Search Results (336)

Background: Poor nutrition drives chronic disease, health disparities, and rising health care costs in the United States. Medically tailored meals (MTMs), designed by registered dietitians, are a Food-as-Medicine intervention with potential to improve outcomes and reduce costs. This review synthesizes evidence on the clinical, economic, and policy implications of MTMs. Methods: We conducted a narrative review of peer-reviewed studies, real-world program evaluations, and policy analyses. Sources included PubMed, Google Scholar, and grey literature from government, nonprofit, and industry organizations. Articles and reports were included if they examined MTMs in Medicare, Medicaid, or other high-risk populations. Results: Evidence demonstrates that MTMs improve health outcomes, reduce hospitalizations, and lower total cost of care. Case studies from Medicaid and Medicare Advantage plans, including those administered by Mom’s Meals^®, report reductions in emergency department visits, hospital readmissions, and total cost of care, alongside sustained high member satisfaction. Despite these findings, gaps in coverage and limited stakeholder awareness hinder broader access and adoption. Conclusions: Federal policy action can expand MTM availability and maximize utilization of existing benefits. Opportunities include establishing a Medicare Fee-for-Service demonstration, expanding and encouraging use in Medicare Advantage, and leveraging MTMs within Center for Medicare and Medicaid Innovation models. Broader implementation and utilization could reduce the nation’s chronic disease burden, advance health equity, and promote value-based care. Full article

Background: Metabolic syndrome (MetS) is a significant global health burden and a known risk factor of cardiovascular disease and diabetes. Growing evidence also links MetS to cancer development, likely via chronic inflammation, insulin resistance, and hormone disruption. However, its association with laryngeal cancer remains largely unclear and underexplored. Methods: For this review, we thoroughly searched PubMed/MEDLINE, Scopus, and Web of Science for observational studies investigating associations of MetS with laryngeal or head and neck cancers (HNCs) until 1 August 2025. Five large population-based studies were found to meet inclusion criteria, and risk of bias was assessed using the Joanna Briggs Institute checklist (JBI). Results: Three Korean cohort studies consistently found that MetS increased the risk of laryngeal cancer (HR 1.13–1.32), independent of smoking and alcohol use. Hypertension and hyperglycemia were the most consistent components associated with increased risk, and chronic MetS conferred the highest hazard. In contrast, analyses from the UK Biobank (HNC) and SEER-Medicare (HNSCC) cohorts showed null and inverse associations, respectively. Additional findings included dose–response effects with increasing MetS components, U-shaped associations for HDL-C and waist circumference and increased risk associated with elevated C-reactive protein. Conclusions: Current evidence suggests a possible association between MetS and risk of laryngeal cancer, although the direction and strength of effect vary across populations. Findings from Korean cohorts provide consistent signals of increased risk, whereas Western datasets have not replicated this pattern. Overall, the certainty of evidence is low to moderate, warranting cautious interpretation and further validation in diverse populations before inferring causality. Full article

Background/Objectives: Lung cancer is the leading cause of cancer death in the United States (U.S.). Virginia, South Carolina, and North Carolina are among the U.S. states with extraordinarily high rates of lung cancer mortality, particularly among Black residents. The current lung cancer screening guidelines, revised in 2021, support screening for younger, non-Medicare age-eligible individuals who smoke. However, their health insurance, if any, may not cover their screening. This lack of access could create more disparities in lung cancer mortality rates. Methods: To address this concern, the Virginia Commonwealth University Massey Comprehensive Cancer Center, the Medical University of South Carolina Hollings Cancer Center, and the University of North Carolina Chapel Hill Lineberger Comprehensive Cancer Center secured a four-year Stand Up To Cancer^® (SU2C) grant titled “Southeastern Consortium for Lung Cancer Screening (SC3) Study” with a novel aim to test the effectiveness of a multimodal, multilevel, barrier-focused patient navigation intervention to promote lung cancer screening among Black patients from federally qualified health centers. Results: A total of 170/675 Black participants have been recruited to date. The majority of participants (n = 134; 78.82%) were aged 55–74 years. Most participants were unmarried (n = 100; 58.82%), more than half had a high school education/GED or less (n = 111; 65.29%), most currently smoked (n = 142; 83.53%), and more males than females participated (n = 107; 62.94% male). Their reported lung cancer screening barriers, addressed by the patient navigators, were cost concerns, insurance coverage issues, and recent medical history precluding screening. Conclusions with Relevance to Cancer Health Equity: This SC3 study includes a unique lung cancer screening cohort that is in direct contrast to the predominantly White cohort in the National Lung Screening Trial. The SU2C study has created a novel, community-engaged approach to lung cancer screening navigation that could become the gold standard in high-risk medically underserved populations. Full article

