Search Results (298)

Background: Medicaid-insured patients experience higher rates of late-stage cancer diagnosis and worse survival than non-Medicaid patients. The impact of Medicaid enrollment timing on cancer outcomes is less clear. This study examines the association between Medicaid enrollment and timing with tumor stage and cancer-specific survival for breast, colorectal, and lung cancers. Methods: We analyzed SEER-Medicaid linked data for 276,755 breast, 104,784 colorectal, and 101,058 lung cancer patients < 65 years of age. Patients were categorized as non-Medicaid enrollees, pre-diagnosis enrollees (≥12 months before), or post-diagnosis enrollees (≤12 months after). Multivariable logistic regression estimated odds ratios of late-stage diagnosis, and cause-specific Cox proportional hazards models were used to assess cancer-specific survival, adjusting for demographic and socioeconomic factors. Results: Compared to non-Medicaid enrollees, post-diagnosis enrollees had the highest odds of late-stage diagnosis (breast cancer: OR: 3.41; colorectal cancer: OR: 3.78; lung cancer: OR: 1.87). Pre-diagnosis enrollees also had increased odds, but the association was weaker than post-diagnosis enrollees. Cancer-specific mortality was higher for both pre- and post-diagnosis enrollees compared to non-Medicaid enrollees for each cancer examined across tumor stage at diagnosis. Among Medicaid enrollees, those enrolled post-diagnosis had higher cancer-specific mortality than those enrolled pre-diagnosis for localized-stage colorectal (HR: 1.82) and lung cancer (HR: 1.30). In contrast, those enrolled post-diagnosis had lower mortality than those enrolled pre diagnosis for distant-stage breast cancer (HR: 0.91). Conclusions: Compared with cancer patients not insured by Medicaid, post-diagnosis Medicaid enrollment was associated with a greater likelihood of late-stage cancer and worse cancer-specific survival across each cancer type examined. Future research is warranted to examine the role of Medicaid enrollment timing in cancer care to better understand its impact on cancer outcomes. Full article

Background/Objectives: Children with Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) frequently rely on pharmacological treatment to manage core symptoms. This study examined how Medicaid expansion and the COVID-19 pandemic influenced medication use among children with ASD or ADHD, including those with comorbid diagnoses. Methods: We analyzed 2016–2023 data from the National Survey of Children’s Health (NSCH) for children aged 3–17 years with caregiver-reported diagnoses. Logistic regression models assessed the association between Medicaid expansion, the pandemic period, and current medication use, including an interaction between expansion and pandemic period. Analyses were conducted for the full sample (N = 35,198) and a subgroup with comorbid ASD and ADHD (N = 4298). Results: Current Medicaid expansion was associated with significantly lower odds of medication use in the full sample (aOR = 0.68, p < 0.001) but not the comorbid group (aOR = 0.98, p = 0.9). Medication use showed no significant change during the COVID-19 period in either the full sample (aOR = 0.99; p > 0.90) or the comorbid subgroup (aOR = 1.22; p = 0.4). A significant interaction indicating increased odds of medication use during the pandemic in expansion states was observed only in the full sample, although a similar but non-significant pattern appeared in the comorbid group. Age, race, and insurance-related differences were significant across groups, with coverage consistency playing a larger role in the full sample. Sensitivity analyses, excluding the 2020 survey year and modeling pre/post pandemic periods, supported the robustness of findings. Conclusions: Medicaid expansion was associated with patterns consistent with buffering pandemic-related disruptions in medication use among children with ASD or ADHD overall, but those with co-occurring conditions remain especially vulnerable. Full article

Background: Population genetic screening (PGS) serves an essential role in identifying individuals at higher risk for hereditary cancer and cardiovascular disease. Nevertheless, the current lack of insurance coverage for screening costs might pose a barrier to its adoption. Health systems might contemplate covering these test expenses, but individuals covered by Medicaid and Medicare may not qualify for cost-free screening due to constraints related to the Beneficiary Inducement Statute. Methods: A cross-sectional online survey was administered to 602 US adults in January 2023. Andersen’s model guided variable selection. An ordered probit model was deployed to explore the association between insurance type and willingness to pay (WTP) for PGS, controlling for demographic and healthcare characteristics. Results: Among the 602 respondents, 524 (87%) were included in our analysis. Over 70% (n = 373) of participants expressed WTP for genetic testing. A similar proportion of respondents with Medicare and Medicaid expressed WTP for screening (68%, and 70%, respectively). Insurance type was not significantly associated with WTP for genetic testing. Notably, lower trust levels and absence of family cancer history were associated with a lower probability of expressing high WTP compared to the reference categories (high levels of trust and having a family cancer history). Conclusions: WTP for genetic testing was not significantly associated with insurance type. Almost 30% of our sample were unwilling to pay for PGS, suggesting variability in WTP for PGS and adding to the limited literature on how individuals value genomic screening tests. Full article

