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| Economics Research: All Publications (in the database)List most recent publications in the database. :chronological alphabetical combined listing:%% Cox, Robynn J. @article{fds165354, Author = {R.J. Cox}, Title = {The Effect of the Prison Industry Enhancement Certificate Program on Labor Market Outcomes of Prison Releasees}, Year = {2009}, Abstract = {This article examines the effects of the federal Prison Industry Enhancement Certificate Program (PIE) on unemployment duration, length of employment, and earnings of inmates released between 1996 through 2001 across 5 states. This is the first nationally representative dataset of PIE and this is the first comprehensive study to analyze the effect of this program on labor market outcomes of the inmate. The results indicate that the PIE program may significantly decrease unemployment duration and increase the length of employment duration for both men and women. In addition, the PIE program may also significantly increase employment and earnings of the former male inmate. <a href="https://fds.duke.edu/db?attachment-25--11655-view-1047">download</a>}, Key = {fds165354} } %% Feunou Kamkui, Bruno @article{fds170317, Author = {B. Feunou Kamkui and Peter Christoffersen and Redouane Elkamhi and Kris Jacobs}, Title = {Option Valuation with Conditional Heteroskedasticity and Nonnormality}, Journal = {Review of Financial Studies}, Volume = {23}, Pages = {2139-2183}, Year = {2010}, Month = {May}, ISSN = {1465-7368}, url = {http://rfs.oxfordjournals.org/cgi/content/full/hhp078v1}, Abstract = {http://rfs.oxfordjournals.org/cgi/content/abstract/hhp078}, Key = {fds170317} } %% Kozecke, Lindsey Eldred @article{fds337008, Author = {Sloan, FA and Robinson, PA and Eldred, LM}, Title = {Advantageous Selection, Moral Hazard, and Insurer Sorting on Risk in the U.S. Automobile Insurance Market.}, Journal = {Journal of Risk and Insurance}, Volume = {85}, Number = {2}, Pages = {545-575}, Year = {2018}, Month = {June}, url = {http://dx.doi.org/10.1111/jori.12170}, Abstract = {This study quantifies the role of private information in automobile insurance policy choice using data on subjective beliefs, risk preference, reckless driving, the respondent's insurer and insurance policy characteristics merged with insurer-specific quality ratings distributed by independent organizations. We find a zero correlation between ex post accident risk and insurance coverage, reflecting advantageous selection in policy choice offset by moral hazard. Advantageous selection is partly attributable to insurer sorting on consumer attributes known and used by insurers. Our analysis of insurer sorting reveals that lower-risk drivers on attributes observed by insurers obtain coverage from insurers with higher-quality ratings.}, Doi = {10.1111/jori.12170}, Key = {fds337008} } @article{fds337009, Author = {Eldred, L and Gifford, EJ}, Title = {Downstream effects of criminal justice involvement}, Journal = {Corrdocs}, Volume = {21}, Number = {2}, Pages = {1-1}, Year = {2018}, Key = {fds337009} } @article{fds337010, Author = {Robinson, P and Sloan, F and Eldred, L}, Title = {Advantageous Selection, Moral Hazard, and Insurer Sorting on Risk in the U.S. Automobile Insurance Market}, Journal = {Journal of Risk and Insurance}, Volume = {85}, Number = {2}, Pages = {545-575}, Publisher = {WILEY}, Year = {2018}, Key = {fds337010} } @article{fds337011, Author = {Gifford, EJ and Eldred, LM and Mccutchan, SA and Sloan, FA}, Title = {Prosecution, Conviction, and Deterrence in Child Maltreatment Cases}, Journal = {Criminal Justice and Behavior}, Volume = {44}, Number = {10}, Pages = {1262-1280}, Publisher = {SAGE Publications}, Year = {2017}, Month = {October}, url = {http://dx.doi.org/10.1177/0093854817727795}, Doi = {10.1177/0093854817727795}, Key = {fds337011} } @article{fds325231, Author = {Sloan, FA and McCutchan, SA and Eldred, LM}, Title = {Alcohol-Impaired Driving and Perceived Risks of Legal Consequences.}, Journal = {Alcoholism, Clinical and Experimental Research}, Volume = {41}, Number = {2}, Pages = {432-442}, Year = {2017}, Month = {February}, url = {http://dx.doi.org/10.1111/acer.13298}, Abstract = {BACKGROUND:Driving while impaired (DWI) is a threat to public health. Codified legal sanctions are a widely implemented strategy to reduce DWI. However, it is unclear that sanctioning affects individual risk perceptions so as to deter alcohol-impaired driving. METHODS:Using survey data collected from individual drivers, police, and defense attorneys specializing in DWI in 8 U.S. cities, we investigated whether risk perceptions about legal consequences for alcohol-impaired driving, both the risk of being stopped if driving while alcohol-impaired and receiving specific penalties following a DWI, deter alcohol-impaired driving. First, we analyzed how different drivers' risk perceptions about being pulled over and facing criminal sanctions related to their self-reported alcohol-impaired driving in the year following the interview at which risk perceptions were elicited. Second, using data from an experimental module in which individual's risk perceptions were randomly updated by the interview, we analyzed how each driver's beliefs about his or her own future alcohol-impaired driving responded to randomly generated increases in the apprehension probability and sanction magnitude. RESULTS:Higher probabilities as estimated by the individuals of being pulled over corresponded to less alcohol-impaired driving in both analyses. Conversely, there was no statistical relationship between perceptions of criminal sanctions for DWI and alcohol-impaired driving with 1 exception-a small significant negative relationship between duration of jail time following a DWI conviction and alcohol-impaired driving. CONCLUSIONS:Perceptions regarding the threat of being apprehended for alcohol-impaired driving were related to actual self-reported driving, while perceived sanctions following a DWI conviction for DWI generally were unrelated to either actual self-reported alcohol-impaired driving or the person's estimate of probability that he or she would drive while alcohol-impaired in the following year. Increasing certainty of apprehension by increasing police staffing and/or conducting sobriety checks is a more effective strategy for reducing alcohol-impaired driving than legislating increased penalties for DWI.}, Doi = {10.1111/acer.13298}, Key = {fds325231} } @article{fds323888, Author = {Sloan, FA and Gifford, EJ and Eldred, LM and McCutchan, SA}, Title = {Does the probability of DWI arrest fall following participation in DWI and hybrid drug treatment court programs?}, Journal = {Accident; Analysis and Prevention}, Volume = {97}, Pages = {197-205}, Year = {2016}, Month = {December}, url = {http://dx.doi.org/10.1016/j.aap.2016.08.029}, Abstract = {Using North Carolina administrative data, this study examined recidivism following participation in specialty hybrid drug and driving while intoxicated (DWI) court programs. Three court program participation levels were considered-being referred to, enrolling in, and completing a specialty court program. Measures of DWI recidivism were: arrest and total number of arrests for DWI, and being convicted of DWI during follow-up periods of two and, alternatively, four years. Propensity score matching was used to obtain comparable control groups. Using a four-year follow-up, persons convicted of a DWI who completed a specialty court program were associated with a greater reduction in DWI re-arrests and re-convictions than did matched individuals who were never referred to a specialty court program. DWI courts were more effective in reducing re-arrests than hybrid drug courts were. Although promising from the vantage point of participants, few persons convicted of a DWI were referred to either court type, thus limiting this strategy's potential effectiveness in reducing DWI.}, Doi = {10.1016/j.aap.2016.08.029}, Key = {fds323888} } @article{fds325232, Author = {Eldred, LM and Gifford, EJ and McCutchan, SA and Sloan, FA}, Title = {Factors predicting prosecution of child maltreatment cases}, Journal = {Children and Youth Services Review}, Volume = {70}, Pages = {201-205}, Publisher = {Elsevier BV}, Year = {2016}, Month = {November}, url = {http://dx.doi.org/10.1016/j.childyouth.2016.09.025}, Doi = {10.1016/j.childyouth.2016.09.025}, Key = {fds325232} } @article{fds325233, Author = {Sloan, F and Eldred, L and McCutchan, S and Platt, A}, Title = {Deterring Rearrests for Drinking and Driving}, Journal = {Southern Economic Journal}, Volume = {83}, Number = {2}, Pages = {416-436}, Publisher = {WILEY}, Year = {2016}, Month = {October}, url = {http://dx.doi.org/10.1002/soej.12159}, Doi = {10.1002/soej.12159}, Key = {fds325233} } @article{fds325234, Author = {Gifford, EJ and Eldred, LM and Evans, KE and Sloan, FA}, Title = {Criminally Involved Parents Who Misuse Substances and Children's Odds of Being Arrested as a Young Adult: Do Drug Treatment Courts Mitigate the Risk?}, Journal = {Journal of Child and Family Studies}, Volume = {25}, Number = {8}, Pages = {2447-2457}, Year = {2016}, Month = {August}, url = {http://dx.doi.org/10.1007/s10826-016-0406-9}, Abstract = {This paper examined (1) the association between parents who are convicted of a substance-related offense and their children's probability of being arrested as a young adult and (2) whether or not parental participation in an adult drug treatment court program mitigated this risk. The analysis relied on state administrative data from North Carolina courts (2005-2013) and from birth records (1988-2003). The dependent variable was the probability that a child was arrested as a young adult (16-21). Logistic regression was used to compare groups and models accounted for the clustering of multiple children with the same mother. Findings revealed that children whose parents were convicted on either a substance-related charge on a non-substance-related charge had twice the odds of being arrested as young adult, relative to children whose parents had not been observed having a conviction. While a quarter of children whose parents participated in a drug treatment court program were arrested as young adults, parental completion this program did not reduce this risk. In conclusion, children whose parents were convicted had an increased risk of being arrested as young adults, irrespective of whether or not the conviction was on a substance-related charge. However, drug treatment courts did not reduce this risk. Reducing intergenerational links in the probability of arrest remains a societal challenge.}, Doi = {10.1007/s10826-016-0406-9}, Key = {fds325234} } @article{fds325235, Author = {Gifford, EJ and Eldred, LM and Sloan, FA and Evans, KE}, Title = {Parental Criminal Justice Involvement and Children's Involvement With Child Protective Services: Do Adult Drug Treatment Courts Prevent Child Maltreatment?}, Journal = {Substance Use & Misuse}, Volume = {51}, Number = {2}, Pages = {179-192}, Year = {2016}, Month = {January}, url = {http://dx.doi.org/10.3109/10826084.2015.1089906}, Abstract = {In light of evidence showing reduced criminal recidivism and cost savings, adult drug treatment courts have grown in popularity. However, the potential spillover benefits to family members are understudied.To examine: (1) the overlap between parents who were convicted of a substance-related offense and their children's involvement with child protective services (CPS); and (2) whether parental participation in an adult drug treatment court program reduces children's risk for CPS involvement.Administrative data from North Carolina courts, birth records, and social services were linked at the child level. First, children of parents convicted of a substance-related offense were matched to (a) children of parents convicted of a nonsubstance-related offense and (b) those not convicted of any offense. Second, we compared children of parents who completed a DTC program with children of parents who were referred but did not enroll, who enrolled for <90 days but did not complete, and who enrolled for 90+ days but did not complete. Multivariate logistic regression was used to model group differences in the odds of being reported to CPS in the 1 to 3 years following parental criminal conviction or, alternatively, being referred to a DTC program.Children of parents convicted of a substance-related offense were at greater risk of CPS involvement than children whose parents were not convicted of any charge, but DTC participation did not mitigate this risk. Conclusion/Importance: The role of specialty courts as a strategy for reducing children's risk of maltreatment should be further explored.}, Doi = {10.3109/10826084.2015.1089906}, Key = {fds325235} } @article{fds325236, Author = {Eldred, LM and Gifford, EJ}, Title = {Empirical evidence on legal levers aimed at addressing child maltreatment}, Journal = {Children and Youth Services Review}, Volume = {60}, Pages = {11-19}, Publisher = {Elsevier BV}, Year = {2016}, Month = {January}, url = {http://dx.doi.org/10.1016/j.childyouth.2015.11.014}, Doi = {10.1016/j.childyouth.2015.11.014}, Key = {fds325236} } @article{fds325237, Author = {Gifford, EJ and Sloan, FA and Eldred, LM and Evans, KE}, Title = {Intergenerational effects of parental substance-related convictions and adult drug treatment court participation on children's school performance.}, Journal = {The American Journal of Orthopsychiatry}, Volume = {85}, Number = {5}, Pages = {452-468}, Year = {2015}, Month = {September}, url = {http://dx.doi.org/10.1037/ort0000087}, Abstract = {This study examined the intergenerational effects of parental conviction of a substance-related charge on children's academic performance and, conditional on a conviction, whether completion of an adult drug treatment court (DTC) program was associated with improved school performance. State administrative data from North Carolina courts, birth records, and school records were linked for 2005-2012. Math and reading end-of-grade test scores and absenteeism were examined for 5 groups of children, those with parents who: were not convicted on any criminal charge, were convicted on a substance-related charge and not referred by a court to a DTC, were referred to a DTC but did not enroll, enrolled in a DTC but did not complete, and completed a DTC program. Accounting for demographic and socioeconomic factors, the school performance of children whose parents were convicted of a substance-related offense was worse than that of children whose parents were not convicted on any charge. These differences were statistically significant but substantially reduced after controlling for socioeconomic characteristics; for example, mother's educational attainment. We found no evidence that parent participation in an adult DTC program led to improved school performance of their children. While the children of convicted parents fared worse on average, much--but not all--of this difference was attributed to socioeconomic factors, with the result that parental conviction remained a risk factor for poorer school performance. Even though adult DTCs have been shown to have other benefits, we could detect no intergenerational benefit in improved school performance of their children.}, Doi = {10.1037/ort0000087}, Key = {fds325237} } @article{fds325238, Author = {Sloan, FA and Eldred, LM}, Title = {Do preferences of drinker-drivers differ?}, Journal = {International Journal of Health Economics and Management}, Volume = {15}, Number = {2}, Pages = {241-268}, Year = {2015}, Month = {June}, url = {http://dx.doi.org/10.1007/s10754-015-9169-x}, Abstract = {Why people engage in illegal activities is not well understood. Using data collected for this research from eight cities in four states, this study investigates alternative explanations as to why people drive while intoxicated (DWI). We find that preferences and subjective beliefs about arrest/incarceration of persons who drink and drive do differ systematically from others in terms of benefits and costs of drink and driving, and in their risk tolerance. While most findings imply that DWI is a deliberate choice, we do find that drinker drivers tend to be more impulsive and lack self-control in their drinking.