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Biomedical subjects

Frank A Sloan

Publications and source records attributed to Frank A Sloan.

At least 19 recordsLinked to original sources
PubMed2006

Trends in cost of major eye diseases to Medicare, 1991 to 2000.

PURPOSE: To estimate impacts of physician-diagnosed eye diseases (age-related macular degeneration (AMD), cataract, diabetic retinopathy, and glaucoma) on Medicare payments in the periods 1991 to 1995 and 1996 to 2000. DESIGN: A retrospective cohort study to estimate program payments per capita and in total for each of the major eye diseases and the four eye diseases in total. METHODS: Data from the 1994 and 1999 National Long-Term Care Survey (NLTCS) and medical claims to Medicare from 1991 to 2000 were merged with the NLTCS. Medicare payments for eye-related procedures on persons with and without major eye diseases as reported on Medicare claims and self-reported data from NLTCS. RESULTS: Overall, the burden of major eye diseases was to increase Medicare spending by 4.8 billion dollars (1999 USD) in 1991 to 1995 and by 4.5 billion dollars in 1996 to 2000. The most expensive eye disease was cataract, costing Medicare 3.8 billion dollars in 1991 to 1995 and 3 billion dollars in 1996 to 2000. CONCLUSIONS: Prevalence of major eye diseases increased over time, but the effect of major eye diseases on Medicare payments decreased, mainly as a result of lower payments for cataract surgery in the later years.

Aged↗
PubMed2006

Uveitis in the elderly: epidemiological data from the National Long-term Care Survey Medicare Cohort.

PURPOSE: There is a paucity of population-based data on the epidemiology of uveitis in the elderly. In the past 40 years, only 2 U.S. population-based studies have examined the epidemiology of uveitis. The conclusions of these studies on the burden of uveitis in the elderly differ greatly. In this analysis, we use Medicare claims data to define the population-based incidence and prevalence of uveitis in the United States elderly population. DESIGN: Cohort study. PARTICIPANTS: A cohort of 21644 Medicare beneficiaries drawn for the National Long-term Care Survey, a random sample of U.S. adults 65 years and older, was followed up from 1991 through 1999. METHODS: The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes specific to uveitis were queried. To decrease the inclusion of uveitis caused by surgery, diagnoses occurring within 3 months of intraocular surgery were excluded. The incidence and prevalence of uveitis by anatomic location was calculated for each year in the study. MAIN OUTCOME MEASURES: The onset of uveitis during a given year and its presence in subsequent years. RESULTS: The cumulative yearly incidence of uveitis ranged from 302/100000 to 424/100000 persons per year and averaged 340.9/100000 persons per year. Anterior uveitis was the most common form of uveitis in this population, with a mean incidence of 243.6 cases per 100000 persons per year. The incidence of posterior uveitis averaged 76.6/100000 and the incidence of panuveitis/endophthalmitis averaged 41.7/100000. Only 2 cases of intermediate uveitis occurred during the study period. The cumulative prevalence of uveitis doubled from 511/100000 in 1991 to 1231/100000 in 1999, with anterior uveitis accounting for most prevalent cases in every year. CONCLUSIONS: The burden of uveitis in the elderly is substantial and is higher than previously thought. Longitudinal analysis of Medicare claims data may provide a useful tool for monitoring uncommon diseases, such as uveitis, in the elderly population.

Aged↗
PubMed2006

Longitudinal rates of cataract surgery.

OBJECTIVE: To determine the cumulative probability of cataract surgery and factors accounting for such surgery. METHODS: Respondents to the Asset and Health Dynamics Among the Oldest Old survey, a national longitudinal panel, were interviewed in 1998, 2000, and 2002 to determine whether they had undergone cataract extraction since the previous interview (N = 8363 in 1998). Multivariate analysis was used to identify factors affecting cataract surgery rates. RESULTS: The annual incidence of cataract surgery from January 1, 1995, to December 31, 2002, was 7.4%. The prevalence of unilateral pseudophakia increased from 7.6% in 1998 to 9.8% in 2002; the prevalence of bilateral pseudophakia increased from 10.5% in 1998 to 22.3% in 2002. The self-reported vision of persons undergoing cataract surgery improved related to that of others (a difference of 0.4 on a 9-point scale; P<.001). Black individuals were less likely to undergo cataract surgery than white individuals (P<.01). The highest rates of surgery were for persons who were 65 years or older in 1998. However, persons with Medicare parts A and B coverage underwent more procedures than those with primary private employer-based coverage or the uninsured. CONCLUSIONS: At 5.3%, the cataract surgery incidence is similar to that given in previous reports. Persons undergoing cataract surgery more often had low self-reported vision before surgery, and their vision improved on average relative to others after surgery.

