Biomedical subjects

James N Laditka

Publications and source records attributed to James N Laditka.

18 recordsLinked to original sources

PubMed2006

Improving knowledge about disability transitions by adding retrospective information to panel surveys. Population health metrics.

BACKGROUND: Panel data are often used to estimate key measures of public health, such as years lived with and without disability. Panel surveys commonly measure disability at intervals of one or two years, and occasionally more than two. It is likely that these intervals often include unreported changes in functional status. Unreported changes may bias estimates of disability transition probabilities, which are commonly used to estimate years lived with and without disability. Most surveys do not ask participants about periods with and without disability in the time since they last responded to the survey. We examined a way to improve the usefulness of panel surveys and our understanding of disability processes, by eliciting retrospective disability information. METHODS: Data were from the United States' National Long Term Care Survey. At each wave, this survey asks disabled respondents how long they have been disabled. We tested whether estimates of probabilities predicting changes in disability status can be improved by making use of this retrospective disability information. Methods included embedded Markov Chain analysis, microsimulation, and the Hausman specification test. RESULTS: Estimates based on data that include retrospective information are significantly different from those that use only the more limited information that is contemporaneous to the surveys. They are also more efficient. At age 65, all estimated probabilities for becoming disabled were higher when retrospective information was used, and all probabilities for remaining disabled were lower. Microsimulation revealed that using retrospective information increased the number of functional status transitions. For example, for women the mean number of transitions from nondisabled to disabled or dead was 52.7% greater when retrospective information was added to the analysis. CONCLUSION: Our results suggest that the value of future panel studies for estimating transitions in disability could be notably enhanced by adding a small number of questions asking respondents for details about their disabilities--and lack of disabilities--in the period since a preceding survey wave. Information provided by such questions could substantially improve both the measurement of disability histories and estimates of disability processes.

Journal Article↗

PubMed2006

Racial and ethnic disparities in potentially avoidable delivery complications among pregnant Medicaid beneficiaries in South Carolina.

OBJECTIVES: To examine race and ethnicity differences in accessibility and effectiveness of health care during pregnancy. METHODS: Data were 26,866 year 2000 Medicaid-insured deliveries from the South Carolina Office of Research and Statistics, and Area Resource File. The access indicator was Potentially Avoidable Maternity Complications (PAMCs). PAMC risks can be reduced through prenatal care, such as infection screening and treatment, and healthy behaviors it promotes. We compared PAMC risks of Blacks, Hispanics, and Whites. Analyses included PAMC rates, Chi-square, t-tests, multilevel logistic regression. Risks were estimated for ages 10-17, and 18+. RESULTS: At ages 10-17 (n=2,691), Blacks and Hispanics had notably higher unadjusted and adjusted PAMC risks (adjusted odds ratios, ORs, 2.26, p < .001; 3.29, p < .05, respectively). At ages 18+, adjusted odds for Hispanics were about half those of Whites (p < .05). Adjusted odds for adult Blacks and Whites did not differ. This may be due to controlling for many risk factors that are more prevalent among Blacks: Single, disabled, poverty, diabetes, hypertension, rurality; however, unadjusted PAMC prevalence also did not differ greatly (3.9 for Blacks, 3.4 for Whites, p < .1). Adjusted risks were high for adults with diabetes (OR 2.40, p < .001) and all rural women (teen OR 4.02, p < .05; adult OR 1.83, p < .001). CONCLUSIONS: Young Blacks and Hispanics have notably higher risks of delivery outcomes indicating less access to prenatal care of reasonable quality. Policies to reduce PAMCs in Medicaid should address needs of young Blacks and Hispanics; enhance diabetes treatment for adult women; and address rural access barriers for all women.

Adolescent↗

PubMed2006

Race, ethnicity and hospitalization for six chronic ambulatory care sensitive conditions in the USA.