}, Doi = {10.1007/s10754-015-9169-x}, Key = {fds325238} } @article{fds324522, Author = {Gifford, EJ and Eldred, LM and McCutchan, SA and Sloan, FA}, Title = {The effects of participation level on recidivism: a study of drug treatment courts using propensity score matching.}, Journal = {Substance Abuse Treatment, Prevention, and Policy}, Volume = {9}, Pages = {40}, Year = {2014}, Month = {September}, url = {http://dx.doi.org/10.1186/1747-597X-9-40}, Abstract = {Empirical evidence has suggested that drug treatment courts (DTCs) reduce re-arrest rates. However, DTC program completion rates are low and little is known about the effectiveness of lower levels of program participation.We examined how DTC program referral, enrollment without completion, and completion, affected re-arrest rates during a two-year follow-up.We used statewide North Carolina data from criminal courts merged with DTC data. Propensity score matching was used to select comparison groups based on demographic characteristics, criminal histories, and drug of choice (when available). Average treatment effects on the treated were computed.DTC participation levels included referral without enrollment, (n = 2,174), enrollment without completion (n = 954), and completion (n = 747). Recidivism measured as re-arrest on a substance-related charge, on a violent offense charge not involving an allegation of substance abuse, and on any charge (excluding infractions) was examined by felony and misdemeanor status during a two-year follow-up period.Re-arrest rates were high, 53-76 percent. In general, re-arrest rates were similar for individuals who were referred but who did not enroll and a matched comparison group consisting of individuals who were not referred. In contrast, enrollees who did not complete had lower re-arrest rates than a matched group of individuals who were referred but did not enroll, for arrests on any charge, on any felony charge, and on substance-related charges (felonies and misdemeanors). Finally, relative to persons who enrolled but did not complete, those who completed had lower re-arrest rates on any charge, any felony charge, any misdemeanor charge, any substance-related charge, any substance-related misdemeanor or felony charge, and any violent felony charge.Enrolling in a DTC, even without completing, reduced re-arrest rates. Given the generally low DTC completion rate, this finding implies that only examining effects of completion underestimates the benefits of DTC programs.}, Doi = {10.1186/1747-597X-9-40}, Key = {fds324522} } @article{fds325240, Author = {Sloan, FA and Eldred, LM and Davis, DV}, Title = {Addiction, drinking behavior, and driving under the influence.}, Journal = {Substance Use & Misuse}, Volume = {49}, Number = {6}, Pages = {661-676}, Year = {2014}, Month = {May}, url = {http://dx.doi.org/10.3109/10826084.2013.858167}, Abstract = {Using a survey of drinkers (N = 1,634), we evaluated alternative explanations of heavy and binge drinking, driving under the influence (DUI), DUI arrests, speeding citations, and chargeable accidents. Explanations included socializing, short-term decision-making, unrealistic optimism, risk preferring behavior, and addiction. Most consistent relationships were between substance use and alcohol addiction and dependent variables for (1) binge drinking and (2) DUI episodes. Respondent characteristics (age, marital and employment status, race, etc.) had important roles for DUI arrests. Drinker-drivers and those arrested for DUI are partially overlapping groups with implications for treatment and policies detecting and incapacitating persons from drinking and driving.}, Doi = {10.3109/10826084.2013.858167}, Key = {fds325240} } @article{fds325241, Author = {Sloan, FA and Eldred, LM and Xu, Y}, Title = {The behavioral economics of drunk driving.}, Journal = {Journal of Health Economics}, Volume = {35}, Pages = {64-81}, Year = {2014}, Month = {May}, url = {http://dx.doi.org/10.1016/j.jhealeco.2014.01.005}, Abstract = {This study investigates whether drinker-drivers attributes are associated with imperfect rationality or irrationality. Using data from eight U.S. cities, we determine whether drinker-drivers differ from other drinkers in cognitive ability, ignorance of driving while intoxicated (DWI) laws, have higher rates of time preference, are time inconsistent, and lack self-control on other measures. We find that drinker-drivers are relatively knowledgeable about DWI laws and do not differ on two of three study measures of cognitive ability from other drinkers. Drinker-drivers are less prone to plan events involving drinking, e.g., selecting a designated driver in advance of drinking, and are more impulsive. Furthermore, we find evidence in support of hyperbolic discounting. In particular, relative to non-drinker-drivers, the difference between short- and long-term discount rates is much higher for drinker-drivers than for other drinkers. Implications of our findings for public policy, including incapacitation, treatment, and educational interventions, are discussed.}, Doi = {10.1016/j.jhealeco.2014.01.005}, Key = {fds325241} } @article{fds325242, Author = {Griffin, CL and Sloan, FA and Eldred, LM}, Title = {CORRECTIONS FOR RACIAL DISPARITIES IN LAW ENFORCEMENT.}, Journal = {William and Mary Law Review}, Volume = {55}, Number = {4}, Pages = {1365-1427}, Year = {2014}, Month = {April}, Abstract = {Much empirical analysis has documented racial disparities at the beginning and end stages of a criminal case. However, our understanding about the perpetuation of - and even corrections for - differential outcomes as the process unfolds remains less than complete. This Article provides a comprehensive examination of criminal dispositions using all DWI cases in North Carolina during the period 2001-2011, focusing on several major decision points in the process. Starting with pretrial hearings and culminating in sentencing results, we track differences in outcomes by race and gender. Before sentencing, significant gaps emerge in the severity of pretrial release conditions that disadvantage black and Hispanic defendants. Yet when prosecutors decide whether to pursue charges, we observe an initial correction mechanism: Hispanic men are almost two-thirds more likely to have those charges dropped relative to white men. Although few cases survive after the plea bargaining stage, a second correction mechanism arises: Hispanic men are substantially less likely to receive harsher sentences and are sent to jail for significantly less time relative to white men. The first mechanism is based in part on prosecutors' reviewing the strength of the evidence but much more on declining to invest scarce resources in the pursuit of defendants who fail to appear for trial. The second mechanism seems to follow more directly from judicial discretion to reverse decisions made by law enforcement. We discuss possible explanations for these novel empirical results and review methods for more precisely identifying causal mechanisms in criminal justice.}, Key = {fds325242} } @article{fds325239, Author = {Gifford, EJ and Eldred, LM and Vernerey, A and Sloan, FA}, Title = {How does family drug treatment court participation affect child welfare outcomes?}, Journal = {Child Abuse & Neglect}, Volume = {38}, Number = {10}, Pages = {1659-1670}, Year = {2014}, Month = {January}, url = {http://dx.doi.org/10.1016/j.chiabu.2014.03.010}, Abstract = {© 2014 Elsevier Ltd. Parental substance use is a risk factor for child maltreatment. Family drug treatment courts (FDTCs) have emerged in the United States as a policy option to treat the underlying condition and promote family preservation. This study examines the effectiveness of FDTCs in North Carolina on child welfare outcomes. Data come from North Carolina records from child protection services, court system, and birth records. Three types of parental participation in a FDTC are considered: referral, enrolling, and completing an FDTC. The sample includes 566 children who were placed into foster care and whose parents participated in a FDTC program. Findings indicate that children of parents who were referred but did not enroll or who enrolled but did not complete had longer stays in foster care than children of completers. Reunification rates for children of completers were also higher. Outcomes for children in the referred and enrolled groups did not differ in the multivariate analyses. While effective substance use treatment services for parents may help preserve families, future research should examine factors for improving participation and completion rates as well as factors involved in scaling programs so that more families are served.}, Doi = {10.1016/j.chiabu.2014.03.010}, Key = {fds325239} } @article{fds337012, Author = {Nouri, K and Huber, D and Walch, K and Promberger, R and Buerkle, B and Ott, J and Tempfer, CB}, Title = {Fertility awareness among medical and non-medical students: a case-control study}, Journal = {Reproductive Biology and Endocrinology}, Volume = {12}, Number = {1}, Pages = {94-94}, Publisher = {Springer Nature}, Year = {2014}, url = {http://dx.doi.org/10.1186/1477-7827-12-94}, Doi = {10.1186/1477-7827-12-94}, Key = {fds337012} } @article{fds325243, Author = {Sloan, FA and Eldred, LM and Guo, T and Xu, Y}, Title = {Are People Overoptimistic about the Effects of Heavy Drinking?}, Journal = {Journal of Risk and Uncertainty}, Volume = {47}, Number = {1}, Pages = {93-127}, Year = {2013}, Month = {August}, url = {http://dx.doi.org/10.1007/s11166-013-9172-x}, Abstract = {We test whether heavy or binge drinkers are overly optimistic about probabilities of adverse consequences from these activities or are relatively accurate about these probabilities. Using data from a survey in eight cities, we evaluate the relationship between subjective beliefs and drinking. We assess accuracy of beliefs about several outcomes of heavy/binge drinking: reduced longevity, liver disease onset, link between alcohol consumption and Driving While Intoxicated (DWI), probability of an accident after drinking, accuracy of beliefs about encountering intoxicated drivers on the road, and legal consequences of DWI-ranging from being stopped to receiving fines and jail terms. Overall, there is no empirical support for the optimism bias hypothesis. We do find that persons consuming a lot of alcohol tend to be more overconfident about their driving abilities and ability to handle alcohol. However, such overconfidence does not translate into over-optimism about consequences of high levels of alcohol consumption.}, Doi = {10.1007/s11166-013-9172-x}, Key = {fds325243} } @article{fds325244, Author = {Sloan, FA and Chepke, LM and Davis, DV}, Title = {Race, gender, and risk perceptions of the legal consequences of drinking and driving.}, Journal = {Journal of Safety Research}, Volume = {45}, Pages = {117-125}, Year = {2013}, Month = {June}, url = {http://dx.doi.org/10.1016/j.jsr.2013.01.007}, Abstract = {This study investigated whether subjective beliefs about the consequences of driving while intoxicated (DWI) differ by race/gender.Beliefs affect driving behaviors and views of police/judicial fairness. The researchers compared risk perceptions of DWI using a survey of drinkers in eight cities in four states with actual arrest and conviction rates and fines from court data in the same cities.With state arrest data as a benchmark, Black males were overly pessimistic about being stopped, whether or not actual drinking occurred, and attributed higher jail penalties to DWI conviction. That Black males overestimated jail sentences incurred by the general population suggests that they did not attribute higher jail penalties to racial bias. Arrest data did not reveal disparities in judicial outcomes following DWI arrest.Blacks' subjective beliefs about DWI consequences may reflect social experiences, which are not jurisdiction- or crime-specific; this is a challenge to policymakers aiming to deter DWI by changing statutes and enforcement.If perception of bias exists despite no actual bias, a change in enforcement policy would not be effective, but a public relations campaign would be helpful in realigning beliefs.}, Doi = {10.1016/j.jsr.2013.01.007}, Key = {fds325244} } @article{fds325245, Author = {Sloan, FA and Chepke, LM and Davis, DV and Acquah, K and Zold-Kilbourn, P}, Title = {Effects of admission and treatment strategies of DWI courts on offender outcomes.}, Journal = {Accident; Analysis and Prevention}, Volume = {53}, Pages = {112-120}, Year = {2013}, Month = {April}, url = {http://dx.doi.org/10.1016/j.aap.2012.12.033}, Abstract = {The purpose of this study is to classify DWI courts on the basis of the mix of difficult cases participating in the court (casemix severity) and the amount of involvement between the court and participant (service intensity). Using our classification typology, we assessed how casemix severity and service intensity are associated with program outcomes. We expected that holding other factors constant, greater service intensity would improve program outcomes while a relatively severe casemix would result in worse program outcomes.The study used data from 8 DWI courts, 7 from Michigan and 1 from North Carolina. Using a 2-way classification system based on court casemix severity and program intensity, we selected participants in 1 of the courts, and alternatively 2 courts as reference groups. Reference group courts had relatively severe casemixes and high service intensity. We used propensity score matching to match participants in the other courts to participants in the reference group court programs. Program outcome measures were the probabilities of participants': failing to complete the court's program; increasing educational attainment; participants improving employment from time of program enrollment; and re-arrest.For most outcomes, our main finding was that higher service intensity is associated with better outcomes for court participants, as anticipated, but a court's casemix severity was unrelated to study outcomes.Our results imply that devoting more resources to increasing duration of treatment is productive in terms of better outcomes, irrespective of the mix of participants in the court's program.}, Doi = {10.1016/j.aap.2012.12.033}, Key = {fds325245} } @article{fds325246, Author = {Sloan, FA and Platt, AC and Chepke, LM and Blevins, CE}, Title = {Deterring domestic violence: Do criminal sanctions reduce repeat offenses?}, Journal = {Journal of Risk and Uncertainty}, Volume = {46}, Number = {1}, Pages = {51-80}, Publisher = {Springer Nature}, Year = {2013}, Month = {February}, url = {http://dx.doi.org/10.1007/s11166-012-9159-z}, Doi = {10.1007/s11166-012-9159-z}, Key = {fds325246} } @article{fds325247, Author = {Sloan, FA and Gifford, EJ and Eldred, LM and Acquah, KF and Blevins, CE}, Title = {Do specialty courts achieve better outcomes for children in foster care than general courts?