Background/Objectives: Breast cancer (BC) represents a major public health problem that is influenced by social and systemic factors. This study evaluates disparities in the BC care continuum based on health insurance type and determines whether these patterns differ according to neighborhood-level deprivation. Methods: Using the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database, we conducted a retrospective cohort study of women aged ≥18 years and diagnosed with BC in Puerto Rico between 2012 and 2016. The main outcomes were diagnostic delay (>60 days) and six-year mortality. Insurance type (private, Medicare, Medicaid, and dual enrollment in Medicare and Medicaid) was the main predictor, with neighborhood deprivation as a modifier. Logistic and Cox models assessed delay and survival, adjusting for key covariates. Results: Disparities in diagnostic delays and risk of death across insurance types were most evident in areas with low to average deprivation, whereas, in neighborhoods with above-average to highest deprivation, these differences diminished for diagnostic delay and disappeared for risk of death. Conclusions: These findings reveal that neighborhood environment, an intermediary social determinant of health, may affect the timeliness and quality of care provided to women diagnosed with BC. Full article

Background: Diabetic foot infections (DFIs) are a major cause of hospitalization, limb loss, and mortality among patients with diabetic foot ulcers (DFUs). This study evaluated the risk of developing DFIs among patients with newly diagnosed DFUs across insurance categories. Methods: Adults ≥18 years with a new DFU diagnosis were identified in the PearlDiver insurance claims database (2010–2020) using validated ICD-9/10 codes. Insurance status at the index DFU was categorized as Medicaid, Medicare, commercial, or self-pay. Propensity score matching (1:3) based on age, sex, Charlson Comorbidity Index, and major comorbidities was used to compare Medicaid vs. non-Medicaid patients. Results: Among 258,122 patients with new DFUs, 20,638 (8.0%) were Medicaid beneficiaries. Medicaid patients were younger (50.1 ± 10.2 vs. 60.6 ± 12.1 years, p < 0.001) but had similar comorbidity burden compared with commercially insured and Medicare patients. In matched analysis post-matching, Medicaid insurance was independently associated with higher odds of DFI-related hospitalization within 12 months (aOR 1.18, 95% CI 1.14–1.24) and major amputation at 3 years (aOR 1.72, 95% CI 1.39–2.13). Higher CCI, chronic kidney disease, congestive heart failure, COPD, and peripheral vascular disease also predicted adverse outcomes. Conclusions: Medicaid insurance was independently associated with increased risks of DFI and major amputation among patients with newly diagnosed DFUs. These findings highlight infection as a potentially modifiable pathway driving limb loss and emphasize the need to improve early ulcer evaluation and infection management for Medicaid beneficiaries. Full article