Background/Objectives: Metformin is one of the most frequently used concomitant medications among prostate cancer (PCa) patients. However, the effects of metformin on all-cause and PCa-specific mortality among men diagnosed with advanced/metastatic PCa treated with androgen-deprivation therapy (ADT) remain poorly understood, but they may be specifically explained by emulating a target trial. Methods: We emulated a target trial of metformin therapy and survival using observational data on 7361 patients diagnosed with advanced PCa, who were treated with ADT, from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2008–2019), with completed follow-up until 2020. We included patients with diabetes, and participants were assigned as either “initiator of metformin within 6 months after advanced PCa diagnosis” or “non-initiator of metformin.” We estimated mortality risks using Cox proportional hazards models with adjustment for risk factors via inverse probability weighting using both intention-to-treat and per-protocol analyses. Results: Over 13 years of follow-up, with a maximum 3 years of follow-up after PCa diagnosis, all-cause mortality occurred in 52 metformin initiators (47.7%) versus 3052 non-initiators (42.1%), while PCa-specific mortality occurred in 36 initiators (33.0%) versus 1919 non-initiators (26.5%). In the intention-to-treat analysis, metformin initiation was not associated with all-cause mortality (Hazard Ratio [HR] = 1.38, 95% CI: 0.98–1.95) or PCa-specific mortality (HR = 0.99, 95% CI: 0.63–1.55). Similarly, in per-protocol analysis, there was no evidence of risk reduction with all-cause (HR = 1.20, 95% CI = 0.80–1.81) or PCa-specific mortality (HR = 1.45, 95% CI = 0.88–2.38) after adjusting for time-varying covariates and allowing a 30-day gap for metformin discontinuation, adjusted for via inverse probability weighting. Conclusions: Our findings align with prior randomized trials showing no survival benefit of metformin in advanced PCa patients receiving ADT. Timing of metformin discontinuation also showed no significant effect. However, the small size of the metformin initiator group precluded subgroup analyses for hormone-sensitive (HSPC) and castrate-resistant prostate cancer (CRPC), limiting our ability to explore potential differential effects. Full article

Background/Objectives: Pressure ulcers are an important patient safety concern. While staging frameworks guide clinical management, the association between anatomical site, stage, and multiple PU presence and outcomes such as length of stay (LOS) and mortality in Medicare patients has not been fully characterized. The study objective is to examine the relationship between PU site, stage, and multiplicity and inpatient LOS and mortality among hospitalized Medicare patients. Methods: A cross-sectional study was conducted with 1,123,121 inpatient Medicare admissions from a 2019 Centers for Medicare and Medicaid Services (CMS) medical claims dataset. PUs were identified using ICD-10-CM codes classified by anatomical site and stage (1 through 4, unstageable, unspecified). Multiple regression models examined associations between PU characteristics and LOS and mortality, adjusting for age, sex, primary diagnosis, and hospital transfer. An analysis was conducted using SPSS version 29. Results: Stage 2 ulcers were the most common (28.6%), while unstageable or unspecified ulcers were frequent in the heels and head. The sacral region, buttocks, and heels were the most common anatomical sites. LOS gradually increased from Stage 1 (9.4 days) to Stage 4 (15.2 days). While the death rate did not increase consistently with stage, it was highest for upper back (14%), head (12.8%), and unspecified hip (12.8%) sites. Multiple regression was conducted to examine the association between PU locality, stage, and multiplicity and mortality (logistic regression) and LOS (linear regression). After controlling for patient demographics, admission, and clinical information, the regression results showed that the presence of multiple PUs, as well as anatomical sites of sacral, hip, head, buttock, and upper back ulcers, is associated with prolonged LOS and increased mortality. The presence of an advanced PU stage was found to be associated with prolonged LOS but not with inpatient mortality. Conclusions: The anatomical site and presence of multiple pressure ulcers were stronger predictors of prolonged hospital stay and increased mortality than ulcer stage alone. Certain ulcer sites, such as sacral, hip, head, buttock, and upper back, were independently associated with a higher risk of poor outcomes. Full article