Aged↗
PubMed2005

Heavy alcohol use and marital dissolution in the USA.

Using the first five waves of the US Health and Retirement Study, a nationally representative survey of middle-aged persons in the USA conducted between 1992 and 2000, we assessed the association between alcohol consumption and separation and divorce (combined as divorced in the analysis) for 4589 married couples during up to four repeated 2-yr follow-up periods. We found that drinking status was positively correlated between spouses. The correlations did not increase over the follow-up period. Discrepancies in alcohol consumption between spouses were more closely related to the probability of subsequent divorce than consumption levels per se. Couples with two abstainers and couples with two heavy drinkers had the lowest rates of divorce. Couples with one heavy drinker were most likely to divorce. Controlling for current consumption levels, a history of problem drinking by either spouse was not significantly associated with an increased probability of divorce. Our findings on alcohol use and marital dissolution were highly robust in alternative specifications.

Alcohol Drinking↗
PubMed2005

Racial differences in glaucoma care: the longitudinal pattern of care.

OBJECTIVE: To examine if racial differences exist in longitudinal care patterns for Medicare beneficiaries with glaucoma. METHODS: We analyzed national longitudinal Medicare claims data from January 1, 1991, through December 31, 1999 in 21 644 Medicare beneficiaries linked to the National Long-Term Care Survey. Logistic regression was used to predict whether a person underwent an eye examination or eye surgery during the year, and negative binomial regression was used to predict the number of eye examinations and surgical procedures for glaucoma per year. Annual use of eye examinations was nearly identical for black persons (1.85 per year) and white persons (1.89 per year), whereas surgery rates were higher among blacks (0.15) than whites (0.08, P<.001). RESULTS: Blacks were more likely than whites to have glaucoma diagnosed, but rates among whites were higher than in prior population-based studies. When we controlled for other factors, blacks were not significantly less likely to undergo eye examination during the year; however, blacks were 78% more likely to undergo surgery (P < .001) and had 76% higher rates of surgical procedures (P < .001). CONCLUSIONS: No systematic pattern was found of underuse among blacks relative to whites after glaucoma diagnosis. Higher rates of surgery among blacks may indicate delayed onset of care and/or greater disease severity.

Black People↗
PubMed2005

Effects of changes in self-reported vision on cognitive, affective, and functional status and living arrangements among the elderly.

PURPOSE: To study effects of changes in self-reported vision on functional status, cognition, depressive symptoms, and living arrangements. DESIGN: Longitudinal analysis of household survey data. METHODS: A total of 6234 sample persons observed in the study of Assets and Health Dynamics Among the Oldest Old (AHEAD) 1995 were followed in 1998, 2000, and 2002 or until death or sample attrition. Effects of changes in self-reported vision and other factors were assessed by means of ordinary least-squares and logistic regression with panel data methods. Main outcome measures were limitations of instrumental activities of daily living (IADLs), activities of daily living (ADLs), and other, cognition, depressive symptoms, and living arrangements. RESULTS: A decline from excellent/good vision to fair/poor near and distance vision had statistically significant effects on several IADL limitations, and some ADL and other limitations. Largest effects were for driving (OR for no limitation: 0.55, P = .003), managing money (OR: 0.61, P < .001), and preparing hot meals (OR: 0.61, P < .001). Onset of fair-poor near vision increased the likelihood of onset of at least one IADL (OR for no limitation: 0.71, P < .01) and ADL (OR: 0.74, P = .003) limitation. Onset of legal blindness resulted in a 78% increase in the likelihood of an IADL limitation (OR for no limitation: 0.22, P < .001). Effects of vision declines on cognition and depressive symptoms were statistically significant but small. Decline in vision increased the probability of nursing home residence. CONCLUSIONS: Visual impairment has major impacts on functional status. Preventing vision loss is likely to appreciably improve the functioning of elderly persons.