Background/Objectives: The rates of adverse maternal and neonatal outcomes—including preterm birth < 37 weeks’ gestation (PTB), hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), small for gestational age (SGA), and large for gestational age (LGA)—remain elevated in the United States. Preventive strategies beyond the current standard of care (SOC) may be needed, particularly in diverse and socioeconomically vulnerable populations. The study evaluated a targeted diet and lifestyle intervention incorporating selected nutrient and gene variant analysis with personalized trimester-based counseling and supplementation (Standard of Care Plus, PLUS). Methods: The prospective observational study compared outcomes among participants receiving PLUS in addition to SOC with regional SOC data. A Nevada PLUS cohort (n = 15), consisting of high-risk participants with 100% Medicaid coverage, received the intervention virtually. An Oregon PLUS cohort (n = 387), consisting of moderate-risk participants with approximately 50% Medicaid coverage, received PLUS through in-person group sessions. Outcomes were compared with regional SOC rates and between PLUS cohorts. Cochran–Mantel–Haenszel (CMH) analyses were performed to account for site-level differences in pooled analyses. Primary outcome was PTB < 37 weeks’ gestation; secondary outcomes included HDP, GDM, SGA, and LGA. Results: The Nevada PLUS application was associated with lower adverse outcome rates compared with regional SOC; however, statistical significance was not observed, likely reflecting limited sample size. The Oregon PLUS cohort experienced statistically significant association with reductions across all five outcomes (all p < 0.001) compared to regional SOC. No statistically significant differences were observed between the Nevada (virtual) and Oregon (in-person) PLUS cohorts. In pooled analyses (n = 402), significant reductions compared with SOC were observed for PTB (RR = 0.23), HDP (RR = 0.11), GDM (RR = 0.06), SGA (RR = 0.25), and LGA (RR = 0.35) (all p < 0.001). Conclusions: The implementation of selected nutrient and gene variant analysis combined with targeted nutritional and lifestyle interventions, delivered in collaboration with standard obstetric care, was associated with reduced adverse maternal and neonatal outcomes. Interpretation of virtual delivery remains limited by small sample size. Full article

Hospitals are energy- and waste-intensive systems. Inpatient buildings dominate the sector’s electricity and gas consumption, and healthcare waste streams—especially device-associated disposables—increase environmental burdens. AI-enabled predictive maintenance (PdM) offers a dual lever: (1) reducing energy use by keeping assets operating at efficient points, and (2) preventing avoidable waste by extending component life, reducing emergency spares, and avoiding device-induced clinical workflow disruptions. In this study, an end-to-end architecture is developed by integrating multi-modal sensing (electrical, thermal, acoustic, vibration), computerized maintenance management systems (CMMS), risk-based maintenance under International Electrotechnical Commission (IEC)/International Organization for Standardization standards (ISO 60601, 62353/62304, 81001-5-1), and learning pipelines (self-supervised anomaly detection, remaining useful life estimators, and carbon-aware work order scheduling). Using representative hospital archetypes and equipment classes (imaging, patient monitoring, laboratory analyzers, sterilizers, and pumps), energy, downtime, and waste avoidance are simulated under baseline preventive maintenance (PM) versus PdM with alternate equipment management. Results showed that 10–22% site electricity reduction was achieved, attributable to equipment efficiency and optimized duty-cycling, 18–35% fewer unplanned failures, and a 12–28% reduction in associated consumable waste and emergency part scrappage across scenarios, while maintaining compliance with Joint Commission/Centers for Medicare & Medicaid Services and IEC safety testing intervals. We discuss cybersecurity (IEC 81001-5-1) and the trustworthiness of AI, present a governance model linking CMMS events to carbon telemetry, and provide an implementation roadmap. Full article

Latino families in the United States experience persistent maternal and child health (MCH) inequities driven by a fragmented immigration and public benefits policy environment rather than inherent health differences. Although most Latino children are U.S.-born citizens, many live in mixed-status families in which immigration status determines eligibility for health care, nutrition assistance, and other essential services. This narrative policy review examines U.S. immigration and public benefit policies from 1965 to 2025 to assess how eligibility rules, enforcement practices, and policy instability shape access to maternal and child health services among Latino populations. Drawing on public health, legal, and social science literature, the review documents substantial variation in access to Medicaid, CHIP, nutrition programs, and emergency care by immigration status and state policy. Findings indicate that restrictive eligibility criteria, expansions and contractions of the public charge rule, and immigration enforcement practices have produced chilling effects that deter eligible families from accessing care, reduce prenatal and postpartum service utilization, and contribute to adverse birth outcomes and intergenerational health inequities. The review concludes that immigration policy functions as a structural determinant of MCH and identifies two key policy priorities: 1. maintaining the 2022 Final Public Charge Rule that excludes public safety-net programs, and 2. waiving the five-year Medicaid waiting period for all pregnant immigrants regardless of documentation status to ensure equitable access to essential maternal and child health care. Full article

