Journal of General Internal Medicine最新文献

Background: Given rising diabetes prevalence in the USA, especially among minoritized communities, it is critical to understand perception of diabetes risk and risk factors in the general population and in subpopulations known to be at increased risk for diabetes.

Objective: We aimed to describe overall and cause-specific perceived diabetes risk, especially racial and ethnic differences in perceived risk.

Design: Cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018, during which years the survey asked participants whether they believed they were at risk for diabetes, and if so, for what reason(s).

Participants: Adult participants in the NHANES without diagnosed diabetes.

Main measures: Self-reported race or ethnicity, as well as educational attainment and glycemic status, was examined as primary exposures. The primary outcomes examined were rates of overall and cause-specific perceived diabetes risk, in strata of race or ethnicity and either educational attainment or glycemic status.

Key results: Compared to non-Hispanic White (NHW) participants, perceived diabetes risk was higher among Mexican-American and Other/Multi-Racial participants and lower among non-Hispanic Asian (NHA) participants. Perceived race-related diabetes risk was higher in all minoritized groups. Perceived overall, family history-related, and race-related risk increased with increasing educational attainment among minoritized but not NHW participants, and with knowledge of pre-diabetes status among all groups (24% perceived risk if normoglycemia, 69% if known pre-diabetes). Family history was the most frequently reported cause for perceived diabetes risk in all groups. In adjusted analyses, race and ethnicity were strongly associated with perceived race-related diabetes risk.

Conclusions: Compared to NHW individuals, US adults of any other race or ethnicity perceived higher race-related diabetes risk, increasing with educational attainment. Further research is needed to explore the impact of this perceived risk on physical and mental health outcomes and health behaviors.

Background: High and rising prescription drug costs for asthma and chronic obstructive pulmonary disease (COPD) contribute to medication nonadherence and poor clinical outcomes. The recently enacted Inflation Reduction Act includes provisions that will cap out-of-pocket prescription drug spending at $2,000 per year and expand low-income subsidies. However, little is known about how these provisions will impact out-of-pocket drug spending for Medicare beneficiaries with asthma and COPD.

Objective: To estimate the impact of the Inflation Reduction Act's out-of-pocket spending cap and expansion of low-income subsidies on Medicare beneficiaries with obstructive lung disease.

Design: We calculated the number of Medicare beneficiaries ≥ 65 years with asthma and/or COPD and out-of-pocket prescription drug spending > $2,000/year, and then estimated their median annual out-of-pocket savings under the Inflation Reduction Act's spending cap. We then estimated the number of beneficiaries with incomes > 135% and ≤ 150% of the federal poverty level who would become newly eligible for low-income subsidies under this policy.

Participants: Respondents to the 2016-2019 Medical Expenditure Panel Survey (MEPS).

Main measures: Annual out-of-pocket prescription drug spending.

Key results: An annual estimated 5.2 million Medicare beneficiaries had asthma and/or COPD. Among them, 360,160 (SE ± 38,021) experienced out-of-pocket drug spending > $2,000/year, with median out-of-pocket costs of $3,003/year (IQR $2,360-$3,941). Therefore, median savings under the Inflation Reduction Act's spending cap would be $1,003/year (IQR $360-$1,941), including $738/year and $1,137/year for beneficiaries with asthma and COPD, respectively. Total annual estimated savings would be $504 million (SE ± $42 M). In addition, 232,155 (SE ± 4,624) beneficiaries would newly qualify for low-income subsidies, which will further reduce prescription drug costs.

Conclusions: The Inflation Reduction Act will have major implications on out-of-pocket prescription drug spending for Medicare beneficiaries with obstructive lung disease resulting in half-a-billion dollars in total out-of-pocket savings per year, which could ultimately have implications on medication adherence and clinical outcomes.