprisingly, very little is known about the multiple race population in the USA. It is well known that some race and ethnic groups experience some respiratory diseases (e.g., asthma) disproportionately. However, not much is known about the experience of multiple race adults. If differences exist in how single/multiple race adults experience respiratory conditions, this information could be useful in public health education.

OBJECTIVE

To explore differences in respiratory conditions between single race white adults, single race American Indian/Alaska Native (AIAN) adults, and adults who are both white and AIAN (largest multiple race group of adults in the USA).

METHODS

Data from the National Health Interview Survey (NHIS), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, were analyzed. Hispanic and black populations are oversampled. Multiple logistic regressions were performed to predict if the occurrence of each respiratory condition analyzed differed by single/multiple race reporting.

SAMPLE

A nationally representative sample of 127,596 civilian non-institutionalized adults (> or = 18 years of age) from the 2000--2003 NHIS.

OUTCOME MEASURE

Adults told by a doctor or other health professional that they had asthma, hay fever, sinusitis, and/or chronic obstructive pulmonary disease.

RESULTS

Adults who are both AIAN and white generally had higher rates of respiratory conditions than did their single race counterparts. These differences persisted even after controlling for socio-demographic and health care access measures.

CONCLUSIONS

This paper presents some of the first research of how the health of some multiple race adults differs from their single race counterparts. Contrary to some previous expectations for these estimates, respiratory condition estimates for adults who are both AIAN and white do not appear to be located between those of the component single race groups.

Summary health statistics for U.S. adults: National Health Interview Survey, 2006

OBJECTIVES

This report presents health statistics from the 2006 National Health Interview Survey for the civilian noninstitutionalized adult population, classified by sex, age, race and ethnicity, education, family income, poverty status, health insurance coverage, marital status, and place and region of residence. Estimates are presented for selected chronic conditions and mental health characteristics, functional limitations, health status, health behaviors, health care access and utilization, and human immunodeficiency virus testing. Percentages and percent distributions are presented in both age-adjusted and unadjusted versions.

SOURCE OF DATA

NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2006, data were collected for 24,275 adults for the Sample Adult questionnaire. The conditional response rate was 81.4%, and the final response rate was 70.8%. The health information for adults in this report was obtained from one randomly selected adult per family. In very rare instances where the sample adult was not able to respond for him or herself, a proxy was allowed.

HIGHLIGHTS

In 2006, 61% of adults 18 years of age or over reported excellent or very good health. Sixty-two percent of adults never participated in any type of vigorous leisure-time physical activity, and 16% of adults did not have a usual place of health care. Eleven percent of adults had been told by a doctor or health professional that they had heart disease, and 23% had been told on two or more visits that they had hypertension. Twenty-one percent of all adults were current smokers and 21% were former smokers. Based on estimates of body mass index, 35% of adults were overweight and 26% were obese.

Summary health statistics for U.S. adults: National Health Interview Survey, 2005

OBJECTIVE

This report presents health statistics from the 2005 National Health Interview Survey (NHIS) for the civilian noninstitutionalized adult population, classified by sex, age, race/ethnicity, education, family income, poverty status, health insurance coverage, marital status, and place and region of residence. Estimates are presented for selected chronic conditions and mental health characteristics, functional limitations, health status, health behaviors, health care access and utilization, and human immunodeficiency virus testing. Percentages and percent distributions are presented in both age-adjusted and unadjusted versions.

SOURCE OF DATA

NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2005, data were collected for 31,428 adults for the Sample Adult questionnaire. The conditional response rate was 80.1%, and the final response rate was 69.0%. The health information for adults in this report was obtained from one randomly selected adult per family. In very rare instances where the sample adult was not able to respond for him- or herself, a proxy was allowed.

HIGHLIGHTS

In 2005, 62% of adults 18 years and over reported excellent or very good health. Sixty-two percent of adults never participated in any type of vigorous leisure-time physical activity, and 15% of adults did not have a usual place of health care. Twelve percent of adults had been told by a doctor or health professional that they had heart disease, and 22% had been told on two or more visits that they had hypertension. Twenty-one percent of all adults were current smokers, and 21% were former smokers. Based on estimates of body mass index, 35% of adults were overweight and 25% were obese.

Summary health statistics for U.S. adults: National Health Interview Survey, 2000

OBJECTIVES

This report presents health statistics from the 2000 National Health Interview Survey for the civilian noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, poverty status, and region of residence for chronic condition prevalence, health status and limitations in activity, health care access and utilization, health behaviors, and human immunodeficiency virus (HIV) testing. Also, health statistics by education, income, health insurance coverage, marital status, and place of residence are presented for health status and limitations in activity, health care access and utilization, health behaviors, and knowledge and attitudes toward HIV.

SOURCE OF DATA

The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized U.S. population. Sociodemographic data are collected for everyone in the family during face-to-face interviews with adults present at the time of the interview. The health information for adults in this report was obtained from one randomly selected adult per family.