Activities of Daily Living↗
PubMed2005

Litigation and the value of tobacco companies.

This study determines how the recent wave of litigation affected returns and systematic risk in the tobacco industry. We test for changes in stock prices coinciding with litigation announcements using a difference-in-difference event study methodology. Unfavorable information concerning litigation reduced tobacco returns. We find a decline in systematic risk as traditionally measured by the covariance between industry returns and returns to a diversified (efficient) portfolio. This decline may imply a substantial decline in the cost of equity capital of at least 2.2% after the period of litigation, which we attribute to common cost shocks experienced by the companies participating in the Master Settlement Agreement combined with the oligopolistic structure of the industry.

Risk Assessment↗
PubMed2005

Disparities among older adults in measures of cognitive function by race or ethnicity.

This study examined racial or ethnic differences in cognitive function, cross-sectionally and longitudinally, using survey data from the Asset and Health Dynamics Among the Oldest Old. A version of the Telephone Interview for Cognitive Status (TICS), proxy assessments of cognition, and difficulties in performing daily tasks were assessed. Blacks performed below Whites on the TICS at baseline and on proxy assessments of cognition. TICS score declined with age for Whites and Blacks, with some relative gains for Blacks. At baseline, Blacks more often had difficulties in performing daily tasks, with some increase in difficulties relative to Whites with age. Differences between other groups and Whites were smaller than those between Blacks and Whites.

Activities of Daily Living↗
PubMed2005

Impacts of managed care patient protection laws on health services utilization and patient satisfaction with care.

OBJECTIVE: To assess effects of patient protection laws implemented by the vast majority of states during the 1990s on the public's satisfaction and trust relating to health care, and on key utilization measures. DATA SOURCES/STUDY SETTING: Measures of individuals' health care utilization and satisfaction, and control variables, came from three waves of the Community Tracking Study (CTS) Household Surveys conducted in 1996-1997, 1998-1999, and 2000-2001. The CTS was conducted in 60 randomly selected communities, throughout the U.S. In addition, a supplemental national sample of households from CTS was also included, resulting in a combined sample with cases from 48 states and the District of Columbia. After applying exclusion restrictions, the analysis sample was 149,688 adults. STUDY DESIGN: Using a fixed-effects methodology, we assessed the influence of patient protection laws on satisfaction with care and utilization of services for the entire sample and for subsamples of persons in poor health, with low income, and who were enrolled in HMOs. DATA COLLECTION/EXTRACTION METHODS: One of the authors (Hall) compiled relevant laws in all U.S. states through 2001 from primary legal sources, checking for accuracy by conducting independent research on statutory changes and by asking three to five regulators in each state to verify that the information was correct. PRINCIPAL FINDINGS: Overall, patient protection laws had little or no effect on either trust, satisfaction with care, or utilization. Significance was found postenactment of a state patient protection law only for emergency room visits in the general sample, and only for physician trust in the low-income sample. Because of the number of possible associations examined, occasional findings of significance could occur by chance. CONCLUSIONS: Enactment of managed care patient protection laws did not generally increase utilization of health services or improve patient satisfaction with care.

Adolescent↗
PubMed2005

Longitudinal analysis of the relationship between regular eye examinations and changes in visual and functional status.

OBJECTIVES: To determine whether regular eye examinations are associated with a greater or lesser rate of loss of ability to read newsprint, onset of blindness or low vision, or onset of limitations in instrumental activities of daily living (IADLs) and activities of daily living (ADLs). DESIGN: A sample of 14,215 Medicare beneficiaries observed between 1994 and 1999 linked to the 1994 and 1999 National Long-Term Care Surveys (NLTCS). Effects of annual examinations were assessed using instrumental variables. SETTING: The Medicare-linked NLTCS is representative of U.S. elderly persons from 1994 to 1999. PARTICIPANTS: Longitudinal observational study of persons aged 65 and older. MEASUREMENTS: Change in self-reported and provider-reported vision and change in functional limitations associated with vision related to the number of years with eye examinations and other factors. RESULTS: Persons with more-regular eye examinations between 1994 and 1998 were less likely to have experienced a decline in vision or in functional status between 1994 and 1999. On average, an additional year with an eye examination was associated with a decrease in the probability of becoming unable to read newsprint of 0.12 (P=.03), a lower probability of onset of low vision or blindness of 0.009 (P=.06), and a decrease in the probability that the number of functional limitations increased of 0.13 (P=.002) for IADLs and 0.05 (P=.003) for ADLs. CONCLUSION: Elderly persons who have regular eye examinations experience less decline in vision and functional status.

