Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-3 (of 3 Records) |
Query Trace: Friedman EE[original query] |
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Screening for latent tuberculosis infection among HIV-infected Medicaid enrollees
Friedman EE , Khan A , Duffus WA . Public Health Rep 2018 133 (4) 33354918776639 OBJECTIVES: In the United States, universal screening for latent tuberculosis (TB) infection among people with HIV is recommended, but the percentage receiving screening is unknown. This study assessed screening for latent TB infection among people with HIV enrolled in Medicaid during 2006-2010. METHODS: We used nationwide fee-for-service Medicaid records to identify people with HIV, measure screening for latent TB infection, and examine associated demographic, social, and clinical factors. We used logistic regression analysis to calculate odds ratios (ORs) and 95% confidence intervals (CIs). We created 2 multivariate models to prevent collinearity between variables for length of HIV infection. RESULTS: Of 152 831 people with HIV, 26 239 (17.2%) were screened for latent TB infection. The factor most strongly associated with screening was TB exposure or suspected TB (OR = 3.78; 95% CI, 3.27-4.37). Significant demographic characteristics associated with screening included being African American (OR = 1.28; 95% CI, 1.24-1.32) or </=20 years of age (OR = 1.35; 95% CI, 1.28-1.42). Significant clinical and social factors associated with screening included poor housing conditions, low body mass index, chemotherapy treatment, and use of certain substances (ORs ranged from 1.24 [95% CI, 1.20-1.27] to 1.47 [95% CI, 1.22-1.76]). The screening rate for latent TB infection was higher among people with newly diagnosed HIV infection than among those with established infection (OR = 1.37; 95% CI, 1.32-1.41) and among people with a longer established HIV infection than among those with shorter HIV infection (OR = 1.24; 95% CI, 1.23-1.26 for each additional year). CONCLUSION: Screening for latent TB infection among fee-for-service Medicaid beneficiaries with HIV was suboptimal, despite the presence of demographic, social, or clinical characteristics that should have increased the likelihood of screening. The lack of certain data in Medicaid may have resulted in an underestimation of screening. |
Incorporation of social determinants of health in the peer-reviewed literature: A systematic review of articles authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Friedman EE , Dean HD , Duffus WA . Public Health Rep 2018 133 (4) 33354918774788 OBJECTIVES: Social determinants of health (SDHs) are the complex, structural, and societal factors that are responsible for most health inequities. Since 2003, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) has researched how SDHs place communities at risk for communicable diseases and poor adolescent health. We described the frequency and types of SDHs discussed in articles authored by NCHHSTP. METHODS: We used the MEDLINE/PubMed search engine to systematically review the frequency and type of SDHs that appeared in peer-reviewed publications available in PubMed from January 1, 2009, through December 31, 2014, with a NCHHSTP affiliation. We chose search terms to identify articles with a focus on the following SDH categories: income and employment, housing and homelessness, education and schooling, stigma or discrimination, social or community context, health and health care, and neighborhood or built environment. We classified articles based on the depth of topic coverage as "substantial" (ie, one of </=3 foci of the article) or "minimal" (ie, one of >/=4 foci of the article). RESULTS: Of 862 articles authored by NCHHSTP, 366 (42%) addressed the SDH factors of interest. Some articles addressed >1 SDH factor (366 articles appeared 568 times across the 7 categories examined), and we examined them for each category that they addressed. Most articles that addressed SDHs (449/568 articles; 79%) had a minimal SDH focus. SDH categories that were most represented in the literature were health and health care (190/568 articles; 33%) and education and schooling (118/568 articles; 21%). CONCLUSIONS: This assessment serves as a baseline measurement of inclusion of SDH topics from NCHHSTP authors in the literature and creates a methodology that can be used in future assessments of this topic. |
Chronic health conditions in Medicare beneficiaries 65 years and older with HIV infection
Friedman EE , Duffus WA . AIDS 2016 30 (16) 2529-2536 OBJECTIVES: to examine sociodemographic factors and chronic health conditions of people living with HIV (PLWHIV/ HIV+) ≥65 years, and to compare their chronic disease prevalence to beneficiaries without HIV. DESIGN: National fee for service (FFS) Medicare claims data (parts A and B) from 2006-2009 were used to create a retrospective cohort of beneficiaries >65 years old. METHODS: Beneficiaries with 1 inpatient or skilled nursing facility claim, or 2 outpatient claims with HIV diagnosis codes were considered HIV+. HIV+ beneficiaries were compared to uninfected beneficiaries on demographic factors and on the prevalence of hypertension, hyperlipidemia, ischemic heart disease, rheumatoid arthritis/osteoarthritis, and diabetes. Odds ratios (OR), 95% confidence intervals (CI), and p-values were calculated. Adjustment variables included age, sex, race/ethnicity, end stage renal disease (ESRD), and dual Medicare-Medicaid enrollment. Chronic conditions were examined individually, and as an index from zero to all five conditions. RESULTS: Of 29,060,418 eligible beneficiaries, 24,735 (0.09%) were HIV+. HIV+ beneficiaries were more likely to be Hispanic, African American, male, and younger (p>0.0001), and were 1.5 to 2.1 times as likely to have a chronic disease (diabetes (aOR) 1.51 95% CI (1.47, 1.55): rheumatoid arthritis/osteoarthritis 2.14 95% CI (2.08, 2.19)), and 2.4 to 7 times as likely to have 1-5 co-morbid chronic conditions (1 condition (aOR) 2.38 95% CI (2.21, 2.57): 5 conditions 7.07 95% CI (6.61, 7.56)). CONCLUSIONS: Our results show that PLWHIV ≥65 years are at higher risk of comorbidities than other FFS Medicare beneficiaries. This finding has implications for both the management and cost of the health of PLWHIV ≥65. |
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