HIGHLIGHTS

In 2000, 64% of adults 18 years of age and over reported excellent or very good health. Eighteen percent of adults under 65 years of age had no health insurance coverage, and 14% of adults did not have a usual place of health care. Eleven percent of adults had ever been told by a doctor or health professional that they had heart disease, and 20% had been told on two or more visits that they had hypertension. Nearly a quarter of adults were current smokers, and 22% were former smokers. Sixty percent did not engage in any leisure-time vigorous physical activity, and, based on estimates of body mass index, 35% were overweight and 21% were obese.

Summary health statistics for U.S. adults: National Health Interview Survey, 1999

OBJECTIVES

This report presents health statistics from the 1999 National Health Interview Survey (NHIS) for the civilian, noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, poverty status, and region of residence for chronic condition prevalence, health status and limitations in activity, health care access and utilization, health behaviors, and attitudes toward Acquired Immune Deficiency Syndrome (AIDS). Also, health statistics by education, income, health insurance coverage, marital status, and place of residence are presented for health status and limitations in activity, health care access and utilization, health behaviors, and knowledge and attitudes toward AIDS.

SOURCE OF DATA

The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized U.S. population. Data are collected during face-to-face interviews with adults present at the time of the interview. The self-reported health information for adults in this report was obtained from one randomly-selected adult per family.

HIGHLIGHTS

In 1999, 65% of adults 18 years of age or over reported excellent or very good health. However, 17% of adults less than 65 years of age had no health insurance coverage, and 16% of adults did not have a usual place of medical care. Eleven percent of adults had ever been told by a doctor or health professional that they had heart disease and 19% had been told on two or more visits that they had hypertension. Nearly a quarter of adults were current smokers, while 23% were former smokers. Sixty-one percent did not engage in any leisure-time vigorous physical activity, and, based on estimates of body mass index, 35% were overweight and 21% were obese.

Summary health statistics for U.S. adults: National Health Interview Survey, 1998

OBJECTIVES

This report presents health statistics from the 1998 National Health Interview Survey for the civilian noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, poverty status, and region of residence for chronic condition prevalence, health status and limitations in activity, health care access and utilization, health behaviors, and attitudes toward acquired immunodeficiency syndrome (AIDS). Health statistics by education, income, health insurance coverage, marital status, and place of residence are also presented for health status and limitations in activity, health care access and utilization, health behaviors, and knowledge and attitudes toward AIDS.

SOURCE OF DATA

The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized U.S. population. Data are collected during face-to-face interviews with adults present at the time of the interview. Also, the self-reported health information for adults in this report was obtained from one randomly selected adult per family.

HIGHLIGHTS

In 1998, 65% of adults 18 years of age and over reported excellent or very good health. However, 17% of adults less than 65 years of age had no health insurance coverage, and 14% of adults did not have a usual place of medical care. Twelve percent of adults had ever been told by a doctor or health professional that they had heart disease and 19% had been told on two or more visits that they had hypertension. Nearly a quarter of adults were current smokers, and 23% were former smokers. Sixty percent did not engage in any leisure-time vigorous physical activity, and based on estimates of body mass index, 35% were overweight and 20% were obese.

Using the National Health Interview Survey: time trends in influenza vaccinations among targeted adults

Context. Influenza and its complications result in significant morbidity and mortality each year. Certain groups are at increased risk for influenza and influenza-related complications. They, and others who are in close contact with them, are target groups to receive a yearly influenza immunization according to recommendations from the Advisory Committee on Immunization Practices (ACIP). Objective. To estimate the proportions of adults in selected target groups who received influenza vaccination in 1995 and 1998 and to identify characteristics associated with vaccination receipt. Data Source. The National Health Interview Survey (NHIS), a nationally representative survey of civilian noninstitutionalized persons conducted annually by the Centers for Disease Control's National Center for Health Statistics. We used data for adults (> 18 years of age) from the 1995 and 1998 NHIS. Outcome Measure. Proportions of persons in target groups self-reporting influenza vaccination in the 12 months before the NHIS interview. Results. Between 1995 and 1998, influenza vaccination increased for persons aged 65 and older (58.2% to 63.3%; P<0.05) and for adults under 65 belonging to selected ACIP target groups (27.5% to 30.1%; P<0.05). Examination of 1998 data shows that regardless of age, the likelihood of influenza vaccination is strongly influenced by having health coverage or a regular source of care. For example, 66% of the elderly with private fee- for-service health care coverage were vaccinated, compared with 23% of the elderly with no insurance (adjusted odds ratio [OR], 3.9; 95% CI, 1.6 to 9.3). For persons aged 18 to 64 years belonging to an ACIP target group, the corresponding figures are 32% vs. 16% (adjusted OR, 1.8; CI, 1.4 to 2.3). The likelihood of vaccination also varied by race and ethnicity: For age 65 and older, 66% of non-Hispanic whites were vaccinated compared with 46% of non-Hispanic blacks (adjusted OR, 2; CI, 1.6 to 2.4). Conclusions. The use of influenza vaccination among adults at high risk for influenza and influenza-related complications increased between 1995 and 1998. Younger individuals at high risk, people without insurance or a regular source of care, and nonwhites still have low vaccination rates.