Activities of Daily Living↗
PubMed2005

Determinants of states' allocations of the master settlement agreement payments.

To determine which factors influence states' allocation decisions for the tobacco Master Settlement Agreement and the four individual settlements' annual payments, including the decision to securitize, we analyzed the effects of voter characteristics, political parties, interest groups, prior spending on public tobacco control programs, and state fiscal health on per capita settlement funds allocated to tobacco-control, health, and other programs. Tobacco-producing states and those with high proportions of conservative Democrats or elderly, black, Hispanic, or wealthy people tended to spend less on tobacco control. Education and medical lobbies had strong positive influences on per capita allocations for tobacco-control and health-related programs. State fiscal crises affected amounts spent by states from settlement funds as well as the probability of securitizing future cash flows from the settlements.

Budgets↗
PubMed2004

The impact of the Master Settlement Agreement on cigarette consumption.

In 1998, 46 states and the four major tobacco companies signed the Master Settlement Agreement (MSA), which stipulated that the tobacco companies pay states $206 billion over 25 years and take steps to reduce youth smoking. The remaining states settled separately. We sought to determine the effect of the settlements on demand for cigarettes. Using a nationwide sample from 1990 to 2002, we estimated a model of the decision to smoke cigarettes. The settlements affected smoking primarily through price increases for cigarettes, although there was evidence that other policy instruments influenced smoking rates for younger smokers. By 2002, the settlements had reduced overall smoking rates by 13 percent for ages 18 to 20 and older than 65 and 5 percent for ages 21 to 64.

Adolescent↗
PubMed2004

Marked increase in Alzheimer's disease identified in medicare claims records between 1991 and 1999.

BACKGROUND: Epidemiologic evidence suggests that African Americans have higher rates of Alzheimer's disease (AD) than do whites. Examining longitudinal trends in the number of persons who are identified as having AD in administrative databases may provide insights into this phenomenon. METHODS: We analyzed 9-year longitudinal data (1991-1999) for 29,679 Medicare beneficiaries who were screened for the National Long-Term Care Survey. Cases of AD were identified using ICD-9-CM diagnosis codes from Medicare claims files. RESULTS: Age-adjusted rates of Medicare beneficiaries identified as having AD rose from 1991-1999 for all groups studied, but particularly among African Americans. In 1991, African Americans made up 6.5% of the identified AD cases but comprised 11.0% of cases in 1999 (X(2) = 6.79, p =.005). The rate of increase in identification of AD was particularly large for women who were aged 85 years and older. CONCLUSIONS: Reasons for increased identification of AD in Medicare claims is likely multifactorial; sharp increases among African Americans may reflect improved access.

Aged↗
PubMed2004

The effect of heavy drinking on social security old-age and survivors insurance contributions and benefits.

This article estimates the effects of heavy alcohol consumption on Social Security Old-Age and Survivor Insurance (OASI) contributions and benefits. The analysis accounts for differential earnings and mortality experiences of individuals with different alcohol consumption patterns and controls for other characteristics, including smoking. Relative to moderate drinkers, heavy drinkers receive fewer OASI benefits relative to their contributions. Ironically, for each cohort of 25-year-olds, eliminating heavy drinking costs the program an additional $3 billion over the cohort's lifetime. Public health campaigns are designed to improve individual health-relevant behaviors and, in the long run, increase longevity. Therefore, if programs for the elderly are structured as longevity-independent defined benefit programs, their success will reward healthier behaviors but increase these programs' outlays and worsen their financial condition.

Accidents, Traffic↗
PubMed2004

Monitoring visual status: why patients do or do not comply with practice guidelines.