}, Journal = {Evaluation Review}, Volume = {37}, Number = {1}, Pages = {3-34}, Year = {2013}, Month = {February}, url = {http://dx.doi.org/10.1177/0193841x13487536}, Abstract = {OBJECTIVE: This study assessed the effects of unified family and drug treatment courts (DTCs) on the resolution of cases involving foster care children and the resulting effects on school performance. METHOD: The first analytic step was to assess the impacts of presence of unified and DTCs in North Carolina counties on time children spent in foster care and the type of placement at exit from foster care. In the second step, the same data on foster care placements were merged with school records for youth in Grades 3-8 in public schools. The effect of children's time in foster care and placement outcomes on school performance as measured by math and reading tests, grade retention, and attendance was assessed using child fixed-effects regression. RESULTS: Children in counties with unified family courts experienced shorter foster care spells and higher rates of reunification with parents or primary caregivers. Shorter foster care spells translated into improved school performance measured by end-of-grade reading and math test scores. Adult DTCs were associated with lower probability of reunification with parents/primary caregivers. CONCLUSION: The shortened time in foster care implies an efficiency gain attributable to unified family courts, which translate into savings for the court system through the use of fewer resources. Children also benefit through shortened stays in temporary placements, which are related to some improved educational outcomes.}, Doi = {10.1177/0193841x13487536}, Key = {fds325247} } @article{fds325248, Author = {Sloan, FA and Chepke, L}, Title = {Litigation, Settlement, and the Public Welfare: Lessons from the Master Settlement Agreement}, Journal = {Widener Law Review}, Volume = {17}, Number = {1}, Pages = {159-226}, Year = {2011}, Key = {fds325248} } @article{fds325249, Author = {Sloan, F and Chepke, L}, Title = {From medical malpractice to quality assurance}, Journal = {Issues in Science and Technology}, Volume = {24}, Number = {3}, Pages = {63-70}, Year = {2008}, Month = {March}, Abstract = {Health care service providers in the US need to implementing a proper a medical malpractice system that focuses on compensating patients for medical errors and finding ways to prevent these errors from occurring. The service providers need to eliminate misconceptions about the problems associated with the medical malpractice system, as a first step toward solving real problems of medical errors and low level of quality assurance. Steps can be taken, to reconstruct the system aimed at improving the quality of medical care, by giving medical professionals better incentives, to deliver the services that people need. A number of options exist, to reform the medical malpractice system, such as enterprise insurance that has the potential to provide the initiative for systematic change.}, Key = {fds325249} } @book{fds337032, Author = {Sloan, F and Chepke, L}, Title = {Medical Malpractice}, Publisher = {M I T PRESS}, Year = {2008}, ISBN = {9780262515160}, Key = {fds337032} } @article{fds325250, Author = {Sloan, FA and Chepke, LM}, Title = {The Law and Economics of Public Health}, Journal = {Foundations and Trends® in Microeconomics}, Volume = {3}, Number = {5-6}, Pages = {331-490}, Publisher = {Now Publishers}, Year = {2007}, url = {http://dx.doi.org/10.1561/0700000020}, Abstract = {The fundamental question addressed by this paper is whether or not and the extent to which imposing tort liability on potential injurers improves the public's health. Conceptually, imposing the threat of litigation on potential injurers gives them an incentive to exercise more care than they would absent the threat. While the conclusion might seem to be obvious at first glance, in reality, the conclusion is far from obvious. For one, insurance coverage may blunt incentives to take care. Also, the tort system may operate far less perfectly than the theory would have it. In the end, the question must be answered on the basis of empirical evidence. © 2007 F. A. Sloan and L. M. Chepke.}, Doi = {10.1561/0700000020}, Key = {fds325250} } %% Rossi, Barbara @article{fds185522, Author = {B. Rossi and T. Sekhposyan}, Title = {Understanding Models' Economic Performance}, Journal = {Journal of Econometrics}, Year = {2010}, Key = {fds185522} } @article{fds185524, Author = {B. Rossi and R. Giacomini}, Title = {Advances in Forecasting under Model Instability}, Booktitle = {Handbook of Forecasting}, Editor = {Elsevier}, Year = {2010}, Key = {fds185524} } @article{fds185528, Author = {B. Rossi and R. Giacomini}, Title = {Forecasting in Macroeconomics}, Booktitle = {Handbook of Research Methods and Applications on Empirical Macroeconomics}, Year = {2010}, Key = {fds185528} } @misc{fds185523, Author = {B. Rossi}, Title = {Comment to: Forecast Rationality Tests Based on Multi-Horizon Bounds}, Journal = {Journal of Business and Economic Statistics}, Year = {2010}, Key = {fds185523} } @article{fds185519, Author = {A. Hall and A. Inoue and J. Nason and B. Rossi}, Title = {Information Criteria for Impulse Response Function Matching Estimation of DSGE Models}, Journal = {Journal of Econometrics}, Year = {2010}, Key = {fds185519} } @article{fds185520, Author = {A. Inoue and B. Rossi}, Title = {Identifying the Sources of Instabilities in Macroeconomic Fluctuations}, Journal = {Review of Economics and Statistics, forthcoming}, Year = {2010}, Key = {fds185520} } @article{fds185521, Author = {B. Rossi and A. Inoue}, Title = {Testing for Weak Identification in Possibly Nonlinear Models}, Journal = {Journal of Econometrics}, Year = {2010}, Key = {fds185521} } @article{fds161830, Author = {B. Rossi and S. Zubairy}, Title = {What is the Importance of Monetary and Fiscal Shocks in Explaining US Macroeconomic Fluctuations?}, Year = {2009}, Key = {fds161830} } @article{fds164746, Author = {Y. Chen and K. Rogoff and B. Rossi}, Title = {Can Exchange Rates Forecast Commodity Prices?}, Journal = {Quarterly Journal of Economics}, Year = {2009}, Key = {fds164746} } @article{fds148801, Author = {R. Giacomini and B. Rossi}, Title = {Detecting and Predicting Forecast Breakdown}, Journal = {Review of Economic Studies}, Year = {2009}, Key = {fds148801} } @article{fds161826, Author = {B. Rossi and T. Sekhoposyan}, Title = {Has Models’ Forecasting Performance Changed Over Time, and When?}, Journal = {International Journal of Forecasting}, Year = {2009}, Key = {fds161826} } @article{fds161828, Author = {B. Rossi and R. Giacomini}, Title = {Forecast Comparisons in Unstable Environments}, Journal = {Journal of Applied Econometrics}, Year = {2009}, Key = {fds161828} } @article{fds161827, Author = {M. Marcellino and B. Rossi}, Title = {Model Selection for Nested and Overlapping Non-Linear Dynamic and Possibly Misspecified Models}, Journal = {Oxford Bulletin of Economics and Statistics 70(s1)}, Year = {2008}, Key = {fds161827} } @misc{fds161831, Author = {Y. Chen and K. Rogoff and B. Rossi}, Title = {Where Are Commodity Prices Headed Next? Look at Exchange Rates}, Journal = {Vox}, Year = {2008}, Key = {fds161831} } @misc{fds164747, Author = {B. Rossi}, Title = {Comment on: Exchange Rate Models Are Not As Bad As You Think}, Journal = {NBER Macroeconomics Annual}, Year = {2007}, Key = {fds164747} } @misc{fds70260, Author = {B. Rossi and T. Sekhoposyan}, Title = {Has Models’ Forecasting Performance Changed Over Time, and Why?}, Year = {2007}, Key = {fds70260} } @article{fds142364, Author = {B. Rossi}, Title = {Expectations Hypotheses Tests at Long Horizons}, Journal = {Econometrics Journal}, Volume = {10}, Number = {3}, Year = {2007}, Key = {fds142364} } @article{fds70256, Author = {E. Pesavento and B. Rossi}, Title = {Impulse Response Confidence Intervals for Persistent Data: What Have We Learned?}, Journal = {Journal of Economic Dynamics and Control}, Volume = {31}, Year = {2007}, Key = {fds70256} } @article{fds70258, Author = {A. Inoue and B. Rossi}, Title = {Monitoring and Forecasting Financial Crises}, Journal = {Journal of Money, Credit and Banking}, Year = {2007}, Key = {fds70258} } @article{fds185530, Author = {R. Giacomini and B. Rossi}, Title = {Model Comparisons in Unstable Environments}, Journal = {work in progress}, Year = {2007}, Key = {fds185530} } @article{fds52920, Author = {R. Giacomini and B. Rossi}, Title = {How stable is the forecasting performance of the yield curve for output growth?}, Journal = {Oxford Bulletin of Economics and Statistics}, Volume = {68(s1)}, Year = {2006}, Month = {December}, Key = {fds52920} } @article{fds52921, Author = {E. Pesavento and B. Rossi}, Title = {Small Sample Confidence Bands for Multivariate Impulse Response Functions}, Journal = {Journal of Applied Econometrics}, Volume = {21(8)}, Year = {2006}, Month = {December}, Key = {fds52921} } @article{fds42405, Author = {B. Rossi}, Title = {Are Exchange Rates Really Random Walks? Some Evidence Robust to Parameter Instability}, Journal = {Macroeconomic Dynamics}, Volume = {10(1)}, Year = {2006}, Month = {February}, Key = {fds42405} } @article{fds42406, Author = {B. Rossi}, Title = {Confidence Intervals for Half-Life Deviations from Purchasing Power Parity}, Journal = {Journal of Business and Economic Statistics}, Volume = {23(4)}, Year = {2005}, Month = {October}, Key = {fds42406} } @article{fds42409, Author = {A. Inoue and B. Rossi}, Title = {Recursive Predictability Tests with Real-Time Data}, Journal = {Journal of Business and Economic Statistics}, Volume = {23(4)}, Year = {2005}, Month = {October}, Key = {fds42409} } @article{fds42411, Author = {B. Rossi}, Title = {"Optimal Tests for Nested Model Selection with Underlying Parameter Instability"}, Journal = {Econometric Theory}, Volume = {21(5)}, Year = {2005}, Month = {October}, Key = {fds42411} } @article{fds42407, Author = {E. Pesavento and B. Rossi}, Title = {Do Technology Shocks Drive Hours Up or Down? A Little Evidence From an Agnostic Procedure}, Journal = {Macroeconomic Dynamics}, Volume = {9(4)}, Year = {2005}, Month = {September}, Key = {fds42407} } @article{fds42408, Author = {B. Rossi}, Title = {Testing Long-Horizon Predictive Ability with High Persistence, and the Meese-Rogoff Puzzle}, Journal = {International Economic Review}, Volume = {46(1)}, Pages = {61-92}, Year = {2005}, Month = {February}, Key = {fds42408} } %% Tarozzi, Alessandro @article{fds184336, Author = {Irene Brambilla and Guido Porto and Alessandro Tarozzi}, Title = {Adjusting to Trade Policy: Evidence from U.S. Antidumping Duties on Vietnamese Catfish}, Journal = {Review of Economics and Statistics}, Year = {2010}, Key = {fds184336} } @article{fds184340, Author = {Lori Bennear and Alessandro Tarozzi and H B Soumya and Alex Pfaff and Ahmed Kazi Matin and Lex van Geen}, Title = {Bright Lines, Risk Beliefs, and Risk Avoidance: Evidence from a Randomized Experiment in Bangladesh}, Journal = {American Economic Journal: Applied Economics}, Year = {2010}, Key = {fds184340} } @misc{fds184339, Author = {Patricia Foo and Alessandro Tarozzi and Aprajit Mahajan and Joanne Yoong, Lakshmi Krishnan and Danel Kopf and Brian Blackburn}, Title = {Lymphatic Filariasis in Orissa, India: Expanded Endemic Range and A Call to Re-evaluate Targeting of Mass Drug Administration Programs}, Journal = {Accepted for Publication at Transactions of the Royal Society of Tropical Medicine and Hygiene}, Year = {2010}, Key = {fds184339} } @article{fds184341, Author = {Alessandro Tarozzi and Aprajit Mahajan and Brian Blackburn and Dan Kopf, Lakshmi Krishnan and Joanne Yoong.}, Title = {Micro-loans, bednets and malaria: Evidence from a randomized controlled trial in Orissa (India)}, Year = {2010}, Key = {fds184341} } @article{fds184342, Author = {Aprajit Mahajan and Alessandro Tarozzi}, Title = {Time Inconsistency, Expectations and Technology Adoption: The case of Insecticide Treated Nets}, Year = {2010}, Key = {fds184342} } @article{fds184343, Author = {Aprajit Mahajan and Alessandro Tarozzi}, Title = {Bednets, Information and Malaria in Orissa}, Year = {2010}, Key = {fds184343} } @article{fds184337, Author = {A. Tarozzi and A. Deaton}, Title = {Using Census and Survey Data to Estimate Poverty and Inequality for Small Areas}, Journal = {Review of Economics and Statistics}, Volume = {91}, Number = {4}, Pages = {773-792}, Year = {2009}, Key = {fds184337} } @misc{fds152887, Author = {Alessandro Tarozzi and Aprajit Mahajan and Joanne Yoong and Brian Blackburn}, Title = {Commitment Mechanisms and Compliance with Health-protecting Behavior: Preliminary Evidence from Orissa (India)}, Journal = {American Economic Review Papers and Proceedings}, Volume = {99}, Number = {2}, Pages = {231-235}, Year = {2009}, Key = {fds152887} } @article{fds161758, Author = {A. Tarozzi}, Title = {Growth Reference Charts and the Nutritional Status of Indian Children}, Journal = {Economics and Human Biology}, Volume = {6}, Number = {3}, Pages = {455-468}, Year = {2008}, url = {http://www.econ.duke.edu/~taroz/Tarozzi}, Key = {fds161758} } @article{fds161759, Author = {Alessandro Tarozzi and Aprajit Mahajan}, Title = {Child Nutrition in India in the Nineties}, Journal = {Economic Development and Cultural Change}, Volume = {55}, Number = {3}, Pages = {441-486}, Year = {2007}, url = {http://www.econ.duke.edu/~taroz/TarozziMahajan06.pdf}, Keywords = {Child Nutrition, India, Child Anthropometry}, Abstract = {India experienced several years of fast economic growth during the 1990s, and according to many observers this period also saw a considerable decline in poverty, especially in urban areas. We use data from two rounds of the National Family and Health Survey to evaluate changes in nutritional status between 1992-93 and 1998-99 among children of age 0 to 3. We find that measures of short-term nutritional status based on weight given height show large improvements, especially in urban areas. Height-forage, an indicator of long-term nutritional status, also shows improvements, but limited to urban areas. However, we also document that the changes in nutritional status were much more favorable for boys than for girls. The gender differences in the changes over time appear to be driven by states in North India, where the existence of widespread son preference has been documented by an immense body of research.}, Key = {fds161759} } @article{fds161760, Author = {Xiaohong Chen and Han Hong and Alessandro Tarozzi}, Title = {Semiparametric Efficiency in GMM Models with Auxiliary Data}, Journal = {Annals of Statistics}, Volume = {36}, Number = {2}, Pages = {808-843}, Year = {2007}, url = {http://www.econ.duke.edu/~taroz/ChenHongTarozziannaledition.pdf}, Key = {fds161760} } @article{fds161761, Author = {Alessandro Tarozzi}, Title = {Calculating Comparable Statistics from Incomparable Surveys, with an Application to Poverty in India}, Journal = {Journal of Business and Economic Statistics}, Volume = {25}, Number = {3}, Pages = {314-336}, Year = {2007}, Keywords = {Poverty, Inequality, India, Method of Moments, Survey Methods.}, Abstract = {Applied economists are often interested in studying trends in important economic indicators, such as inequality or poverty, but comparisons over time can be made impossible by changes in data collection methodology. We describe an easily implemented procedure, based on inverse probability weighting, that allows to recover comparability of estimated parameters identified implicitly by a moment condition. The validity of the procedure requires the existence of a set of auxiliary variables whose reports are not affected by the different survey design, and whose relation with the main variable of interest is stable over time. We analyze the asymptotic properties of the estimator taking into account the presence of clustering, stratification and sampling weights which characterize most household surveys. The main empirical motivation of the paper is provided by a recent controversy on the extent of poverty reduction in India in the 1990s. Due to important changes in the expenditure questionnaire adopted for data collection in the 1999-2000 round of the Indian National Sample Survey, the resulting poverty numbers are likely to understate poverty relative to the previous rounds. We use previous waves of the same survey to provide evidence supporting the plausibility of the identifying assumptions and conclude that most, but not all, of the very large reduction in poverty implied by the official figures appears to be real, and not a statistical artifact.