Hydrocodone, a commonly prescribed opioid, was rescheduled from Schedule III to Schedule II in October 2014, imposing stricter prescribing regulations. While prior studies have examined its effects in general populations, its impact on breast cancer patients remains unclear. We evaluated changes in pain management among older women with early-stage breast cancer following this policy change. Using SEER-Medicare data from 2011–2019, we identified a retrospective cohort of 52,792 women aged ≥66 years. We assessed trends in the use of hydrocodone, non-hydrocodone opioids, NSAIDs, and antidepressants before and after rescheduling. Hydrocodone use declined from 55% to 40%, while non-hydrocodone opioid use increased from 43% to 50%. Multivariable logistic regression adjusted for demographic and clinical factors confirmed a significant decrease in hydrocodone use (AOR: 0.81, 95% CI: 0.75–0.86) and an increase in non-hydrocodone opioid use (AOR: 1.25, 95% CI: 1.21–1.30). Hydrocodone dosage also declined, while non-hydrocodone opioid dosages remained stable. No significant changes were observed in NSAID or antidepressant use. These findings suggest that hydrocodone rescheduling significantly altered opioid prescribing patterns, reducing hydrocodone use and prompting a shift toward alternative opioids. Further research is warranted to evaluate the appropriateness and outcomes of such shifts in cancer pain management. Full article

Background/Objectives: We here describe the impact of navigated care on utilization patterns of pharmacologic and minimally invasive overactive bladder therapies. Methods: This retrospective observational cohort study used electronic medical record data from the Precision Point Specialty Analytics Portal in the United States. Eligible patients were adults (≥18 years) newly diagnosed and treated for non-neurogenic overactive bladder (1 January 2015 to 31 December 2019). Categorical endpoints were analyzed by chi-square test or Fisher exact test. Of 170,000 eligible patients, 8982 (≈5%) were randomly selected and stratified by navigation status (navigated: 1150 [12.8%]; non-navigated: 7832 [87.2%]). Results: Overall, 60.0% of patients were female, 69.9% were White, and 42.7% had Medicare coverage. Navigated care was more common among women, Black patients, and those covered by Medicaid/Medicare. Initial pharmacologic treatment rates were similar between navigated and non-navigated groups (anticholinergic: 57.0% vs. 57.4%; beta-3 agonist: 43.0% vs. 42.6%). Greater percentages of navigated versus non-navigated patients received minimally invasive therapy (23.8% vs. 10.8%, respectively; p < 0.0001). Discontinuation rates were lower for navigated versus non-navigated patients undergoing pharmacologic treatment (62.5% vs. 71.3%; p < 0.0001). Conclusions: Patient navigation for overactive bladder may help increase access to minimally invasive therapies and may be a tool to address treatment disparities. Full article

Objectives: Urinary tract infections (UTIs) are the most common healthcare-associated infections in Skilled Nursing Facilities (SNFs); they are associated with longer lengths of stay, higher levels of care, increased treatment costs, and higher mortality rates. This study aimed to develop a machine learning classification model to predict the risk of high catheter-associated urinary tract infection rates based on SNF characteristics. Methods: We analyzed 94,877 total SNF-year observations from 2019 to 2024, not unique facilities; thus, individual SNFs may appear in multiple years. The factor variables were average length of stay in days, number of staffed beds, total nurse and total physical therapy staffing hours per resident per day, facility ownership, geographic classification, facility accreditation, Accountable Care Organization affiliations, Centers for Medicare and Medicaid Services SNF Overall Star Rating, and the SNF-year of the observations. We utilized three machine learning models for this analysis: Random Forest, XGBoost, and LightGBM. We used Shapley Additive exPlanations to interpret the best-performing machine learning model by visualizing feature importance and examining the relationship between key predictors and the outcome. Results: We found that machine learning models outperformed traditional logistic regression in predicting UTIs in skilled nursing facilities. Using the best-performing model, Random Forest, we identified rural SNFs, and the number of staffed beds as the most influential predictors of high UTI rates, followed by average length of stay, and geographic location. Conclusions: This study demonstrates the value of using facility-level characteristics to predict the risk of UTIs in SNFs with machine learning models. Results from this study can inform infection prevention efforts in post-acute care settings. Full article