OBJECTIVE: To determine factors affecting compliance with guidelines for annual eye examinations for persons diagnosed with diabetes mellitus (DM) or age-related macular degeneration (ARMD). DATA SOURCES/STUDY SETTING: Nationally representative, longitudinal sample of individuals 65+ drawn from the National Long-Term Care Survey (NLTCS) with linked Medicare claims records from 1991 to 1999. STUDY DESIGN: Medicare beneficiaries were followed from 1991 to 1999, unless mortality intervened. All claims data were analyzed for presence of ICD-9 codes indicating diagnosis of DM or ARMD and the performance of eye exams. The dependent variable was a binary indicator for whether a person had an eye exam or not during a 15-month period. Independent variables for demographics, living conditions, supplemental insurance, income, and other factors affecting the marginal cost and benefit of an eye exam were assessed to determine reasons for noncompliance. DATA COLLECTION/EXTRACTION METHODS: Panel data were created from claims files, 1991-1999, merged with data from the NLTCS. PRINCIPAL FINDINGS: The probability of having an exam reflected perceived benefits, which vary by patient characteristics (e.g., education, no dementia), and factors associated with the ease of visit. African Americans were much less likely to be examined than were whites. CONCLUSIONS: Having an exam reflects multiple factors. However, much of the variation in the probability of an exam remained unexplained as were reasons for the racial differences in use.

Aged↗
PubMed2004

The effect of dementia on outcomes and process of care for Medicare beneficiaries admitted with acute myocardial infarction.

OBJECTIVES: To determine differences in mortality after admission for acute myocardial infarction (AMI) and in use of noninvasive and invasive treatments for AMI between patients with and without dementia. DESIGN: Retrospective chart review. SETTING: Cooperative Cardiovascular Project. PATIENTS: Medicare patients admitted for AMI (N=129,092) in 1994 and 1995. MEASUREMENTS: Dementia noted on medical chart as history of dementia, Alzheimer's disease, chronic confusion, or senility. Outcome measures included mortality at 30 days and 1-year postadmission; use of aspirin, beta-blocker, angiotensin-converting enzyme (ACE) inhibitor, thrombolytic therapy, cardiac catheterization, coronary angioplasty, and cardiac bypass surgery compared by dementia status. RESULTS: Dementia was associated with higher mortality at 30 days (relative risk (RR)=1.16, 95% confidence interval (CI)=1.09-1.22) and at 1-year postadmission (RR=1.18, 95% CI=1.13-1.23). There were few to no differences in the use of aspirin and beta-blockers between patients with and without a history of dementia. Patients with a history of dementia were less likely to receive ACE inhibitors during the stay (RR=0.89, 95% CI=0.86-0.93) or at discharge (RR=0.90, 95% CI=0.86-0.95), thrombolytic therapy (RR=0.82, 95% CI=0.74-0.90), catheterization (RR=0.51, 95% CI=0.47-0.55), coronary angioplasty (RR=0.58, 95% CI=0.51-0.66), and cardiac bypass surgery (RR=0.41, 95% CI=0.33-0.50) than patients without a history of dementia. CONCLUSION: The results imply that the presence of dementia had a major effect on mortality and care patterns for this condition.

Aged↗
PubMed2003

Estimates of incidence rates with longitudinal claims data.

OBJECTIVE: To estimate incidence rates of the 3 major chronic eye diseases--diabetic retinopathy (DR), glaucoma, and age-related macular degeneration (ARMD)--by using longitudinal claims data from Medicare. METHODS: Longitudinal cases were ascertained by using a national probability sample of Medicare beneficiaries aged 65 years and older in 1991 who initially had none of the eye diseases documented. After adjusting for death and enrollment in a health maintenance organization, claims filed by optometrists or ophthalmologists with an International Classification of Diseases, Ninth Revision, Clinical Modification code for all forms of DR, glaucoma, and ARMD were used to indicate diagnosis. RESULTS: Annual incidence rates for the 3 conditions after the first year of observation ranged from 14.3% to 17.7% (higher earlier) across an 8-year longitudinal follow-up. Incidence rates among those with diabetes mellitus for any form of DR varied between 3.8% and 6.5%, while those for glaucoma varied between 4.6% and 7.8% and those for ARMD varied between 7.5% and 9.3%. CONCLUSIONS: Longitudinal claims data after the first year provide relatively stable estimates of incidence rates on an annual basis. These estimates are comparable with those of the few population-based studies available.

Centers for Medicare and Medicaid Services, U.S.↗