}, Key = {fds161761} } @article{fds161763, Author = {Alessandro Tarozzi}, Title = {The Indian Public Distribution System as Provider of Food Security: Evidence from Child Anthropometry in Andhra Pradesh}, Journal = {European Economic Review}, Volume = {49}, Number = {5}, Pages = {1305-1330}, Year = {2005}, Month = {July}, Abstract = {We study whether a sudden increase of the price of rice supplied by the Indian Public Distribution System in Andhra Pradesh, a large Indian state, had a negative impact on child nutrition. A few months after the price increase, a health survey started to record weight for a large sample of children. The data collection continued for several months, so that children measured later lived for a longer period of time in a less favorable price regime. Using different estimation techniques we find that longer exposure to high prices are not accompanied by worse nutritional status, as measured by weight-for-age.}, Key = {fds161763} } @misc{fds30338, Author = {Angus Deaton and Alessandro Tarozzi}, Title = {Prices and Poverty in India}, Booktitle = {Data and Dogma: The Great Indian Poverty Debate}, Publisher = {Macmillan (New Delhi)}, Editor = {Angus Deaton and Valerie Kozel}, Year = {2004}, Key = {fds30338} } %% Yashkin, Arseniy @article{fds369683, Author = {Arbeev, KG and Bagley, O and Yashkin, AP and Duan, H and Akushevich, I and Ukraintseva, SV and Yashin, AI}, Title = {Understanding Alzheimer's disease in the context of aging: Findings from applications of stochastic process models to the Health and Retirement Study.}, Journal = {Mechanisms of Ageing and Development}, Volume = {211}, Pages = {111791}, Year = {2023}, Month = {April}, url = {http://dx.doi.org/10.1016/j.mad.2023.111791}, Abstract = {There is growing literature on applications of biodemographic models, including stochastic process models (SPM), to studying regularities of age dynamics of biological variables in relation to aging and disease development. Alzheimer's disease (AD) is especially good candidate for SPM applications because age is a major risk factor for this heterogeneous complex trait. However, such applications are largely lacking. This paper starts filling this gap and applies SPM to data on onset of AD and longitudinal trajectories of body mass index (BMI) constructed from the Health and Retirement Study surveys and Medicare-linked data. We found that APOE e4 carriers are less robust to deviations of trajectories of BMI from the optimal levels compared to non-carriers. We also observed age-related decline in adaptive response (resilience) related to deviations of BMI from optimal levels as well as APOE- and age-dependence in other components related to variability of BMI around the mean allostatic values and accumulation of allostatic load. SPM applications thus allow revealing novel connections between age, genetic factors and longitudinal trajectories of risk factors in the context of AD and aging creating new opportunities for understanding AD development, forecasting trends in AD incidence and prevalence in populations, and studying disparities in those.}, Doi = {10.1016/j.mad.2023.111791}, Key = {fds369683} } @article{fds369841, Author = {Akushevich, I and Yashkin, A and Kovtun, M and Kravchenko, J and Arbeev, K and Yashin, AI}, Title = {Forecasting prevalence and mortality of Alzheimer's disease using the partitioning models.}, Journal = {Exp Gerontol}, Volume = {174}, Pages = {112133}, Year = {2023}, Month = {April}, url = {http://dx.doi.org/10.1016/j.exger.2023.112133}, Abstract = {OBJECTIVES: Health forecasting is an important aspect of ensuring that the health system can effectively respond to the changing epidemiological environment. Common models for forecasting Alzheimer's disease and related dementias (AD/ADRD) are based on simplifying methodological assumptions, applied to limited population subgroups, or do not allow analysis of medical interventions. This study uses 5 %-Medicare data (1991-2017) to identify, partition, and forecast age-adjusted prevalence and incidence-based mortality of AD as well as their causal components. METHODS: The core underlying methodology is the partitioning analysis that calculates the relative impact each component has on the overall trend as well as intertemporal changes in the strength and direction of these impacts. B-spline functions estimated for all parameters of partitioning models represent the basis for projections of these parameters in future. RESULTS: Prevalence of AD is predicted to be stable between 2017 and 2028 primarily due to a decline in the prevalence of pre-AD-diagnosis stroke. Mortality, on the other hand, is predicted to increase. In all cases the resulting patterns come from a trade-off of two disadvantageous processes: increased incidence and disimproved survival. Analysis of health interventions demonstrates that the projected burden of AD differs significantly and leads to alternative policy implications. DISCUSSION: We developed a forecasting model of AD/ADRD risks that involves rigorous mathematical models and incorporation of the dynamics of important determinative risk factors for AD/ADRD risk. The applications of such models for analyses of interventions would allow for predicting future burden of AD/ADRD conditional on a specific treatment regime.}, Doi = {10.1016/j.exger.2023.112133}, Key = {fds369841} } @article{fds370816, Author = {Yashkin, AP and Gorbunova, GA and Tupler, L and Yashin, AI and Doraiswamy, M and Akushevich, I}, Title = {Differences in Risk of Alzheimer's Disease Following Later-Life Traumatic Brain Injury in Veteran and Civilian Populations.}, Journal = {The Journal of Head Trauma Rehabilitation}, Year = {2023}, Month = {February}, url = {http://dx.doi.org/10.1097/htr.0000000000000865}, Abstract = {<h4>Objective</h4>To directly compare the effect of incident age 68+ traumatic brain injury (TBI) on the risk of diagnosis of clinical Alzheimer's disease (AD) in the general population of older adults, and between male veterans and nonveterans; to assess how this effect changes with time since TBI.<h4>Setting and participants</h4>Community-dwelling traditional Medicare beneficiaries 68 years or older from the Health and Retirement Study (HRS).<h4>Design</h4>Fine-Gray models combined with inverse-probability weighting were used to identify associations between incident TBI, post-TBI duration, and TBI treatment intensity, with a diagnosis of clinical AD dementia. The study included 16 829 older adults followed over the 1991-2015 period. For analyses of veteran-specific risks, 4281 veteran males and 3093 nonveteran males were identified. Analysis of veteran females was unfeasible due to the age structure of the population. Information on occurrence(s) of TBI, and onset of AD and risk-related comorbidities was constructed from individual-level HRS-linked Medicare claim records while demographic and socioeconomic risk factors were based on the survey data.<h4>Results</h4>Later-life TBI was strongly associated with increased clinical AD risk in the full sample (pseudo-hazard ratio [HR]: 3.22; 95% confidence interval [CI]: 2.57-4.05) and in veteran/nonveteran males (HR: 5.31; CI: 3.42-7.94), especially those requiring high-intensity/duration care (HR: 1.58; CI: 1.29-1.91). Effect magnitude decreased with time following TBI (HR: 0.72: CI: 0.68-0.80).<h4>Conclusion</h4>Later-life TBI was strongly associated with increased AD risk, especially in those requiring high-intensity/duration care. Effect magnitude decreased with time following TBI. Univariate analysis showed no differences in AD risk between veterans and nonveterans, while the protective effect associated with veteran status in Fine-Gray models was largely due to differences in demographics, socioeconomics, and morbidity. Future longitudinal studies incorporating diagnostic procedures and documentation quantifying lifetime TBI events are necessary to uncover pathophysiological mediating and/or moderating mechanisms between TBI and AD.}, Doi = {10.1097/htr.0000000000000865}, Key = {fds370816} } @article{fds370204, Author = {Akushevich, I and Kravchenko, J and Yashkin, A and Doraiswamy, PM and Hill, CV and Alzheimer's Disease and Related Dementia Health Disparities Collaborative Group}, Title = {Expanding the scope of health disparities research in Alzheimer's disease and related dementias: Recommendations from the "Leveraging Existing Data and Analytic Methods for Health Disparities Research Related to Aging and Alzheimer's Disease and Related Dementias" Workshop Series.}, Journal = {Alzheimer'S & Dementia (Amsterdam, Netherlands)}, Volume = {15}, Number = {1}, Pages = {e12415}, Year = {2023}, url = {http://dx.doi.org/10.1002/dad2.12415}, Abstract = {Topics discussed at the "Leveraging Existing Data and Analytic Methods for Health Disparities Research Related to Aging and Alzheimer's Disease and Related Dementias" workshop, held by Duke University and the Alzheimer's Association with support from the National Institute on Aging, are summarized. Ways in which existing data resources paired with innovative applications of both novel and well-known methodologies can be used to identify the effects of multi-level societal, community, and individual determinants of race/ethnicity, sex, and geography-related health disparities in Alzheimer's disease and related dementia are proposed. Current literature on the population analyses of these health disparities is summarized with a focus on identifying existing gaps in knowledge, and ways to mitigate these gaps using data/method combinations are discussed at the workshop. Substantive and methodological directions of future research capable of advancing health disparities research related to aging are formulated.}, Doi = {10.1002/dad2.12415}, Key = {fds370204} } @article{fds364200, Author = {Akushevich, I and Yashkin, A and Kovtun, M and Yashin, AI and Kravchenko, J}, Title = {Underlying mechanisms of change in cancer prevalence in older U.S. adults: contributions of incidence, survival, and ascertainment at early stages.}, Journal = {Cancer Causes Control}, Volume = {33}, Number = {9}, Pages = {1161-1172}, Year = {2022}, Month = {September}, url = {http://dx.doi.org/10.1007/s10552-022-01595-6}, Abstract = {PURPOSE: To quantitatively evaluate contributions of trends in incidence, relative survival, and stage at diagnosis to the dynamics in the prevalence of major cancers (lung, prostate, colon, breast, urinary bladder, ovaries, stomach, pancreas, esophagus, kidney, liver, and skin melanoma) among older U.S. adults age 65 +. METHODS: Trend partitioning was applied to the Surveillance, Epidemiology, and End Results Program data for 1973-2016. RESULTS: Growth of cancer prevalence in older adults decelerated or even decreased over time for all studied cancers due to decreasing incidence and improving survival for most of cancers, with a smaller contribution of the stage at cancer diagnosis. Changes in the prevalence of cancers of the lung, colon, stomach, and breast were predominantly due to decreasing incidence, increasing survival and more frequent diagnoses at earlier stages. Changes in prevalence of some other cancers demonstrated adverse trends such as decreasing survival in localized and regional stages (urinary bladder and ovarian) and growing impact of late-stage diagnoses (esophageal cancer). CONCLUSION: While decelerating or decreasing prevalence of many cancers were due to a beneficial combination of decreasing incidence and increasing survival, there are cancers for which decelerating prevalence is due to lack of improvement in their stage-specific survival and/or increasing frequency of diagnosis at advanced stages. Overall, if the observed trends persist, it is likely that the burden associated with cancer prevalence in older U.S. adults will be lower comparing to projections based on constant increasing prevalence have previously estimated.}, Doi = {10.1007/s10552-022-01595-6}, Key = {fds364200} } @article{fds365173, Author = {Akushevich, I and Kolpakov, S and Yashkin, AP and Kravchenko, J}, Title = {Vulnerability to Hypertension Is a Major Determinant of Racial Disparities in Alzheimer's Disease Risk.}, Journal = {Am J Hypertens}, Volume = {35}, Number = {8}, Pages = {745-751}, Year = {2022}, Month = {August}, url = {http://dx.doi.org/10.1093/ajh/hpac063}, Abstract = {BACKGROUND: Higher incidence levels of Alzheimer's disease (AD) in Black Americans are well documented. However, quantitative explanations of this disparity in terms of risk-factor diseases acting through well-defined pathways are lacking. METHODS: We applied a Blinder-Oaxaca-based algorithm modified for censored data to a 5% random sample of Medicare beneficiaries age 65+ to explain Black/White disparities in AD risk in terms of differences in exposure and vulnerability to morbidity profiles based on 10 major AD-risk-related diseases. RESULTS: The primary contribution to racial disparities in AD risk comes from morbidity profiles that included hypertension with about 1/5th of their contribution due to differences in prevalence (exposure effect) and 4/5ths to differences in the effects of the morbidity profile on AD risk (vulnerability effect). In total, disease-related effects explained a higher proportion of AD incidence in Black Americans than in their White counterparts. CONCLUSIONS: Disease-related causes may represent some of the most straightforward targets for targeted interventions aimed at the reduction of racial disparities in health among US older adults. Hypertension is a manageable and potentially preventable condition responsible for the majority of the Black/White differences in AD risk, making mitigation of the role of this disease in engendering higher AD incidence in Black Americans a prominent concern.}, Doi = {10.1093/ajh/hpac063}, Key = {fds365173} } @article{fds363366, Author = {Akushevich, I and Yashkin, AP and Kravchenko, J and Kertai, MD}, Title = {Extended anesthesia exposure for abdominal and pelvic procedures in older adults with colorectal cancer: Associations with chart dementia diagnoses.}, Journal = {Exp Gerontol}, Volume = {164}, Pages = {111830}, Year = {2022}, Month = {July}, url = {http://dx.doi.org/10.1016/j.exger.2022.111830}, Abstract = {BACKGROUND: We hypothesized that cumulative anesthesia exposure over the course of routine treatment of colorectal cancer in older adults can increase long-term risk of Alzheimer's disease (AD), Alzheimer's disease-related dementias (ADRD), and other chronic neurocognitive disorders (CND). METHODS: We conducted a SEER-Medicare-based retrospective cohort study of 84,770 individuals age 65 years and older diagnosed with colorectal cancer between 1998 and 2007 using a proportional hazards model with inverse probability weighted estimators. The primary exploratory variable was a time-variant measure of cumulative anesthesia exposure for abdominal and pelvic procedures, updated continuously. RESULTS: Our primary outcomes, AD and ADRD, occurred in 6005/84,770 (7.1%) and 14,414/83,444 (17.3%) individuals respectively. No statistically significant association was found between cumulative anesthesia exposure and AD (hazard ratio [HR], 0.993; 95% CI, 0.973-1.013). However, it was moderately associated with the risk of ADRD (HR, 1.016; 95% CI, 1.004-1.029) and some secondary outcomes including most notably: cerebral degeneration (HR, 1.048; 95% CI, 1.033-1.063), hepatic encephalopathy (HR, 1.133; 95% CI, 1.101-1.167), encephalopathy-not elsewhere classified (HR,1.095; 95% CI: 1.076-1.115), and incident/perioperative delirium (HR, 1.022; 95% CI, 1.012-1.032). Furthermore, we observed an association between perioperative delirium and increased risk of AD (HR, 2.05; 95% CI, 1.92-2.09). CONCLUSION: Cumulative anesthesia exposure for abdominal and pelvic procedures was not associated with increased risk of AD directly and had a small but statistically significant association with ADRD and a number of other CNDs. Cumulative anesthesia exposure was also associated with perioperative delirium, which had an independent adverse association with AD risk.