OBJECTIVES: Hospitalization for ambulatory care sensitive conditions, also called preventable hospitalization, has been widely accepted as an indicator of access to primary health care, and of the overall success of the primary health care system. Our objective is to examine associations between preventable hospitalization and race and ethnicity in the USA, separately for six major chronic diseases: angina, asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes and hypertension. DESIGN: We used the 1997 Nationwide Inpatient Sample, 1997 Current Population Survey and 1997 National Health Interview Survey, to calculate rates of preventable hospitalization, and the prevalence of ambulatory care sensitive conditions, for African Americans, Hispanics and non-Hispanic whites. Rates were calculated for ages 19-64, and 65 and over. Preventable hospitalization rates that accounted for underlying hospitalization patterns were also estimated. A final set of estimations adjusted the preventable hospitalization rates for disease prevalence. RESULTS: Preventable hospitalization rates were notably higher for African Americans and Hispanics than for non-Hispanic whites for almost all of the conditions, both for women and men and for both age groups. Rates adjusted for underlying hospitalization patterns showed a similar pattern. Adjusted for disease prevalence, rate differences remained notably large for both women and men, and for both age groups. Particularly great, for both African Americans and Hispanics of both sexes, are the risks of preventable hospitalization for asthma, diabetes and hypertension. CONCLUSION: African Americans and Hispanics have high preventable hospitalization rates for major chronic conditions, even after disease prevalence and underlying hospital utilization patterns are considered. These rates are particularly high for asthma, diabetes and hypertension, which are amenable to prevention and management interventions. Our results suggest a need to improve access to quality primary health care for African Americans and Hispanics in the USA, and for enhanced support of targeted prevention efforts.

Adult↗

PubMed2006

Access to health care and hospitalization for ambulatory care sensitive conditions.

Hospitalization for Ambulatory Care Sensitive Conditions (ACSH) is an accepted indicator of access to health care and avoidable morbidity. Accessible care of reasonable quality should reduce ACSH. Little research has examined the indicator's external validity. We calculated standardized ACSH rates for 32 areas of Victoria, Australia (population 4.4 million). A representative survey measured access, disease prevalence, propensity to seek care, disease burden, social determinants of health services use, and behavioral risk factors. Regression analyses compared self-rated access with ACSH rates. Independent of prevalence, propensity to seek care, disease burden, and physician supply, better access was associated with lower ACSH rates. Results provide support for the ACSH indicator. When rural residence was considered, the covariate measuring access was not significant. However, rural residence also may contribute importantly to access. Results suggest both the complexity of the meaning of access and the desirability of further research to validate the ACSH indicator.

Adolescent↗

PubMed2006

Home- and community-based service use by older African American, Hispanic, and non-Hispanic white women and men.

This study examined associations between use of home- and community-based services and race, ethnicity, and gender. Using the 1994 Second Longitudinal Study of Aging (n = 9,447) and descriptive, standard logistic, and multinomial logistic analyses, both the likelihood of service use and intensity of use were examined for nine home- and community-based services. In descriptive analyses, African Americans used the largest number of services, followed by Hispanics, and non-Hispanic whites. In multivariate results, all compared with non-Hispanic white women, African American women had higher odds of using Personal Care Aides, Transportation, Adult Day Centers, and Information and Referral. Hispanic women had higher odds of using Adult Day Centers and Transportation services. Non-Hispanic white men were less likely to use Personal Care Aides, Senior Centers, and Transportation. In the intensity analysis, compared with non-Hispanic white women, African American women used services more intensively. Non-Hispanic white men used services less intensively. Results highlight the need for flexibility in services provision, and a continued emphasis on supporting a range of services.

Black or African American↗

PubMed2005

More may be better: evidence of a negative relationship between physician supply and hospitalization for ambulatory care sensitive conditions.

OBJECTIVE: To conduct an empirical test of the relationship between physician supply and hospitalization for ambulatory care sensitive conditions (ACSH). DATA SOURCES/STUDY SETTING: A data set of county ACSH rates compiled by the Safety Net Monitoring Initiative of the Agency for Healthcare Research and Quality (AHRQ). The analytical data set consists of 642 urban counties and 306 rural counties. We supplemented the AHRQ data with data from the Area Resource File and the Environmental Protection Agency. STUDY DESIGN: Ordinary least squares regression estimated ACSH predictors. Physician supply, the independent variable of interest in this analysis, was measured as a continuous variable (MDs/100,000). Urban and rural areas were modeled separately. Separate models were estimated for ages 0-17, 18-39, and 40-64. DATA EXTRACTION METHODS: Data were limited to 20 states having more than 50 percent of counties with nonmissing data. PRINCIPAL FINDINGS: In the urban models for ages 0-17, standardized estimates indicate that, among the measured covariates in our model, physician supply has the largest negative adjusted relationship with ACSH (p<.0001). For ages 18-39 and 40-64, physician supply has the second largest negative adjusted relationship with ACSH (p<.0001, both age groups). Physician supply was not associated with ACSH in rural areas. CONCLUSIONS: Physician supply is positively associated with the overall performance of the primary health care system in a large sample of urban counties of the United States.

Adolescent↗

PubMed2005

Delivery complications associated with prenatal care access for Medicaid-insured mothers in rural and urban hospitals.