Opioids and benzodiazepines (BZD) are commonly prescribed for older cancer survivors with co-occurring pain and anxiety. The prescribing rate of gabapentinoids (GABA), Selective Serotonin Reuptake Inhibitors (SSRIs), and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) in the general population has increased as opioid/BZD alternatives, but little is known on temporal/regional trends in use of these alternatives among older cancer survivors. A retrospective cohort study using SEER-Medicare data was conducted. Patients aged ≥ 66 years, diagnosed with breast, colorectal, prostate, or lung cancer as their first cancer diagnosis any time from 2000 to 2015 and who were alive more than 5 years after cancer diagnosis, were eligible for inclusion. Temporal trends varied by region (p < 0.0001) and opioid-naïve status (p < 0.0001). Compared to 2013, GABA and SNRI use increased, while BZD and opioid use decreased. All regions experienced declines in opioid use. From 2013 to 2018, all regions saw an increase in GABA use, with a decline in 2020. GABA prescriptions increased more in opioid-naïve groups compared to non-opioid-naïve patients. The yearly trends in GABA and SSRI/SNRI use varied by region among older cancer survivors. Clinical practice variation suggests needs for further research on improving consistency and quality of cancer care. Full article

Background: Hydromorphone is a semi-synthetic opioid agonist and a hydrogenated ketone of morphine. This study examined hydromorphone use in the United States (US) using three databases. Methods: The distribution of hydromorphone in the US (in grams) was provided by the US Drug Enforcement Administration’s Automated Reports and Consolidated Orders System (ARCOS) by state, zip code, and business type (pharmacies, hospitals, providers, etc.). Hydromorphone prescription claims were also examined using the Medicaid and Medicare Part D programs from 2010 to 2023. Results: Hydromorphone increased by +30.6% by 2013, followed by a decrease of −55.9% by 2023 in ARCOS. Medicaid prescriptions increased by +39.6% by 2015 and decreased by −48.9% by 2023. Medicare Part D claims increased by +8.5% by 2015 and decreased by −31.9% by 2023. There were also pronounced regional disparities in hydromorphone use identified in ARCOS (158.7-fold), Medicaid (17.5-fold), and Medicare Part D (13.7-fold). Conclusions: Hydromorphone use in the US has decreased substantially from 2010 to 2023. Additionally, these findings highlight considerable regional disparities, which may inform targeted opioid stewardship initiatives and guide policymakers to ensure safe and equitable opioid prescribing practices. Full article

Diabetes mellitus (DM) is a major global health concern, associated with both microvascular and macrovascular complications. Early identification of individuals at risk of hyperglycemia and diabetes progression is crucial for preventing long-term complications and improving patient outcomes. We investigated the association between neck circumference (NC) and hyperglycemia in non-diabetic individuals and in patients with uncontrolled DM, using data from the nationally representative Korea National Health and Nutrition Examination Survey (KNHANES) 2019–2021. Uncontrolled DM was defined as hemoglobin A1c (HbA1c) ≥ 7.0%, while hyperglycemia in non-diabetic individuals was defined as fasting blood glucose ≥ 126 mg/dL or HbA1c ≥ 6.5%. Logistic regression analyses were conducted to evaluate the association between NC and glycemic outcomes. NC was independently associated with hyperglycemia in non-diabetic individuals (Model 1: odds ratio (OR): 1.09; 95% confidence interval (CI): 1.05–1.13; Model 2: OR: 1.09; 95% CI: 1.05–1.13) and patients with uncontrolled DM (Model 1: OR: 1.10; 95% CI: 1.03–1.17; Model 2: OR: 1.11; 95% CI: 1.04–1.18) after adjusting for potential confounders. This study demonstrates that NC is a significant risk factor for hyperglycemia in the general population and for individuals with uncontrolled DM. NC may serve as a simple, non-invasive anthropometric marker to help identify individuals at elevated risk for poor glycemic control. Full article

Medicare fraud poses a substantial challenge to healthcare systems, resulting in significant financial losses and undermining the quality of care provided to legitimate beneficiaries. This study investigates the use of machine learning (ML) to enhance Medicare fraud detection, addressing key challenges such as class imbalance, high-dimensional data, and evolving fraud patterns. A dataset comprising inpatient claims, outpatient claims, and beneficiary details was used to train and evaluate five ML models: Random Forest, KNN, LDA, Decision Tree, and AdaBoost. Data preprocessing techniques included resampling SMOTE method to address the class imbalance, feature selection for dimensionality reduction, and aggregation of diagnostic and procedural codes. Random Forest emerged as the best-performing model, achieving a training accuracy of 99.2% and validation accuracy of 98.8%, and F1-score (98.4%). The Decision Tree also performed well, achieving a validation accuracy of 96.3%. KNN and AdaBoost demonstrated moderate performance, with validation accuracies of 79.2% and 81.1%, respectively, while LDA struggled with a validation accuracy of 63.3% and a low recall of 16.6%. The results highlight the importance of advanced resampling techniques, feature engineering, and adaptive learning in detecting Medicare fraud effectively. This study underscores the potential of machine learning in addressing the complexities of fraud detection. Future work should explore explainable AI and hybrid models to improve interpretability and performance, ensuring scalable and reliable fraud detection systems that protect healthcare resources and beneficiaries. Full article