}, Doi = {10.1016/j.exger.2022.111830}, Key = {fds363366} } @article{fds363974, Author = {Yu, B and Akushevich, I and Yashkin, AP and Yashin, AI and Lyerly, HK and Kravchenko, J}, Title = {Epidemiology of geographic disparities in heart failure among US older adults: a Medicare-based analysis.}, Journal = {Bmc Public Health}, Volume = {22}, Number = {1}, Pages = {1280}, Year = {2022}, Month = {July}, url = {http://dx.doi.org/10.1186/s12889-022-13639-2}, Abstract = {BACKGROUND: There are prominent geographic disparities in the life expectancy (LE) of older US adults between the states with the highest (leading states) and lowest (lagging states) LE and their causes remain poorly understood. Heart failure (HF) has been proposed as a major contributor to these disparities. This study aims to investigate geographic disparities in HF outcomes between the leading and lagging states. METHODS: The study was a secondary data analysis of HF outcomes in older US adults aged 65+, using Center for Disease Control and Prevention sponsored Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database and a nationally representative 5% sample of Medicare beneficiaries over 2000-2017. Empiric estimates of death certificate-based mortality from HF as underlying cause of death (CBM-UCD)/multiple cause of death (CBM-MCD); HF incidence-based mortality (IBM); HF incidence, prevalence, and survival were compared between the leading and lagging states. Cox regression was used to investigate the effect of residence in the lagging states on HF incidence and survival. RESULTS: Between 2000 and 2017, HF mortality rates (per 100,000) were higher in the lagging states (CBM-UCD: 188.5-248.6; CBM-MCD: 749.4-965.9; IBM: 2656.0-2978.4) than that in the leading states (CBM-UCD: 79.4-95.6; CBM-MCD: 441.4-574.1; IBM: 1839.5-2138.1). Compared to their leading counterparts, lagging states had higher HF incidence (2.9-3.9% vs. 2.2-2.9%), prevalence (15.6-17.2% vs. 11.3-13.0%), and pre-existing prevalence at age 65 (5.3-7.3% vs. 2.8-4.1%). The most recent rates of one- (77.1% vs. 80.4%), three- (59.0% vs. 60.7%) and five-year (45.8% vs. 49.8%) survival were lower in the lagging states. A greater risk of HF incidence (Adjusted Hazards Ratio, AHR [95%CI]: 1.29 [1.29-1.30]) and death after HF diagnosis (AHR: 1.12 [1.11-1.13]) was observed for populations in the lagging states. The study also observed recent increases in CBMs and HF incidence, and declines in HF prevalence, prevalence at age 65 and survival with a decade-long plateau stage in IBM in both leading and lagging states. CONCLUSION: There are substantial geographic disparities in HF mortality, incidence, prevalence, and survival across the U.S.: HF incidence, prevalence at age 65 (age of Medicare enrollment), and survival of patients with HF contributed most to these disparities. The geographic disparities and the recent increase in incidence and decline in survival underscore the importance of HF prevention strategies.}, Doi = {10.1186/s12889-022-13639-2}, Key = {fds363974} } @article{fds361336, Author = {Nazarian, A and Arbeev, KG and Yashkin, AP and Kulminski, AM}, Title = {Genome-wide analysis of genetic predisposition to common polygenic cancers.}, Journal = {Journal of Applied Genetics}, Volume = {63}, Number = {2}, Pages = {315-325}, Year = {2022}, Month = {May}, url = {http://dx.doi.org/10.1007/s13353-021-00679-4}, Abstract = {Lung, breast, prostate, and colorectal cancers are among the most common and fatal malignancies worldwide. They are mainly caused by multifactorial mechanisms and are genetically heterogeneous. We investigated the genetic architecture of these cancers through genome-wide association, pathway-based, and summary-based transcriptome-/methylome-wide association analyses using three independent cohorts. Our genome-wide association analyses identified the associations of 33 single-nucleotide polymorphisms (SNPs) at P < 5E - 06, of which 32 SNPs were not previously reported and did not have proxy variants within their ± 1 Mb flanking regions. Moreover, other polymorphisms mapped to their closest genes were not previously associated with the same cancers at P < 5E - 06. Our pathway enrichment analyses revealed associations of 32 pathways; mainly related to the immune system, DNA replication/transcription, and chromosomal organization; with the studied cancers. Also, 60 probes were associated with these cancers in our transcriptome-wide and methylome-wide analyses. The ± 1 Mb flanking regions of most probes had not attained P < 5E - 06 in genome-wide association studies. The genes corresponding to the significant probes can be considered as potential targets for further functional studies. Two genes (i.e., CDC14A and PMEL) demonstrated stronger evidence of associations with lung cancer as they had significant probes in both transcriptome-wide and methylome-wide association analyses. The novel cancer-associated SNPs and genes identified here would advance our understanding of the genetic heterogeneity of the common cancers.}, Doi = {10.1007/s13353-021-00679-4}, Key = {fds361336} } @article{fds368508, Author = {Gary, KM and Hoque, M and Yashkin, AP and Yashin, AI and Akushevich, I}, Title = {Does the Chronic Stress of Everyday Discrimination or Race Itself Better Predict AD Onset Risk?}, Journal = {Gerontology & Geriatric Medicine}, Volume = {8}, Pages = {23337214221142944}, Year = {2022}, Month = {January}, url = {http://dx.doi.org/10.1177/23337214221142944}, Abstract = {Using evidence from the Health and Retirement Study, we explore racial disparities in Alzheimer's Disease (AD) onset risk. From a stress process perspective, there is substantial evidence in the literature that everyday discrimination is a chronic strain for Black individuals that acts as a social determinant of illness. However, few studies have examined specific relationships between this social stressor, race, and AD onset risk. Using Cox Proportional Hazard Models, we examined racial differences in exposure and vulnerability to everyday discrimination. Findings suggest that everyday discrimination predicts AD onset risk, and Black individuals experience more frequent exposure to everyday discrimination as a chronic strain. However, contrary to the stress process model, Black respondents were not more vulnerable to the effect of everyday discrimination on AD onset risk. Racial bias from medical professionals during the diagnostic process and mortality selection bias may explain this effect. Overall, the results of this study provide further evidence that discrimination is a key factor in predicting AD while also considering that many racial minorities with high rates of this type of social stress may not receive an unbiased diagnosis and/or survive to late life to develop AD.}, Doi = {10.1177/23337214221142944}, Key = {fds368508} } @misc{fds370818, Author = {Ukraintseva, S and Popov, V and Duan, H and Yashkin, A and Akushevich, I and Arbeev, K and Yashin, A}, Title = {ADULT INFECTIONS ARE ASSOCIATED WITH HIGHER RISK OF ALZHEIMER'S DISEASE BUT LOWER RISK OF CANCER}, Journal = {Innovation in Aging}, Volume = {6}, Pages = {765-766}, Year = {2022}, Key = {fds370818} } @misc{fds370819, Author = {Akushevich, I and Yashkin, A and Kravchenko, J}, Title = {GEOGRAPHIC DISPARITIES IN INCIDENCE AND MORTALITY OF ALZHEIMER'S DISEASE}, Journal = {Innovation in Aging}, Volume = {6}, Pages = {2-2}, Year = {2022}, Key = {fds370819} } @misc{fds370820, Author = {Ukraintseva, S and Arbeev, K and Duan, H and Holmes, R and Akushevich, I and Yashkin, A and Whitson, H and Yashin, A}, Title = {PATTERNS OF AGING CHANGES IN BODY WEIGHT AND BMI MAY PREDICT CHANCES OF ALZHEIMER'S DISEASE AND LONGEVITY}, Journal = {Innovation in Aging}, Volume = {6}, Pages = {326-326}, Year = {2022}, Key = {fds370820} } @misc{fds370817, Author = {Yashkin, A and Akushevich, I and Yashin, A and Gorbunova, G and Ukraintseva, S}, Title = {FUNGAL INFECTIONS, USE OF ANTIFUNGAL AGENTS, AND THE RISK OF ALZHEIMER'S DISEASE}, Journal = {Innovation in Aging}, Volume = {6}, Pages = {1-2}, Year = {2022}, Key = {fds370817} } @misc{fds370821, Author = {Arbeev, K and Bagley, O and Yashkin, A and Duan, H and Nalawade, V and Akushevich, I and Ukraintseva, S and Yashin, A}, Title = {ALZHEIMER'S DISEASE AND COMORBIDITIES: A COMPLEX INTERPLAY IN THE CONTEXT OF AGING}, Journal = {Innovation in Aging}, Volume = {6}, Pages = {49-50}, Year = {2022}, Key = {fds370821} } @misc{fds370822, Author = {Akushevich, I and Yashkin, A and Kovtun, M and Kravchenko, J and Arbeev, K and Yashin, A}, Title = {FORECASTING PREVALENCE AND MORTALITY OF ALZHEIMER'S DISEASE AND RELATED DEMENTIAS USING PARTITIONING MODELS}, Journal = {Innovation in Aging}, Volume = {6}, Pages = {472-472}, Year = {2022}, Key = {fds370822} } @article{fds366756, Author = {Akushevich, I and Yashkin, AP and Kravchenko, J and Kertai, MD}, Title = {Chemotherapy and the Risk of Alzheimer's Disease in Colorectal Cancer Survivors: Evidence From the Medicare System.}, Journal = {Jco Oncol Pract}, Volume = {17}, Number = {11}, Pages = {e1649-e1659}, Year = {2021}, Month = {November}, url = {http://dx.doi.org/10.1200/OP.20.00729}, Abstract = {PURPOSE: Evidence on the nature of the relationship between patients receiving chemotherapy as an essential part of guideline-concordant cancer care and the onset of Alzheimer's Disease (AD) and other adverse cognitive outcomes has been mixed. Biological mechanisms were proposed to support both a potentially beneficial and an adverse role. To explore the relationship between chemotherapy and onset of AD and other neurocognitive disorders (ND) in colorectal cancer survivors. METHODS: We conducted a retrospective cohort study of 135,834 individuals older than 65 years diagnosed with colorectal cancer between 1998 and 2007, using SEER-Medicare data. A proportional hazards model was used before and after the use of inverse probability weighting to account for populational differences between the chemotherapy and nonchemotherapy groups. Weights were normalized to the total sample size. RESULTS: After inverse probability weighting, chemotherapy was associated with decreased AD risk (hazard ratio [HR]: 0.791; 95% CI: 0.758 to 0.824) and lower risk for the majority of other ND including AD-related diseases (HR: 0.823; CI: 0.802 to 0.844), dementia (permanent mental disorder) (HR: 0.807; CI: 0.782 to 0.832), and dementia (senile) (HR: 0.772; CI: 0.745 to 0.801). The only adverse effect to remain significant was cerebral degeneration (excluding AD) (HR: 1.067; CI: 1.033 to 1.102). The effects for AD remained after treatment was stratified by chemotherapy agent type and remained significant for up to 6 years past diagnosis. CONCLUSION: Chemotherapy use in colorectal cancer survivors demonstrated an association with reduced risk for AD and other ND.}, Doi = {10.1200/OP.20.00729}, Key = {fds366756} } @article{fds366757, Author = {Akushevich, I and Yashkin, AP and Yashin, AI and Kravchenko, J}, Title = {Geographic disparities in mortality from Alzheimer's disease and related dementias.}, Journal = {Journal of the American Geriatrics Society}, Volume = {69}, Number = {8}, Pages = {2306-2315}, Year = {2021}, Month = {August}, url = {http://dx.doi.org/10.1111/jgs.17215}, Abstract = {<h4>Objectives</h4>The regions with highest and lowest Alzheimer's disease (AD) mortality across the United States at state/county levels were identified and their contribution to the differences in total mortality rates between these regions was evaluated. The disease, disease group, sex, race/ethnicity, and place-of-death-related inter-region differences that engender the disparity in mortality were quantitatively described. The hypothesis that inter-regional differences in filling out death certificates are a major contributor to differences in AD mortality was tested.<h4>Design</h4>Retrospective evaluation of death certificate data.<h4>Setting</h4>The United States.<h4>Participants</h4>Deceased US residents, 1999-2018.<h4>Methods</h4>Region-specific age-adjusted mortality rates and group-specific rate decomposition.<h4>Results</h4>The county clusters with the highest and lowest AD mortality rates were in Washington (WA) and New York (NY), respectively, with other notable high-mortality clusters on the border of Tennessee, Georgia, and Alabama as well as in North Dakota and South Dakota. These patterns were stable over the 1999-2018 period. AD had the highest contribution to total mortality difference between WA and NY (156%, higher in WA), in contrast circulatory diseases had a contribution of comparable magnitude (154%) but were higher in NY. Differences in cause-of-death certificate coding, either through coding of non-AD dementias, or other conditions accompanying a potential AD death could not account for differences in AD mortality between NY and WA.<h4>Conclusions</h4>Inter-regional differences in filling out death certificates were not a major contributor to variation in AD mortality between the regions with the highest and lowest rates. The respective mitigation of the effects of neural and circulatory diseases and several other high-impact conditions would not negate the disparity in mortality between NY and WA.}, Doi = {10.1111/jgs.17215}, Key = {fds366757} } @article{fds366758, Author = {Yashin, AI and Wu, D and Arbeev, K and Bagley, O and Akushevich, I and Duan, M and Yashkin, A and Ukraintseva, S}, Title = {Interplay between stress-related genes may influence Alzheimer's disease development: The results of genetic interaction analyses of human data.}, Journal = {Mechanisms of Ageing and Development}, Volume = {196}, Pages = {111477}, Year = {2021}, Month = {June}, url = {http://dx.doi.org/10.1016/j.mad.2021.111477}, Abstract = {Emerging evidence from experimental and clinical research suggests that stress-related genes may play key roles in AD development. The fact that genome-wide association studies were not able to detect a contribution of such genes to AD indicates the possibility that these genes may influence AD non-linearly, through interactions of their products. In this paper, we selected two stress-related genes (GCN2/EIF2AK4 and APP) based on recent findings from experimental studies which suggest that the interplay between these genes might influence AD in humans. To test this hypothesis, we evaluated the effects of interactions between SNPs in these two genes on AD occurrence, using the Health and Retirement Study data on white indidividuals. We found several interacting SNP-pairs whose associations with AD remained statistically significant after correction for multiple testing. These findings emphasize the importance of nonlinear mechanisms of polygenic AD regulation that cannot be detected in traditional association studies. To estimate collective effects of multiple interacting SNP-pairs on AD, we constructed a new composite index, called Interaction Polygenic Risk Score, and showed that its association with AD is highly statistically significant. These results open a new avenue in the analyses of mechanisms of complex multigenic AD regulation.}, Doi = {10.1016/j.mad.2021.111477}, Key = {fds366758} } @article{fds366759, Author = {Yashkin, AP and Greenup, RA and Gorbunova, G and Akushevich, I and Oeffinger, KC and Hwang, ES}, Title = {Outcomes and Costs for Women After Breast Cancer: Preparing for Improved Survivorship of Medicare Beneficiaries.