CONTEXT: Pregnancy complications affect many women. It is likely that some complications can be avoided through routine primary and prenatal care of reasonable quality. PURPOSE: The authors examined access to health care during pregnancy for mothers insured by Medicaid. The access indicator is potentially avoidable maternity complications (PAMCs). Potentially avoidable maternity complications are often preventable through routine prenatal care, such as infection screening and treatment. The authors examined the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity. METHODS: Data are from the year 2000 Nationwide Inpatient Sample (NIS). The stratified sample represents all discharges from 20.5% of community hospitals in the United States. The Nationwide Inpatient Sample identifies hospital locations, but not patients' areas of residence. Analyses, which accounted for the sample design, included calculation of potentially avoidable maternity complication rates by race or ethnicity, chi2, t tests, and multivariate logistic regression. FINDINGS: Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals (odds ratio, 0.78; CI, 0.62 to 0.99). In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non-Hispanic whites (odds ratio, 1.72; CI, 1.26 to 2.36). In urban hospitals, risk of potentially avoidable maternity complications was not significantly higher for African Americans. Hispanics and Asians had notably lower risks of potentially avoidable maternity complications in urban hospitals than did non-Hispanic whites. CONCLUSIONS: Providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.

Adolescent↗

PubMed2005

Potentially avoidable maternity complications: an indicator of access to prenatal and primary care during pregnancy.

OBJECTIVE: We identified Potentially Avoidable Maternity Complications (PAMCs). Used with hospital discharge data, PAMCs may indicate lack of prenatal care access. METHODS: A research team of two obstetrician/gynecologists and three health services researchers developed the PAMC indicator, which was verified by external review. AIM 1 used the National Maternal and Infant Health Survey, with prenatal care information and 8,661 pregnancy hospitalizations, to examine associations between prenatal care, risk factors, and PAMCs. AIM 2 used the 1997 Nationwide Inpatient Sample (NIS), with 895,259 pregnancy-related hospitalizations, to examine PAMC risks for groups likely to have prenatal care access problems. RESULTS: In AIM 1, adequate prenatal care reduced PAMC risks by 57% (p < .01). Compared to nonsmokers, the odds of a PAMC for smokers were 86% higher (p < .01). Cocaine use increased PAMC risk notably (odds ratio 3.35, p < .0001). In the multivariate analyses of AIM 2, African Americans, the uninsured, and Medicaid beneficiaries had high PAMC risks (all p < .0001). CONCLUSIONS: Findings suggest adequate prenatal care may reduce PAMC risks. Results for groups with less prenatal care access were consistent with previous research using less refined indicators, such as low birth weight. PAMCs improve on earlier measures, and readily permit adjustments for mothers' ages and comorbidities.

Adolescent↗

PubMed2004

Physician supply, physician diversity, and outcomes of primary health care for older persons in the United States.

This study examines effects of physician supply and diversity on hospitalization for ambulatory care sensitive conditions (ACSH). Data are from 31 metropolitan areas in the 1984-1990 United States Longitudinal Study of Aging, and the Area Resource File. Discrete-time hazard models estimate ACSH risk. High ACSH risk may indicate problems with the accessibility or quality of primary care. Results show low supply areas have high risk. Adequate supply areas have significantly lower risk. Areas with greater supply have high risk, which may indicate supplier-induced hospitalization. Greater physician diversity reduces ACSH risk. Results support policies promoting physician placement in underserved areas, and those that educate minority physicians.

Aged↗

PubMed2004

Patient perceptions of service quality in group versus solo practice clinics.

OBJECTIVE: To compare patient perceptions of service quality at solo and group practices, and to examine the association of perceptions with 'potential patient loyalty' (PPL), the potential for seeking future service from the same clinic. DESIGN: A self-administered, cross-sectional survey of clinic outpatients, using an adapted SERVQUAL questionnaire translated into Chinese, with additional items on overall satisfaction and intent to return/recommend the clinic to others. Sampling and study subjects. Every third outpatient at all newly started group practices (four) and solo clinics (thirteen) in Taiwan in the preceding 4-7 months, including 150 and 50 patients from each group and solo practice, respectively, for a total of 1250 patients. MAIN OUTCOME MEASURES: Perceived service quality on five dimensions-tangibles, reliability, responsiveness, assurance, and empathy-and PPL. All constructs were measured on a five-point scale. RESULTS: After accounting for random effects of clinical and geographical location, group practice patients perceived significantly higher service quality on all dimensions relative to solo practice patients, after adjusting for age, gender, education, and illness type. All service quality dimensions except assurance were significantly positively associated with PPL after adjusting for age, gender, education, and illness type, and random effects at the clinical and geographical location levels. CONCLUSIONS: Patients perceive better service quality at group practices compared with solo practices on all dimensions. Patients' quality perceptions are significant predictors of PPL. The implications for physician practices both internationally and in Taiwan are discussed, as well as policy implications for the Taiwan government.