Coverage expansions and affordability reforms often presume that improved access to care yields better population health. We examine this premise in a capacity-constrained healthcare system, where congestion and throughput determine whether potential access translates into realized care. Using U.S. state-year panel data from 2006 to 2023, we study (i) how healthcare workforce density relates to multiple access margins and (ii) whether the mortality effects of access improvements depend on local delivery capacity. Reduced-form estimates show that higher workforce density is associated with higher insurance coverage and fewer cost-related barriers to care, while associations with having a usual source of care are weaker. With full controls these relationships attenuate, and Medicaid expansion and poverty explain much of the remaining variation. Instrumental variable models suggest that policy-driven improvements in effective access are associated with lower mortality, although the first-stage strength varies across specifications. Interaction-IV estimates indicate capacity dependence: for all-cause and external-cause mortality, implied benefits are larger in lower-capacity settings and diminish as workforce density increases; for endocrine mortality, benefits are concentrated in higher-capacity settings, while respiratory effects are not detectable. Overall, the results support a systems perspective in which the health returns to access expansions depend on local delivery capacity, underscoring the importance of aligning access reforms with constraints in healthcare production and flow. Full article

Screening for spinal muscular atrophy (SMA) was adopted by all US state newborn screening programs between 2018 and 2024; by the end of 2022, 48 states were screening for SMA. We assessed trends in health insurance records of SMA diagnoses to quantify improvements in the timeliness of SMA identification following the adoption of screening. We used nationally representative Medicaid claims data for approximately half of US births covered by public insurance and a convenience sample of employer-sponsored health plans. We analyzed records for birth cohorts with at least 1 full year of follow-up (i.e., through the end of the following calendar year). For 2017 births, 1.3 per 100,000 infants had SMA codes first recorded by 1 month of age; this increased to 6.6 per 100,000 among publicly insured newborns born in 2022. The rollout of SMA newborn screening across US states was also followed by improvements in the timely detection of SMA. The proportion of infants with SMA detected by 1 month increased from 18% in 2017 to 61% in 2021 and is projected to reach 75% in 2022. Growth in timely detection was even greater in the employer-insured sample. Timely diagnosis of SMA can enable the initiation of treatment prior to the irreversible loss of motor function. Full article

Maternal and child health (MCH) disparities remain a critical public health concern in the United States, with the Southern region experiencing some of the nation’s highest maternal mortality rates. Black and Latinx women are disproportionately affected, reflecting persistent structural and systemic inequities. This review examines maternal health disparities among Black and Latinx women in the Southern United States and identifies structural, social, and policy-related contributors to these inequities. A narrative review approach was used to synthesize epidemiological data, policy reports, and peer-reviewed literature published between 2000 and 2025, drawing on national surveillance systems such as CDC WONDER and the National Center for Health Statistics, as well as state-level reports and policy analyses relevant to maternal health in Southern states. Across the region, maternal mortality rates frequently exceeded the national average of 23.2 deaths per 100,000 live births, with several states reporting rates above 38 deaths per 100,000. Structural contributors included limited access to maternity care, rural hospital closures, Medicaid non-expansion, chronic disease burden, and experiences of discrimination within healthcare systems, while social determinants such as poverty, housing instability, language barriers, and immigration-related fears further compounded risks for Black and Latinx women. In the post-Roe context, restrictive reproductive health policies intensified existing inequities. Overall, maternal health disparities among Black and Latinx women in the Southern United States are driven by interconnected structural, social, and policy factors, underscoring the need for coordinated policy reforms, expansion of culturally responsive care models, and targeted investment in Southern communities disproportionately affected by maternal mortality. Full article

This study explores how hospital location (rural/non-rural) may moderate the nurse staffing ratio’s impact on three hospital-acquired infections. This study used data from 2022 to 2024 on nurse staffing and hospital characteristics from the American Hospital Association Annual Survey and data on hospital-acquired infection rates from the Medicare Care Compare dataset provided by the Centers for Medicare and Medicaid Services. After removing missing values, the final dataset included 7997 hospital-year observations across the US. Independent variables include rural hospital designation, nursing hours per patient day, and RN FTE per adjusted day. The dependent variables included infection rates of Central Line-Associated Bloodstream Infection, Catheter-Associated Urinary Tract Infection, and Methicillin-Resistant Staphylococcus aureus. Multiple regression was performed in Stata 18. Our research found that across all three infection types, an increase in nursing hours per patient day is significantly associated with a decrease in the infection rate, and that impact was not moderated by hospital rurality. Extra time spent with patients in either a rural or non-rural hospital decreased hospital-acquired infection rates. While RN FTEs were included in the model, total nursing hours per patient day emerged as the more consistent predictor of lower hospital-acquired infection rates. Full article