}, Journal = {Jco Oncol Pract}, Volume = {17}, Number = {4}, Pages = {e469-e478}, Year = {2021}, Month = {April}, url = {http://dx.doi.org/10.1200/OP.20.00155}, Abstract = {PURPOSE: Increasing health care costs, longer life expectancy, improved breast cancer (BC) survival, and higher levels of complex comorbidities have important implications for future Medicare expenditures. METHODS: Data from the SEER program linked to Medicare claims records were used. Women with BC (cases) were categorized into 3 groups on the basis of their year of diagnosis (1998, 2003, or 2008) and were propensity score matched to women without a BC diagnosis (controls). All stage and stage-specific longitudinal changes in survival, morbidity levels using the Elixhauser index, and Medicare expenditures in 2018 dollars were calculated and compared. RESULTS: More than 15% of BC cases were diagnosed in patients over the age of 85 years. The prevalence of most comorbidities increased over time. Costs among cases increased between 1998 and 2008. Spending directly correlated with the stage of disease at diagnosis, with the lowest per-patient costs in the ductal carcinoma in situ (DCIS) subgroup ($14,792 in 1998 and $19,652 in 2008) and the highest in those with distant cancer ($37,667 in 1998 and $43,675 in 2008). Assuming no significant changes in the distribution of BC stage or age at diagnosis, the total annual costs of caring for patients with BC in women 65 years of age or older at diagnosis increased by at least $1.1 billion between 1998 and 2008. CONCLUSION: Improvements in BC survivorship are associated with intensive use of health care resources and substantially higher downstream costs among Medicare beneficiaries. Appropriate planning, in both the fiscal and the oncology care infrastructure, is required to prepare the health system for these emerging health care trends.}, Doi = {10.1200/OP.20.00155}, Key = {fds366759} } @article{fds366761, Author = {Ukraintseva, S and Duan, M and Arbeev, K and Wu, D and Bagley, O and Yashkin, AP and Gorbunova, G and Akushevich, I and Kulminski, A and Yashin, A}, Title = {Interactions Between Genes From Aging Pathways May Influence Human Lifespan and Improve Animal to Human Translation.}, Journal = {Frontiers in Cell and Developmental Biology}, Volume = {9}, Pages = {692020}, Year = {2021}, Month = {January}, url = {http://dx.doi.org/10.3389/fcell.2021.692020}, Abstract = {A major goal of aging research is identifying genetic targets that could be used to slow or reverse aging - changes in the body and extend limits of human lifespan. However, majority of genes that showed the anti-aging and pro-survival effects in animal models were not replicated in humans, with few exceptions. Potential reasons for this lack of translation include a highly conditional character of genetic influence on lifespan, and its heterogeneity, meaning that better survival may be result of not only activity of individual genes, but also gene-environment and gene-gene interactions, among other factors. In this paper, we explored associations of genetic interactions with human lifespan. We selected candidate genes from well-known aging pathways (IGF1/FOXO growth signaling, P53/P16 apoptosis/senescence, and mTOR/SK6 autophagy and survival) that jointly decide on outcomes of cell responses to stress and damage, and so could be prone to interactions. We estimated associations of pairwise statistical epistasis between SNPs in these genes with survival to age 85+ in the Atherosclerosis Risk in Communities study, and found significant (FDR < 0.05) effects of interactions between SNPs in <i>IGF1R</i>, <i>TGFBR2</i>, and <i>BCL2</i> on survival 85+. We validated these findings in the Cardiovascular Health Study sample, with <i>P</i> < 0.05, using survival to age 85+, and to the 90th percentile, as outcomes. Our results show that interactions between SNPs in genes from the aging pathways influence survival more significantly than individual SNPs in the same genes, which may contribute to heterogeneity of lifespan, and to lack of animal to human translation in aging research.}, Doi = {10.3389/fcell.2021.692020}, Key = {fds366761} } @article{fds370604, Author = {Yashin, AI and Wu, D and Arbeev, K and Yashkin, AP and Akushevich, I and Bagley, O and Duan, M and Ukraintseva, S}, Title = {Roles of interacting stress-related genes in lifespan regulation: insights for translating experimental findings to humans.}, Journal = {Journal of Translational Genetics and Genomics}, Volume = {5}, Number = {4}, Pages = {357-379}, Year = {2021}, Month = {January}, Abstract = {<h4>Aim</h4>Experimental studies provided numerous evidence that caloric/dietary restriction may improve health and increase the lifespan of laboratory animals, and that the interplay among molecules that sense cellular stress signals and those regulating cell survival can play a crucial role in cell response to nutritional stressors. However, it is unclear whether the interplay among corresponding genes also plays a role in human health and lifespan.<h4>Methods</h4>Literature about roles of cellular stressors have been reviewed, such as amino acid deprivation, and the integrated stress response (ISR) pathway in health and aging. Single nucleotide polymorphisms (SNPs) in two candidate genes (<i>GCN2/EIF2AK4</i> and <i>CHOP/DDIT3</i>) that are closely involved in the cellular stress response to amino acid starvation, have been selected using information from experimental studies. Associations of these SNPs and their interactions with human survival in the Health and Retirement Study data have been estimated. The impact of collective associations of multiple interacting SNP pairs on survival has been evaluated, using a recently developed composite index: the <i>SNP-specific Interaction Polygenic Risk Score</i> (SIPRS).<h4>Results</h4>Significant interactions have been found between SNPs from <i>GCN2/EIF2AK4</i> and <i>CHOP/DDI3T</i> genes that were associated with survival 85+ compared to survival between ages 75 and 85 in the total sample (males and females combined) and in females only. This may reflect sex differences in genetic regulation of the human lifespan. Highly statistically significant associations of SIPRS [constructed for the rs16970024 (GCN2/EIF2AK4) and rs697221 (CHOP/DDIT3)] with survival in both sexes also been found in this study.<h4>Conclusion</h4>Identifying associations of the genetic interactions with human survival is an important step in translating the knowledge from experimental to human aging research. Significant associations of multiple SNPxSNP interactions in ISR genes with survival to the oldest old age that have been found in this study, can help uncover mechanisms of multifactorial regulation of human lifespan and its heterogeneity.}, Key = {fds370604} } @article{fds366760, Author = {Akushevich, I and Yashkin, AP and Kravchenko, J and Yashin, AI}, Title = {Analysis of Time Trends in Alzheimer's Disease and Related Dementias Using Partitioning Approach.}, Journal = {J Alzheimers Dis}, Volume = {82}, Number = {3}, Pages = {1277-1289}, Year = {2021}, url = {http://dx.doi.org/10.3233/JAD-210273}, Abstract = {BACKGROUND: Understanding the dynamics of epidemiologic trends in Alzheimer's disease (AD) and related dementias (ADRD) and their epidemiologic causes is vital to providing important insights into reducing the burden associated with these conditions. OBJECTIVE: To model the time trends in age-adjusted AD/ADRD prevalence and incidence-based mortality (IBM), and identify the main causes of the changes in these measures over time in terms of interpretable epidemiologic quantities. METHODS: Trend decomposition was applied to a 5%sample of Medicare beneficiaries between 1991 and 2017. RESULTS: Prevalence of AD was increasing between 1992 and 2011 and declining thereafter, while IBM increased over the study period with a significant slowdown in its rate of growth from 2011 onwards. For ADRD, prevalence and IBM increased through 2014 prior to taking a downwards turn. The primary determinant responsible for declines in prevalence and IBM was the deceleration in the increase and eventual decrease in incidence rates though changes in relative survival began to affect the overall trends in prevalence/IBM in a noticeable manner after 2008. Other components showed only minor effects. CONCLUSION: The prevalence and IBM of ADRD is expected to continue to decrease. The directions of these trends for AD are not clear because AD incidence, the main contributing component, is decreasing but at a decreasing rate suggesting a possible reversal. Furthermore, emerging treatments may contribute through their effects on survival. Improving ascertainment of AD played an important role in trends of AD/ADRD over the 1991-2009/10 period but this effect has exhausted itself by 2017.}, Doi = {10.3233/JAD-210273}, Key = {fds366760} } @misc{fds370823, Author = {Yashin, A and Wu, D and Arbeev, K and Bagley, O and Akushevich, I and Yashkin, A and Duan, M and Ukraintseva, S}, Title = {THE INTERPLAY BETWEEN STRESS RELATED GENES AND ITS ROLE IN HUMAN LONGEVITY: INSIGHTS FOR TRANSLATIONAL STUDIES}, Journal = {Innovation in Aging}, Volume = {5}, Pages = {668-668}, Year = {2021}, Key = {fds370823} } @misc{fds370824, Author = {Yashin, A and Wu, D and Arbeev, K and Bagley, O and Akushevich, I and Duan, M and Yashkin, A and Ukraintseva, S}, Title = {SIGNIFICANT ASSOCIATIONS OF THE INTERPLAY BETWEEN STRESS RELATED GENES WITH ALZHEIMER'S DISEASE}, Journal = {Innovation in Aging}, Volume = {5}, Pages = {637-638}, Year = {2021}, Key = {fds370824} } @misc{fds370825, Author = {Nikitin, SK and Yashkin, A and Akushevich, I}, Title = {LINKS OF AUTOIMMUNE THYROID DISORDERS TO ALZHEIMER'S DISEASE FOR MEDICARE BENEFICIARIES AGES 65+}, Journal = {Innovation in Aging}, Volume = {5}, Pages = {303-303}, Year = {2021}, Key = {fds370825} } @misc{fds370826, Author = {Yu, B and Akushevich, I and Yashkin, A and Kravchenko, J}, Title = {EPIDEMIOLOGIC DETERMINANTS OF DYNAMICS IN HEART FAILURE PREVALENCE AND MORTALITY IN OLDER US ADULTS}, Journal = {Innovation in Aging}, Volume = {5}, Pages = {163-163}, Year = {2021}, Key = {fds370826} } @misc{fds370827, Author = {Yashkin, A and Gorbunova, G and Yashin, A and Akushevich, I}, Title = {IMPLICATIONS OF RACIAL DIFFERENCES IN THE SHIFTS IN THE SETTING OF CARE FOR ALZHEIMER'S DISEASE AND RELATED DEMENTIAS}, Journal = {Innovation in Aging}, Volume = {5}, Pages = {644-645}, Year = {2021}, Key = {fds370827} } @misc{fds370828, Author = {Akushevich, I and Yashkin, A and Kravchenko, J}, Title = {GEOGRAPHIC DISPARITIES OF ALZHEIMER'S DISEASE MORTALITY IN FEMALES WITH BREAST CANCER}, Journal = {Innovation in Aging}, Volume = {5}, Pages = {59-60}, Year = {2021}, Key = {fds370828} } @misc{fds370829, Author = {Akushevich, I and Yashkin, A and Nikitin, SK and Kravchenko, J}, Title = {THE EFFECT OF TRAUMATIC BRAIN INJURY ON ALZHEIMER'S DISEASE AND COGNITIVE DECLINE IN VETERANS AND NON-VETERANS}, Journal = {Innovation in Aging}, Volume = {5}, Pages = {304-304}, Year = {2021}, Key = {fds370829} } @misc{fds370830, Author = {Yashkin, A and Yashin, A and Gorbunova, G and Akushevich, I}, Title = {RACIAL DIFFERENCES IN THE EFFECT OF ALZHEIMER'S DISEASE ON ADHERENCE TO MEDICATION THERAPY FOR CHRONIC DISEASES}, Journal = {Innovation in Aging}, Volume = {5}, Pages = {60-60}, Year = {2021}, Key = {fds370830} } @misc{fds370831, Author = {Nikitin, SK and Yashkin, A and Kravchenko, J and Akushevich, I}, Title = {CAUSES OF THE RACIAL DISPARITIES IN THE RISK OF ALZHEIMER'S DISEASE}, Journal = {Innovation in Aging}, Volume = {5}, Pages = {59-59}, Year = {2021}, Key = {fds370831} } @misc{fds370832, Author = {Yashkin, A}, Title = {USING ADMINISTRATIVE CLAIMS TO MODEL HEALTH-RELATED BEHAVIORS: MEASURES OF SCREENING AND MEDICATION ADHERENCE}, Journal = {Innovation in Aging}, Volume = {5}, Pages = {274-274}, Year = {2021}, Key = {fds370832} } @article{fds352299, Author = {Sloan, FA and Yashkin, AP and Akushevich, I and Inman, BA}, Title = {The Cost to Medicare of Bladder Cancer Care.}, Journal = {Eur Urol Oncol}, Volume = {3}, Number = {4}, Pages = {515-522}, Year = {2020}, Month = {August}, url = {http://dx.doi.org/10.1016/j.euo.2019.01.015}, Abstract = {BACKGROUND: Bladder cancer care is costly, including cost to Medicare, but the medical cost associated with bladder cancer patients relative to identical persons without bladder cancer is unknown. OBJECTIVE: To determine incremental bladder cancer cost to Medicare and the impact of diagnosis stage and bladder cancer survival on cost. DESIGN, SETTING, AND PARTICIPANTS: A case-control study was conducted using 1998-2013 Surveillance, Epidemiology and End Results-Medicare data. Controls were propensity score matched for diagnosis year, age, gender, race, and 31 Elixhauser Comorbidity Index values. Three incident cohorts, 1998 (n=3136), 2003 (n=7000), and 2008 (n=7002), were compared. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Survival following diagnosis and Medicare payments (in 2018 dollars) were tabulated, and compared between cases and controls. RESULTS AND LIMITATIONS: From 1998 to 2008, bladder cancer patients became older and had more comorbidities at diagnosis, although no stage migration or change in survival occurred. Incremental costs (above those associated with controls) were highest during the 1st year after diagnosis and were higher for distant ($47533) than for regional ($42403) or localized ($14304) cancer. Bladder cancer survival was highly stage dependent. After an initial spike in costs lasting 1-2yrs, monthly costs dropped in survivors but remained higher than for controls. Long-term survivors in the full sample accrued cumulative Medicare costs of $172426 over 16yrs-46% higher than for controls. Limitations include omission of indirect costs and reliance on traditional Medicare. CONCLUSIONS: While a bladder cancer diagnosis incurs initial high Medicare cost, particularly in patients with advanced cancers, the cumulative costs of bladder cancer in long-term survivors are higher still. Bladder cancer prevention saves Medicare money. However, while early detection, better therapies, and life extension of bladder cancer patients are worthwhile goals, they come at the cost of higher Medicare outlays. PATIENT SUMMARY: The lifetime cost of bladder cancer, reflecting surveillance, treatment, and management of complications, is substantial. Since care is ongoing, cost increases with the length of life after diagnosis as well as the severity of initial diagnosis.}, Doi = {10.1016/j.euo.2019.01.015}, Key = {fds352299} } @article{fds350513, Author = {Akushevich, I and Yashkin, AP and Inman, BA and Sloan, F}, Title = {Partitioning of time trends in prevalence and mortality of bladder cancer in the United States.}, Journal = {Ann Epidemiol}, Volume = {47}, Pages = {25-29}, Year = {2020}, Month = {July}, url = {http://dx.doi.org/10.1016/j.annepidem.2020.05.006}, Abstract = {PURPOSE: The aim of the study was to evaluate the relative contributions of incidence, stage-specific relative survival, and stage ascertainment to changes in bladder cancer (BC) prevalence and incidence-based mortality. METHODS: Partitioning of prevalence and incidence-based mortality trends into their epidemiologic components. RESULTS: BC prevalence estimated from our model increased but at monotonically decreasing rates until 2007, after which it decreased again. The main forces underlying observed trends in BC prevalence were relative BC survival, which improved throughout the period, and BC incidence, which increased at a decreasing rate until 2005 and declined thereafter. Mortality of persons ever diagnosed with BC increased at an increasing rate until 1997, increased at a decreasing rate from 1997 to 2005, and decreased thereafter. The primary forces accounting for mortality trends were changes in mortality in the general population, which improved at an increasing rate during most of 1992-2010, the most important factor, and changes in incidence. Stage ascertainment did not improve during 1992-2010. CONCLUSIONS: Although mortality rates improved, these gains largely reflected improvements in U.S. population survival rather than from improvements in BC-specific outcomes.