Importance: Understanding trends in the use of hormonal therapy (HT) for prostate cancer (PCa) is crucial to optimize treatment strategies, particularly for older men with locally advanced and metastatic disease. Objective: To evaluate changes in the patterns of adjuvant and primary HT use over time in older U.S. men diagnosed with locally advanced and metastatic prostate cancer. Design, Setting, and Participants: This cohort study utilized SEER-Medicare data, which covers approximately 48% of the U.S. population and links cancer registry data with Medicare claims, including 149,515 men aged ≥66 years diagnosed with PCa between 2010 and 2019. We analyzed trends in the use of adjuvant HT for higher-risk and primary HT for lower-risk PCa. Multivariable logistic regression models were used to adjust for clinical and demographic factors. Main Outcomes and Measures: The primary outcome was the proportion of men receiving any form of HT within 6 months of PCa diagnosis. HT included injectable Gonadotropin-releasing hormone (GnRH) agonists and antagonists, orchiectomy, and anti-androgens agents. Results: The rate of adjuvant HT in higher-risk PCa patients increased significantly from 53.6% in 2010 to 68.1% in 2019 (p < 0.0001), with a steady rise in the last four years. In contrast, the rate of men with lower-risk disease receiving primary HT declined from 25% in 2010 to 16.9% in 2013, then peaked at 28.2% in 2015, and stabilized between 25% and 27.3% from 2017 to 2019. The overall HT usage increased from 33.5% in 2010 to 45.2% in 2019, showing a consistent increase over the years. These patterns persisted after adjusting for clinical and demographic factors. Conclusions and Relevance: The increasing use of adjuvant HT in higher-risk PCa patients aligns with evolving treatment guidelines, while the stable rate of primary HT in lower-risk patients represents persistent inappropriate use and highlights the need for further efforts to optimize treatment choices. While previous studies focused on men with intermediate-risk PCa receiving radiation therapy, our study broadens the scope to include men who did not undergo radiation therapy, providing a more inclusive view of HT trends. Future research should focus on refining strategies to reduce inappropriate primary HT use and improve adjuvant HT administration. Full article

Identifying hospitals that disproportionately serve minority and publicly insured patients is important because patients at these hospitals often experience worse outcomes. Studies commonly identify disproportion by using the top decile of hospitals with the greatest proportion of Black discharges nationally. Our study aimed to identify a broader measure that accounts for disproportion by multiple characteristics. Using fee-for-service Medicare data, we classified hospitals as either serving disproportionately or not, examined overlaps in classification, and assessed differences in hospital quality. We found that using a combined measure for any hospitals in the top decile or above a threshold of twice their local healthcare market average of Black, Hispanic, minority, or dual-eligible discharges classified 28.1% (n = 680/2420) of hospitals as serving disproportionately, compared to only 10% (n = 242/2420) when using the top decile of a single characteristic. The combined measure detected moderate differences in hospital star quality ratings (mean difference of 0.57–0.87, all p-values < 0.001; standardized mean difference: 0.50–0.79, 95% CIs all above 0). The combined measure identified hospitals that were smaller, more rural, and served other minorities, namely, Asian and American Indian populations. Future work should consider using this combined measure to more comprehensively identify hospitals that disproportionately serve minority or publicly insured patients. Full article

The primary goal of Transportation systems is to provide transportation accessibility to opportunities. Equitable access to essential destinations encompassing social, recreational, educational, and civic opportunities needs to be more consistent across different social groups. This study evaluates the disparities in social justice using social equity as a measure of transit access and walk access to non-work amenities. These non-work amenities include grocery stores, personal services, retail outlets, recreational venues, entertainment centers, and healthcare facilities in the U.S. Logistic regression models are developed using the 2017 National Community Livability Survey data. The results indicate regressive public transit access for socially disadvantaged groups, including older citizens, non-drivers, Medicare/Medicaid beneficiaries, and non-metropolitan residents. Walk access inequities similarly affect older individuals, non-drivers, the physically disabled, the unemployed, students, women, and non-metropolitan residents. This research emphasizes the importance of addressing transit and walk-access inequities to non-work amenities within transportation systems. By acknowledging the disparities in transportation equity, decision-makers and communities can foster more inclusive and equitable access to essential destinations, thereby promoting social cohesion and overall community well-being. Full article