Adolescent↗

PubMed2004

Nonoccupational physical activity by degree of urbanization and U.S. geographic region.

PURPOSE: To estimate levels of nonoccupational leisure-time physical activity (LTPA) by degree of urbanization and geographic region of the United States. METHODS: Participants were respondents to the Behavioral Risk Factor Surveillance System (BRFSS) in 2001 (N = 137,359). Moderate- and vigorous-intensity LTPA was categorized as meeting recommended levels, insufficient, or inactive. The U.S. Department of Agriculture rural-urban continuum codes were used to describe degrees of urbanization (metro, large urban, small urban, and rural). Geographic regions were defined by the U.S. Bureau of the Census (Northeast, Midwest, South, and West). Prevalence estimates were calculated using sample weights to account for the design of the BRFSS. Multivariate logistic regression analyses examined regional differences in the odds of physical inactivity (physically inactive vs insufficient or meets) by degree of urbanization after adjustment for sex, age, race, BMI, education, and occupational physical activity. RESULTS: Large urban areas (49.0%) and the western United States (49.0%) had the highest prevalence of recommended levels of LTPA. Rural areas (24.1%) and the southern United States (17.4%) had the highest prevalence of inactivity. Adults living in the four urbanization categories of the midwestern (metro (OR = 1.47, 95% CI = 1.31, 1.65), large urban (OR = 1.83, 95% CI = 1.51, 2.23), small urban (OR = 1.99, 95% CI = 1.65, 2.40), and rural (OR = 2.59, 95% CI = 1.35, 4.97)); and southern (metro (OR = 1.70, 95% CI = 1.53, 1.88), large urban (OR = 2.04, 95% CI = 1.72, 2.41), small urban (OR = 2.32, 95% CI = 2.02, 2.67), and rural (OR = 5.49, 95% CI = 2.82, 10.68)) U.S. regions were more likely to be inactive than adults living in similar areas of the western United States. Adults in northeast metro and large urban areas (OR = 1.62, 95% CI = 1.45, 1.81; and OR = 1.37, 95% CI = 1.08, 1.74, respectively) were more likely to be inactive than those residing in western metro and large urban areas. CONCLUSION: The prevalence of physical inactivity varies by degree of urbanization and geographic region of the United States.

Activities of Daily Living↗

PubMed2004

Insurance status and access to primary health care:disparate outcomes for potentially preventable hospitalization.

This study examines associations between hospitalization for ambulatory care sensitive (ACS) conditions and insurance status for working age adults, and for people age 65 and older. ACS hospitalization is a recognized indicator of access to primary care. Using data from the 1997 U.S. Nationwide Inpatient Sample and the U.S. Census, we calculate population-based rates of ACS hospitalization. We also use the 1997 Medical Expenditure Panel Survey to calculate the prevalence of ACS conditions in the groups studied. Among working age adults, those receiving Medicaid and the uninsured had higher ACS hospitalization rates than insured individuals, even after adjusting for the prevalence of ACS conditions. Among Medicare beneficiaries, those who also received Medicaid benefits had higher ACS hospitalization rates than others, again after adjusting for the prevalence of ACS conditions; those with private insurance supplementing Medicare had lower ACS hospitalization rates.

Adult↗

PubMed2003

Hospital utilization for ambulatory care sensitive conditions: health outcome disparities associated with race and ethnicity.

Our study examines associations between race and ethnicity and hospitalization for ambulatory care sensitive (ACS) conditions for working age adults, and for individuals age 65 or older. We use ACS hospitalization as an outcome indicator to evaluate access to primary care. The prevalence of ACS conditions in the population, including those not hospitalized, and the occurrence of ACS and non-ACS hospitalization, are estimated using nationally representative data from the 1997 US Medical Expenditure Panel Survey. We calculate population-based relative rates of ACS hospitalization using the 1997 Nationwide Inpatient Sample, a large sample of United States' community hospitals, and the US Census. We investigate the sensitivity of these relative rates to the inclusion of conditions for which hospitalization varies notably across areas, and adjust the rates for both underlying hospitalization patterns for non-ACS conditions, and for disease prevalence in the population groups studied. The analyses consistently show that African Americans and Hispanics have significantly higher rates of ACS hospitalization than non-Hispanic whites. This result applies to women and men, and both age groups studied. These higher rates persist after adjusting for disease prevalence and non-ACS admission rates, and for the inclusion of high variation conditions.