COVID-19 exposed longstanding racial and ethnic inequities among underserved populations. This retrospective cohort study examined inequities across stages of the hospitalization continuum—from COVID-19 diagnosis at admission to in-hospital mortality, including mortality patterns among COVID-19 hospitalizations—among Medicaid beneficiaries in Kentucky during 2020–2021. Statewide hospitalizations were analyzed using multivariable regression models, with propensity score matching (PSM) used as a confirmatory approach. Non-Hispanic Black patients were more likely than non-Hispanic White patients to be hospitalized with COVID-19 (adjusted odds ratio [aOR] = 1.41; 95% confidence interval [CI] = 1.26–1.59). Across the full cohort, COVID-19 hospitalizations were associated with substantially higher in-hospital mortality compared with non-COVID-19 hospitalizations (adjusted hazard ratio [aHR] = 2.38; 95% CI = 2.09–2.70). Additionally, hospitalizations among non-Hispanic Black patients had a modestly lower hazard of in-hospital mortality compared with non-Hispanic White patients (aHR = 0.81; 95% CI = 0.70–0.94). However, in analyses restricted to COVID-19 hospitalizations, adjusted estimates showed no Black–White differences in in-hospital mortality, with consistent findings from PSM analyses. These results indicate that racial inequities were more pronounced at hospital admission than during inpatient care, underscoring the importance of prevention, early diagnosis, and timely outpatient care as COVID-19 enters an endemic phase. Full article

Pregnant people in U.S. jails experience high rates of opioid use disorder (OUD), yet access to medications for opioid use disorder (MOUD) remains inconsistent. This mixed-methods study examines how jail policies, treatment infrastructure, and political context shape MOUD provision for pregnant incarcerated individuals. We conducted a secondary analysis of a national survey of 2885 U.S. jails (analytic sample = 836). Logistic regression models assessed associations between MOUD provision and telemedicine capacity, community MOUD availability, state Medicaid expansion, and 2020 presidential voting outcomes. Qualitative responses characterized barriers to care. Findings confirm that MOUD access for pregnant incarcerated individuals remains limited and structurally patterned. Fewer than half of jails continued methadone or buprenorphine for pregnant individuals already in treatment, and initiation was uncommon. MOUD provision was more likely in Democrat-won states, jails with telemedicine capacity, and jails located in communities with MOUD providers, while limited community availability reduced odds of provision. Qualitative themes highlighted restrictive jail policies, provider discretion, diversion concerns, and misconceptions regarding fetal harm. These findings underscore persistent structural barriers to evidence-based perinatal OUD treatment in carceral settings and highlight the importance of telemedicine expansion, community treatment capacity, and standardized correctional policies to advance perinatal health equity. Full article

Background/Objectives: Gestational exposure to substances (GES) is associated with adverse developmental outcomes. Early identification is limited by reliance on self-reported data. This study assessed the incidence and predictors of discordance in GES reporting between birth certificates and Medicaid claims among Medicaid-covered births in Nevada from 2022 to 2024. Methods: A statewide, hospital-clustered, cross-sectional analysis was conducted using linked Medicaid billing and birth record data. Discordance was defined as GES identified in one source but not the other. Incidence per 1000 live births was stratified by demographic characteristics. Multilevel logistic regression assessed patient- and hospital-level predictors, with random hospital intercepts. Results: Among 50,394 live births, the discordance rate was 95.09 per 1000 (95% Confidence Interval: 92.5–97.7). Substantial disparities were observed by race/ethnicity, socioeconomic status, and geography, with higher discordance among White non-Hispanic mothers, those residing in rural or frontier counties, and individuals with lower educational attainment or living in lower-income areas. Modest but meaningful variation was also observed across hospitals, including differences by hospital size and teaching or research status. Conclusions: Findings highlight substantial discordance in GES reporting and underscore the limitations of single-source surveillance. Findings also have clear policy relevance, indicating that improved cross-system data integration would strengthen statewide surveillance, enhance early detection, and support more equitable resource allocation and intervention strategies. Full article