}, Doi = {10.1016/j.annepidem.2020.05.006}, Key = {fds350513} } @article{fds347334, Author = {Sloan, FA and Yashkin, AP and Akushevich, I and Inman, BA}, Title = {Longitudinal patterns of cost and utilization of medicare beneficiaries with bladder cancer.}, Journal = {Urol Oncol}, Volume = {38}, Number = {2}, Pages = {39.e11-39.e19}, Year = {2020}, Month = {February}, url = {http://dx.doi.org/10.1016/j.urolonc.2019.10.016}, Abstract = {BACKGROUND: Bladder cancer (BC) is highly prevalent and costly. This study documented cost and use of services for BC care and for other (non-BC) care received over a 15-year follow-up period by a cohort of Medicare beneficiaries diagnosed with BC in 1998. METHODS: Data came from the Surveillance, Epidemiology and End Results Program linked to Medicare claims. Medicare claims provided data on diagnoses, services provided, and Medicare Parts A and B payments. Cost was actual Medicare payments to providers inflated to 2018 US$. Cost and utilization were BC-related if the claim contained a BC diagnosis code. Otherwise, costs were for "other care." For utilization, we grouped Part B-covered services into 6 mutually-exclusive categories. Utilization rates were ratios of the count of claims in a particular category during a follow-up year divided by the number of beneficiaries with BC surviving to year-end. RESULTS: Cumulatively over 15-years, for all stages combined, total BC-related cost per BC beneficiary was $42,011 (95% Confidence Interval (CI): $42,405-$43,417); other care cost was about twice this number. Cumulative total BC-related cost of 15-year BC survivors for all stages was $43,770 (CI: $39,068-$48,522), intensity of BC-related care was highest during the first year following BC diagnosis, falling substantially thereafter. After follow-up year 5, there were few statistically significant changes in BC-related utilization. Utilization of other care remained constant during follow-up or increased. CONCLUSIONS: Substantial costs were incurred for non-BC care. While increasing BC survivorship is an important objective, non-BC care would remain a burden to Medicare.}, Doi = {10.1016/j.urolonc.2019.10.016}, Key = {fds347334} } @article{fds366762, Author = {Akushevich, I and Yashkin, AP and Greenup, RA and Hwang, ES}, Title = {A medicare-based comparative mortality analysis of active surveillance in older women with DCIS.}, Journal = {Npj Breast Cancer}, Volume = {6}, Number = {1}, Pages = {57}, Year = {2020}, url = {http://dx.doi.org/10.1038/s41523-020-00199-0}, Abstract = {Over 97% of individuals diagnosed with ductal carcinoma in situ (DCIS) will choose to receive guideline concordant care (GCC), which was originally designed to treat invasive cancers and is associated with treatment related morbidity. An alternative to GCC is active surveillance (AS) where therapy is delayed until medically necessary. Differences in mortality risk between the two approaches in women age 65+ are analyzed in this study. SEER and Medicare information on treatment during the first year after diagnosis was used to identify three cohorts based on treatment type and timing: GCC (N = 21,772; immediate consent for treatment), AS1 (N = 431; delayed treatment within 365 days), and AS2 (N = 205; no treatment/ongoing AS). A propensity score-based approach provided pseudorandomization between GCC and AS groups and survival was then compared. Strong influence of comorbidities on the treatment received was observed for all age-groups, with the greatest burden observed in the AS2 group. All-cause and breast-cancer-specific mortality hazard ratios (HR) for AS1 were not statistically different from the GCC group; AS2 was associated with notably higher risk for both all-cause (HR:3.54; CI:3.29, 3.82) and breast-cancer-specific (HR:10.73; CI:8.63,13.35) mortality. Cumulative mortality was substantially higher from other causes than from breast cancer, regardless of treatment group. Women managed with AS for DCIS had higher all-cause and breast-cancer-specific mortality. This effect declined after accounting for baseline comorbidities. Delays of up to 12 months in initiation of GCC did not underperform immediate surgery.}, Doi = {10.1038/s41523-020-00199-0}, Key = {fds366762} } @article{fds343334, Author = {Akushevich, I and Kravchenko, J and Yashkin, AP and Fang, F and Yashin, AI}, Title = {Partitioning of time trends in prevalence and mortality of lung cancer.}, Journal = {Stat Med}, Volume = {38}, Number = {17}, Pages = {3184-3203}, Year = {2019}, Month = {July}, url = {http://dx.doi.org/10.1002/sim.8170}, Abstract = {BACKGROUND: Time trends of lung cancer prevalence and mortality are the result of three competing processes: changes in the incidence rate, stage-specific survival, and ascertainment at early stages. Improvements in these measures act concordantly to improve disease-related mortality, but push the prevalence rate in opposite directions making a qualitative interpretation difficult. The goal of this paper is to evaluate the relative contributions of these components to changes in lung cancer prevalence and mortality. METHODS: Partitioning of prevalence and mortality trends into their components using SEER data for 1973-2013. RESULTS: The prevalence of lung cancer increases for females and decreases for males. In 1998, the former was due to increased incidence (45%-50% of total trend), improved survival (40%-45%), and increased ascertainment at early stages (10%-15%). In males, a rapidly declining incidence rate overpowered the effects of survival and ascertainment resulting in an overall decrease in prevalence over time. Trends in lung cancer mortality are determined by incidence during 1993-2002 with noticeable contribution of survival after 2002. CONCLUSION: Lung cancer incidence was the main driving force behind trends in prevalence and mortality. Improved survival played essential role from 2000 onwards. Trends in stage ascertainment played a small but adverse role. Our results suggest that further improvement in lung cancer mortality can be achieved through advances in early stage ascertainment, especially for males, and that in spite of success in treatment, adenocarcinoma continues to exhibit adverse trends (especially in female incidence) and its role among other histology-specific lung cancers will increase in the near future.}, Doi = {10.1002/sim.8170}, Key = {fds343334} } @article{fds342134, Author = {Akushevich, I and Yashkin, A and Kravchenko, J and Fang, F and Arbeev, K and Sloan, F and Yashin, AI}, Title = {A forecasting model of disease prevalence based on the McKendrick-von Foerster equation.}, Journal = {Math Biosci}, Volume = {311}, Pages = {31-38}, Year = {2019}, Month = {May}, url = {http://dx.doi.org/10.1016/j.mbs.2018.12.017}, Abstract = {A new model for disease prevalence based on the analytical solutions of McKendric-von Foerster's partial differential equations is developed. Derivation of the model and methods to cross check obtained results are explicitly demonstrated. Obtained equations describe the time evolution of the healthy and unhealthy age-structured sub-populations and age patterns of disease prevalence. The projection of disease prevalence into the future requires estimates of time trends of age-specific disease incidence, relative survival functions, and prevalence at the initial age and year available in the data. The computational scheme for parameter estimations using Medicare data, analytical properties of the model, application for diabetes prevalence, and relationship with partitioning models are described and discussed. The model allows natural generalization for the case of several diseases as well as for modeling time trends in cause-specific mortality rates.}, Doi = {10.1016/j.mbs.2018.12.017}, Key = {fds342134} } @article{fds343590, Author = {Nazarian, A and Arbeev, KG and Yashkin, AP and Kulminski, AM}, Title = {Genetic heterogeneity of Alzheimer's disease in subjects with and without hypertension.}, Journal = {Geroscience}, Volume = {41}, Number = {2}, Pages = {137-154}, Year = {2019}, Month = {April}, url = {http://dx.doi.org/10.1007/s11357-019-00071-5}, Abstract = {Alzheimer's disease (AD) is a progressive neurodegenerative disorder caused by the interplay of multiple genetic and non-genetic factors. Hypertension is one of the AD risk factors that has been linked to underlying pathological changes like senile plaques and neurofibrillary tangles formation as well as hippocampal atrophy. In this study, we investigated the differences in the genetic architecture of AD between hypertensive and non-hypertensive subjects in four independent cohorts. Our genome-wide association analyses revealed significant associations of 15 novel potentially AD-associated polymorphisms (P < 5E-06) that were located outside the chromosome 19q13 region and were significant either in hypertensive or non-hypertensive groups. The closest genes to 14 polymorphisms were not associated with AD at P < 5E-06 in previous genome-wide association studies (GWAS). Also, four of them were located within two chromosomal regions (i.e., 3q13.11 and 17q21.2) that were not associated with AD at P < 5E-06 before. In addition, 30 genes demonstrated evidence of group-specific associations with AD at the false discovery rates (FDR) < 0.05 in our gene-based and transcriptome-wide association analyses. The chromosomal regions corresponding to four genes (i.e., 2p13.1, 9p13.3, 17q12, and 18q21.1) were not associated with AD at P < 5E-06 in previous GWAS. These genes may serve as a list of prioritized candidates for future functional studies. Our pathway-enrichment analyses revealed the associations of 11 non-group-specific and four group-specific pathways with AD at FDR < 0.05. These findings provided novel insights into the potential genetic heterogeneity of AD among subjects with and without hypertension.}, Doi = {10.1007/s11357-019-00071-5}, Key = {fds343590} } @misc{fds370833, Author = {Greenup, RA and Yashkin, A and Gorbunova, G and Akusevich, I and Hwang, ES}, Title = {Abstract PD6-08: Medicare costs for women after breast cancer: Preparing for survivorship}, Journal = {Cancer Research}, Volume = {79}, Number = {4_Supplement}, Publisher = {American Association for Cancer Research (AACR)}, Year = {2019}, Month = {February}, url = {http://dx.doi.org/10.1158/1538-7445.sabcs18-pd6-08}, Abstract = {<jats:title>Abstract</jats:title> <jats:p>BACKGROUND</jats:p> <jats:p>Improvements in breast cancer survival and increasing population life expectancy have resulted in a growing number of women receiving subsequent health care after breast cancer diagnosis and treatment. We sought to determine the magnitude of increases in healthcare costs related to breast cancer survivorship, in anticipation of predicted increases in enrollment, higher intensity utilization, and greater healthcare spending among Medicare beneficiaries.</jats:p> <jats:p>METHODS</jats:p> <jats:p>Women age 65+ diagnosed with stage 0-III breast cancer in 1998, 2003 or 2008, were identified from the SEER database linked to Medicare records. After restrictions they were propensity score matched to a comparable group of non-breast-cancer women on demographic characteristics and co-morbidities at time of diagnosis based on the Elixhauser co-morbidity index. Line payments to care providers were then calculated for the first year of care after diagnosis (cases only) as well as years 2-6, 8-11 and 12-16 post-diagnosis (cases and controls). Direct Medicare costs were adjusted for inflation using the experimental Medicare costs Price Index and compared under real world and alternative survival scenarios.</jats:p> <jats:p>RESULTS</jats:p> <jats:p>Overall, the costs of care were progressively higher in later cohorts across all time periods. Differences in survivorship were the primary driver of differences in costs between breast cancer cases and controls. All-stage costs in years 2-6 were higher in the cancer group ($2,499, $10,261 and $12,029 higher per-person in 1998, 2003 and 2008 respectively), however, higher mortality in the cancer group reduced the costs and quantity of care received in later years [years 7-11 ($2,183 lower per-person in 1998) and 12-16 ($2,431 lower per-person in 1998)]. In pairs with identical survival, costs in the cancer group were significantly higher than in matched non-breast-cancer controls across all time periods (years 2-6: $4,799, $9,545 and $12,245 higher in 1998/2003/2008; years 7-11: $2,922 and $5,597 higher in 1998/2003). Stratification by stage changed the magnitude but not the general pattern of our results. The first year of care in 2003 was on average $4,933 dollars higher than in 1998; in 2008 costs again increased by $4,223 per-person. In years 2-6 the cost of cancer care increased by $12,440 (2003 vs 1998) and $3,456 (2008 vs 2003) per-person; Finally, cancer care for years 7-11 in 2003 $3,964 higher than in 1998 per-person.</jats:p> <jats:p>CONCLUSION</jats:p> <jats:p>Improved breast cancer survival and increased overall life expectancy among women in the United States will contribute to higher Medicare expenditures. Future risk-based capitation schemes should account for these advancements when preparing for healthcare delivery after cancer.</jats:p> <jats:p>Citation Format: Greenup RA, Yashkin A, Gorbunova G, Akusevich I, Hwang ES. Medicare costs for women after breast cancer: Preparing for survivorship [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD6-08.</jats:p>}, Doi = {10.1158/1538-7445.sabcs18-pd6-08}, Key = {fds370833} } @misc{fds370834, Author = {Arbeev, KG and Bagley, O and Duan, H and Yashkin, AP and Kulminski, AM and Culminskaya, IV and Ukraintseva, SV and Yashin, AI}, Title = {Genetics of the measure of physiological dysregulation: findings from the health and retirement study}, Journal = {Genetic Epidemiology}, Volume = {42}, Number = {7}, Pages = {687-687}, Publisher = {WILEY}, Year = {2018}, Month = {October}, Key = {fds370834} } @article{fds335441, Author = {Akushevich, I and Kravchenko, J and Yashkin, AP and Yashin, AI}, Title = {Time trends in the prevalence of cancer and non-cancer diseases among older U.S. adults: Medicare-based analysis.}, Journal = {Exp Gerontol}, Volume = {110}, Pages = {267-276}, Year = {2018}, Month = {September}, url = {http://dx.doi.org/10.1016/j.exger.2018.06.017}, Abstract = {Longer lifespan is accompanied by a larger number of chronic diseases among older adults. Because of a growing proportion of older adults in the U.S., this brings the problem of age-related morbidity to the forefront as a major contributor to rising medical expenditures. We evaluated 15-year time trends (from 1998 to 2013) in the prevalence of 48 acute and chronic non-cancer diseases and cancers in older U.S. adults aged 65+ and estimated the annual percentage changes of these prevalence trends using SEER-Medicare and HRS-Medicare data. We found that age-adjusted prevalence of cancers of kidney, pancreas, and melanoma, as well as diabetes, renal disease, limb fracture, depression, anemia, weight deficiency, dementia/Alzheimer's disease, drug/medications abuse and several other diseases/conditions increased over time. Conversely, prevalence of myocardial infarction, heart failure, cardiomyopathy, pneumonia/influenza, peptic ulcer, and gastrointestinal bleeding, among others, decreased over time. There are also diseases whose prevalence did not change substantially over time, e.g., a group of fast progressing cancers and rheumatoid arthritis. Analysis of trends of multiple diseases performed simultaneously within one study design with focus on the same time interval and the same population for all diseases allowed us to provide insight into the epidemiology of these conditions and identify the most alarming and/or unexpected trends and trade-offs. The obtained results can be used for health expenditures planning for growing sector of older adults in the U.S.