Adult↗

PubMed2003

Hazards of hospitalization for ambulatory care sensitive conditions among older women: evidence of greater risks for African Americans and Hispanics.

Hospitalization for Ambulatory Care Sensitive conditions (ACSH) has been widely accepted as an indicator of the accessibility and overall performance of primary health care. Previous studies have found conflicting evidence about ACSH disparities associated with race or ethnicity for older persons. This study estimates discrete-time ACSH hazards for women aged 69 or older, using longitudinal data with multivariate controls. Data are from the 1984 to 1990 Longitudinal Study of Aging, linked with Medicare claims. The multivariate results are adjusted for age, education, insurance and marital status, and other factors associated with health status and primary care access, and also for important indicators of need that include self-rated health, comorbidities, physical impairments, and previous hospitalizations. Many of these factors are permitted to vary across time for each individual, thus limiting measurement error. Results suggest that older African American and Hispanic women have markedly higher ACSH risks than older non-Hispanic white women.

Black or African American↗

PubMed2003

Increased hospitalization risk for recently widowed older women and protective effects of social contacts.

This study examines effects of recent widowhood on health for a nationally representative sample of older women in the United States. Mediating effects of social connectedness on the health of recently widowed women are also explored. Using data from the 1984-1990 Longitudinal Study of Aging and Medicare claims, discrete-time hazard models estimate the risk of hospitalization for any 30-day period for women who were married at the time of the baseline survey (n = 1,138). Compared to women who are not recently widowed, those recently widowed have a 40% higher risk of hospitalization. Social connectedness, measured by having phoned a friend/neighbor or family member in the period prior to the baseline survey, significantly decreases hospitalization risk for the recently widowed. The findings indicate that recent widowhood has a large adverse effect on the health of older women. Results highlight the need to provide additional support to recently widowed older women.

Aged↗

PubMed2002

Patterns of active life among older women: differences within and between groups.

This study examines the distribution of total, unimpaired, and impaired life for several groups of older women defined by race, education, and marital history. Using data from the 1984-1990 Longitudinal Study of Aging, we model transitions among functional statuses using discrete-time Markov chains, and use microsimulation to produce summary indices of active life. Remaining years of life and the proportion of remaining years with disability vary substantially, both within each group of women studied and between pairs of groups. Of all groups studied, never-married, more-educated white women live the longest, healthiest lives. Ever-married nonwhite women with low education have the shortest life expectancy, and experience the most disability. Our findings show that life expectancy is an incomplete indicator of the time women, in particular sub-groups, can expect to live with and without impairment. These findings highlight the heterogeneity of disability processes and life expectancy for older women.

Activities of Daily Living↗

PubMed2002

Recent perspectives on active life expectancy for older women.

This article provides a critical review of recent active life expectancy literature, describing trends of special interest to women. We review findings from leading perspectives used to study life expectancy and active life expectancy, including gender, racial and socioeconomic differences, disease-specific effects, and biodemography. We examine three competing theories of population health that frame active life expectancy research-compression of morbidity, expansion of morbidity, and dynamic equilibrium-concluding there is support for both the compression of morbidity and dynamic equilibrium theories. Policy implications for women include a greater understanding of the role of education and racial and ethnic diversity in active life trends, and an increased public policy emphasis on prevention and treatment of chronic disease, together with adoption of more healthy lifestyles.

Activities of Daily Living↗

PubMedDate not supplied

Evaluating hospital care for individuals with Alzheimer's disease using inpatient quality indicators.

The purpose of this study was to determine whether persons with Alzheimer's disease (AD) were at greater risk for in-hospital mortality than non-AD patients as a result of poor quality of care. The study focused on six common medical conditions that result in hospital mortality. Using 1995 to 2000 data from New York state (n = 7,021,065), analysts compared mortality risk for individuals with and without AD. Among men, adjusted odds of death were greater for those with AD for gastrointestinal (GI) hemorrhage (+52 percent), congestive heart failure (CHF) (+42 percent), hip fracture (+35 percent), and acute myocardial infarction (AMI) (+30 percent) (all p < .0001). Among women, AD did not affect risks for most conditions. The results of the study show that men with AD are at higher risk of hospital mortality for common medical conditions, which may indicate poor quality of care. Their risk of hospital death was greater than that of men without AD for AMI, CHF, hip fracture, and GI hemorrhage. Their risk was also greater than that of women with AD for CHF, pneumonia, hip fracture, and GI hemorrhage. With the exception of pneumonia, this risk difference notably exceeded the analogous difference between women and men without AD. Hospital staff should be alerted to greater mortality risk for men with AD, as this risk may indicate lower quality of care.

Aged↗