Biomedical subjects

Frank Sloan

Publications and source records attributed to Frank Sloan.

4 recordsLinked to original sources

PubMed2006

Increasing rates of dementia at time of declining mortality from stroke.

BACKGROUND AND PURPOSE: Stroke is associated with increased risk of dementia. There has been a decline in mortality from stroke among persons 65 and over in recent decades in the US. It is not clear, however, how this process has affected incidence of various dementias. METHODS: We evaluated over time changes in stroke admission rates and survival, and in rates of newly diagnosed dementias (Alzheimer disease, senile, and cerebrovascular disease-related dementia) in persons with and without stroke aged 65 and over, using Medicare inpatient records, 1984 to 2001, linked to the National Long-Term Care Survey (about 380,000 person-years totally). RESULTS: Age-adjusted stroke rate increased from 0.0066 to 0.008 (P=0.08) from 1984-1990 to 1991-2001. One-year survival after stroke improved from 53% in 1984 to 1990 to 65% in 1991 to 1996 (P<0.0001). Age-standardized rate of diagnosed dementias increased from 0.0062 in 1984 to 1990 to 0.0095 in 1991 to 2000 (P=0.001). Among stroke patients the rate rose from 0.043 to 0.080. The relative increase in risk was largest for cerebrovascular disease-related dementia (3.68). For senile dementia, the increase was small and not significant. Rates of dementia among persons without stroke rose mainly attributable to Alzheimer disease. CONCLUSIONS: Mortality from stroke declined mainly because of declining stroke case-fatality. In parallel, the rate of diagnosed dementia increased. The increase was larger for persons with stroke compared with stroke-free population. Improved survival from stroke may contribute to this trend. Other contributing factors may include better diagnostics, an increased propensity to make the diagnosis, and increasing dementia risk attributable to factors other than stroke.

Age Factors↗

PubMed2004

The effect of the tobacco settlement and smoking bans on alcohol consumption.

In the last few years, the price of cigarettes has increased considerably in the USA. In addition, a number of states have also imposed smoking bans. These increases in the cost and barriers to smoking have created a natural experiment to study relationships between smoking and drinking behaviors. In this study, we employ data from the first six waves of the Health and Retirement Survey (HRS) to analyze the effects of smoking bans and cigarette prices on alcohol consumption. We also test if past cigarette and alcohol consumption affect current alcohol consumption as predicted by co-addiction models. We estimate dynamic panel models using GMM estimators. Our approach allows us to obtain consistent estimates irrespective of the number of time periods. The three main findings of this study are: (1) there is positive reinforcement effect of past cigarette consumption on current alcohol consumption, (2) smoking bans reduce alcohol consumption and (3) there is a positive effect of cigarette prices on alcohol consumption.

Aged↗

PubMed2004

Do routine eye exams improve vision?

We use a longitudinal national sample of Medicare claims linked to the National Long-Term Care Survey (NLTCS) to assess the productivity of routine eye examinations. Although such exams are widely recommended by professional organizations for certain populations, there is limited empirical evidence on the productivity of such care. We measure two outcomes, the ability to continue reading, and no onset of blindness or low vision, accounting for potential endogeneity of frequency of eye exams. Using instrumental variables, we find a statistically significant and beneficial effect of routine eye exams for both outcomes. Marginal effects for reading ability are large, but decline in the number of years with eye exams. Effects for blindness/low vision are smaller for the general elderly population, but larger for persons with diabetes. Instrumental variables provide a useful approach for assessing the productivity of particular interventions, particularly in situations in which randomized controlled trials are expensive or perhaps unethical and difficult to conduct over a lengthy time period.

Cost-Benefit Analysis↗

PubMed2002

Are for-profit hospital conversions harmful to patients and to Medicare?

We examine how changes in hospital ownership to and from for-profit status affect quality and Medicare payments per hospital stay. We hypothesize that hospitals converting to for-profit ownership boost post acquisition profitability by reducing dimensions of quality not readily observed by patients and by raising prices. We find that 1-2 years after conversion to for-profit status, mortality of patients, which is difficult for outsiders to monitor, increases while hospital profitability rises markedly and staffing decreases. Thereafter, the decline in quality is much lower. A similar decline in quality is not observed after hospitals switch from for-profit to government or private nonprofit status.

Diagnosis-Related Groups↗