}, Doi = {10.1016/j.exger.2018.06.017}, Key = {fds335441} } @article{fds330152, Author = {Yashin, AI and Fang, F and Kovtun, M and Wu, D and Duan, M and Arbeev, K and Akushevich, I and Kulminski, A and Culminskaya, I and Zhbannikov, I and Yashkin, A and Stallard, E and Ukraintseva, S}, Title = {Hidden heterogeneity in Alzheimer's disease: Insights from genetic association studies and other analyses.}, Journal = {Experimental Gerontology}, Volume = {107}, Pages = {148-160}, Year = {2018}, Month = {July}, url = {http://dx.doi.org/10.1016/j.exger.2017.10.020}, Abstract = {Despite evident success in clarifying many important features of Alzheimer's disease (AD) the efficient methods of its prevention and treatment are not yet available. The reasons are likely to be the fact that AD is a multifactorial and heterogeneous health disorder with multiple alternative pathways of disease development and progression. The availability of genetic data on individuals participated in longitudinal studies of aging health and longevity, as well as on participants of cross-sectional case-control studies allow for investigating genetic and non-genetic connections with AD and to link the results of these analyses with research findings obtained in clinical, experimental, and molecular biological studies of this health disorder. The objective of this paper is to perform GWAS of AD in several study populations and investigate possible roles of detected genetic factors in developing AD hallmarks and in other health disorders. The data collected in the Framingham Heart Study (FHS), Cardiovascular Health Study (CHS), Health and Retirement Study (HRS) and Late Onset Alzheimer's Disease Family Study (LOADFS) were used in these analyses. The logistic regression and Cox's regression were used as statistical models in GWAS. The results of analyses confirmed strong associations of genetic variants from well-known genes APOE, TOMM40, PVRL2 (NECTIN2), and APOC1 with AD. Possible roles of these genes in pathological mechanisms resulting in development of hallmarks of AD are described. Many genes whose connection with AD was detected in other studies showed nominally significant associations with this health disorder in our study. The evidence on genetic connections between AD and vulnerability to infection, as well as between AD and other health disorders, such as cancer and type 2 diabetes, were investigated. The progress in uncovering hidden heterogeneity in AD would be substantially facilitated if common mechanisms involved in development of AD, its hallmarks, and AD related chronic conditions were investigated in their mutual connection.}, Doi = {10.1016/j.exger.2017.10.020}, Key = {fds330152} } @article{fds333664, Author = {Akushevich, I and Yashkin, AP and Kravchenko, J and Fang, F and Arbeev, K and Sloan, F and Yashin, AI}, Title = {Identifying the causes of the changes in the prevalence patterns of diabetes in older U.S. adults: A new trend partitioning approach.}, Journal = {J Diabetes Complications}, Volume = {32}, Number = {4}, Pages = {362-367}, Year = {2018}, Month = {April}, url = {http://dx.doi.org/10.1016/j.jdiacomp.2017.12.014}, Abstract = {AIMS: To identify how efforts to control the diabetes epidemic and the resulting changes in diabetes mellitus, type II (T2D) incidence and survival have affected the time-trend of T2D prevalence. METHODS: A newly developed method of trend decomposition was applied to a 5% sample of Medicare administrative claims filed between 1991 and 2012. RESULTS: Age-adjusted prevalence of T2D for adults age 65+ increased at an average annual percentage change of 2.31% between 1992 and 2012. Primary contributors to this trend were (in order of magnitude): improved survival at all ages, increased prevalence of T2D prior to age of Medicare eligibility, decreased incidence of T2D after age of Medicare eligibility. CONCLUSIONS: Health services supported by the Medicare system, coupled with improvements in medical technology and T2D awareness efforts provide effective care for individuals age 65 and older. However, policy maker attention should be shifted to the prevention of T2D in younger age groups to control the increase in prevalence observed prior to Medicare eligibility.}, Doi = {10.1016/j.jdiacomp.2017.12.014}, Key = {fds333664} } @article{fds333203, Author = {Yashkin, AP and Sloan, F}, Title = {Adherence to Guidelines for Screening and Medication Use: Mortality and Onset of Major Macrovascular Complications in Elderly Persons With Diabetes Mellitus.}, Journal = {Journal of Aging and Health}, Volume = {30}, Number = {4}, Pages = {503-520}, Publisher = {SAGE Publications}, Year = {2018}, Month = {April}, url = {http://dx.doi.org/10.1177/0898264316684270}, Abstract = {<h4>Objective</h4>The objective of this study is to investigate relationships between adherence to recommended screening and medication use and severe macrovascular complications and all-cause mortality among persons aged above 68 years with diabetes mellitus (DM).<h4>Method</h4>Data came from a 5% Medicare claims sample of beneficiaries initially diagnosed with DM during 2006-2008; follow-up was up to 7 years.<h4>Results</h4>Adherence to screening guidelines led to reduced mortality-hazard ratio (HR) = 0.57, 95% confidence interval [CI] = [0.56, 0.58]; congestive heart failure [CHF], HR = 0.89, CI = [0.87, 0.91]; acute myocardial infarction [AMI], HR = 0.90, CI = [0.85, 0.95]; and stroke/transient ischemic attack [Stroke/TIA], HR = 0.92, CI = [0.87, 0.97]-during follow-up. Recommended medication use led to lower mortality: HR = 0.72, CI = [0.70, 0.73]; CHF, HR = 0.67, CI = [0.66, 0.69]; AMI, HR = 0.68, CI = [0.65, 0.71]; and Stroke/TIA, HR = 0.79, CI = [0.76, 0.83].<h4>Discussion</h4>Elderly persons newly diagnosed with diabetes who adhered to recommended care experienced reduced risk of mortality and severe macrovascular complications.}, Doi = {10.1177/0898264316684270}, Key = {fds333203} } @article{fds333750, Author = {Kulminski, AM and Huang, J and Loika, Y and Arbeev, KG and Bagley, O and Yashkin, A and Duan, M and Culminskaya, I}, Title = {Strong impact of natural-selection-free heterogeneity in genetics of age-related phenotypes.}, Journal = {Aging}, Volume = {10}, Number = {3}, Pages = {492-514}, Year = {2018}, Month = {March}, url = {http://dx.doi.org/10.18632/aging.101407}, Abstract = {A conceptual difficulty in genetics of age-related phenotypes that make individuals vulnerable to disease in post-reproductive life is genetic heterogeneity attributed to an undefined role of evolution in establishing their molecular mechanisms. Here, we performed univariate and pleiotropic genome-wide meta-analyses of 20 age-related phenotypes leveraging longitudinal information in a sample of 33,431 individuals and dealing with the natural-selection-free genetic heterogeneity. We identified 142 non-proxy single nucleotide polymorphisms (SNPs) with phenotype-specific (18 SNPs) and pleiotropic (124 SNPs) associations at genome-wide level. Univariate meta-analysis identified two novel (11.1%) and replicated 16 SNPs whereas pleiotropic meta-analysis identified 115 novel (92.7%) and nine replicated SNPs. Pleiotropic associations for most novel (93.9%) and all replicated SNPs were strongly impacted by the natural-selection-free genetic heterogeneity in its unconventional form of antagonistic heterogeneity, implying antagonistic directions of genetic effects for directly correlated phenotypes. Our results show that the common genome-wide approach is well adapted to handle homogeneous univariate associations within Mendelian framework whereas most associations with age-related phenotypes are more complex and well beyond that framework. Dissecting the natural-selection-free genetic heterogeneity is critical for gaining insights into genetics of age-related phenotypes and has substantial and unexplored yet potential for improving efficiency of genome-wide analysis.}, Doi = {10.18632/aging.101407}, Key = {fds333750} } @article{fds332155, Author = {Yashkin, AP and Kravchenko, J and Yashin, AI and Sloan, F}, Title = {Mortality and Macrovascular Risk in Elderly With Hypertension and Diabetes: Effect of Intensive Drug Therapy.}, Journal = {Am J Hypertens}, Volume = {31}, Number = {2}, Pages = {220-227}, Year = {2018}, Month = {January}, url = {http://dx.doi.org/10.1093/ajh/hpx151}, Abstract = {BACKGROUND: This study identifies the effect of intensive drug therapy (IDT) in individuals age 65+ with diabetes (type 2 diabetes mellitus (T2D)) and hypertension on all-cause death, congestive heart failure (CHF), hospitalization for myocardial infarction (MI), and stroke or transient ischemic attack (TIA). METHODS: Individuals from the Medicare 5% dataset with hypertension and T2D undergoing IDT for these conditions were propensity score matched to a nonintensive drug-therapy group. Hazard ratios (HRs) were obtained using the Cox proportional hazard model. RESULTS: IDT was associated with increased risk of CHF (HR 2.32; 95% confidence interval (CI) 2.32-2.38), MI (HR 4.27; 95% CI 4.05-4.52), and stroke or TIA (HR 1.80; 95% CI 1.70-1.89) but decreased risk of death (HR 0.95; 95% CI 0.93-0.97). Risk for CHF (HR 0.73; 95% CI 0.71-0.73), MI (HR 0.64; 95% CI 0.62-0.67), stroke or TIA (HR 0.82; 95% CI 0.78-0.86), and death (HR 0.29; 95% CI 0.28-0.29) was decreased by adherence to diabetes management guidelines. CONCLUSIONS: Use of IDT in a high-risk population delays death but not severe macrovascular outcomes. Protective effects of IDT in high-risk patients likely outweigh polypharmacy-related health concerns.}, Doi = {10.1093/ajh/hpx151}, Key = {fds332155} } @article{fds370835, Author = {Yashkin, AP and Akushevich, I and Ukraintseva, S and Yashin, A}, Title = {The Effect of Adherence to Screening Guidelines on the Risk of Alzheimer's Disease in Elderly Individuals Newly Diagnosed With Type 2 Diabetes Mellitus.}, Journal = {Gerontology & Geriatric Medicine}, Volume = {4}, Pages = {2333721418811201}, Year = {2018}, Month = {January}, url = {http://dx.doi.org/10.1177/2333721418811201}, Abstract = {<b>Objective:</b> The aim of this study was to examine the possibility that type 2 diabetes and Alzheimer's disease may share common behavioral protective factors such as adherence to type 2 diabetes treatment guidelines given that these two diseases have both epidemiological and metabolic similarities. <b>Method</b>: The method used in this study is a retrospective cohort study of 3,797 U.S. Medicare fee-for-service beneficiaries aged 66+ newly diagnosed with type 2 diabetes and without a prior record of Alzheimer's disease based on the Health and Retirement Study. <b>Results</b>: Results of a left-truncated Cox model showed that adherence reduces the risk of Alzheimer's disease by 20% to 24%. Other significant effects were college education (hazard ratio [HR]: 0.65; <i>p</i> value: .023), stroke (HR: 1.40; <i>p</i> value: .013), and 4+ limitations in physical functioning (HR: 1.33; <i>p</i> value: .008). <b>Discussion</b>: Risk of Alzheimer's disease can be reduced by behavioral factors. Possible mechanisms may include earlier start of interventions to reduce blood glucose levels and improve insulin sensitivity.}, Doi = {10.1177/2333721418811201}, Key = {fds370835} } @article{fds335442, Author = {Akushevich, I and Yashkin, AP and Kravchenko, J and Ukraintseva, S and Stallard, E and Yashin, AI}, Title = {Time Trends in the Prevalence of Neurocognitive Disorders and Cognitive Impairment in the United States: The Effects of Disease Severity and Improved Ascertainment.}, Journal = {J Alzheimers Dis}, Volume = {64}, Number = {1}, Pages = {137-148}, Year = {2018}, url = {http://dx.doi.org/10.3233/JAD-180060}, Abstract = {BACKGROUND: Trends in the prevalence of cognitive impairment (CI) based on cognitive assessment instruments are often inconsistent with those of neurocognitive disorders (ND) based on Medicare claims records. OBJECTIVE: We hypothesized that improved ascertainment and resulting decrease in disease severity at the time of diagnosis are responsible for this phenomenon. METHODS: Using Medicare data linked to the Health and Retirement Study (1992-2012), we performed a joint analysis of trends in CI and ND to test our hypothesis. RESULTS: We identified two major contributors to the divergent directions in CI and ND trends: reductions in disease severity explained more than 60% of the differences between CI and ND prevalence over the study period; the remaining 40% was explained by a decrease in the fraction of undiagnosed individuals. DISCUSSION: Improvements in the diagnoses of ND diseases were a major contributor to reported trends in ND and CI. Recent forecasts of CI and ND trends in the U.S. may be overly pessimistic.}, Doi = {10.3233/JAD-180060}, Key = {fds335442} } @article{fds324088, Author = {Akushevich, I and Yashkin, AP and Kravchenko, J and Fang, F and Arbeev, K and Sloan, F and Yashin, AI}, Title = {Theory of partitioning of disease prevalence and mortality in observational data.}, Journal = {Theor Popul Biol}, Volume = {114}, Pages = {117-127}, Year = {2017}, Month = {April}, url = {http://dx.doi.org/10.1016/j.tpb.2017.01.003}, Abstract = {In this study, we present a new theory of partitioning of disease prevalence and incidence-based mortality and demonstrate how this theory practically works for analyses of Medicare data. In the theory, the prevalence of a disease and incidence-based mortality are modeled in terms of disease incidence and survival after diagnosis supplemented by information on disease prevalence at the initial age and year available in a dataset. Partitioning of the trends of prevalence and mortality is calculated with minimal assumptions. The resulting expressions for the components of the trends are given by continuous functions of data. The estimator is consistent and stable. The developed methodology is applied for data on type 2 diabetes using individual records from a nationally representative 5% sample of Medicare beneficiaries age 65+. Numerical estimates show excellent concordance between empirical estimates and theoretical predictions. Evaluated partitioning model showed that both prevalence and mortality increase with time. The primary driving factors of the observed prevalence increase are improved survival and increased prevalence at age 65. The increase in diabetes-related mortality is driven by increased prevalence and unobserved trends in time-periods and age-groups outside of the range of the data used in the study. Finally, the properties of the new estimator, possible statistical and systematical uncertainties, and future practical applications of this methodology in epidemiology, demography, public health and health forecasting are discussed.}, Doi = {10.1016/j.tpb.2017.01.003}, Key = {fds324088} } @article{fds332156, Author = {He, L and Kernogitski, Y and Kulminskaya, I and Loika, Y and Arbeev, KG and Loiko, E and Bagley, O and Duan, M and Yashkin, A and Ukraintseva, SV and Kovtun, M and Yashin, AI and Kulminski, AM}, Title = {Corrigendum: Pleiotropic Meta-Analyses of Longitudinal Studies Discover Novel Genetic Variants Associated with Age-Related Diseases.}, Journal = {Frontiers in Genetics}, Volume = {8}, Pages = {226}, Year = {2017}, Month = {January}, url = {http://dx.doi.org/10.3389/fgene.2017.00226}, Abstract = {[This corrects the article on p. 179 in vol. 7, PMID: 27790247.].}, Doi = {10.3389/fgene.2017.00226}, Key = {fds332156} } @article{fds320869, Author = {Kulminski, AM and He, L and Culminskaya, I and Loika, Y and Kernogitski, Y and Arbeev, KG and Loiko, E and Arbeeva, L and Bagley, O and Duan, M and Yashkin, A and Fang, F and Kovtun, M and Ukraintseva, SV and Wu, D and Yashin, AI}, Title = {Pleiotropic Associations of Allelic Variants in a 2q22 Region with Risks of Major Human Diseases and Mortality.}, Journal = {Plos Genetics}, Volume = {12}, Number = {11}, Pages = {e1006314}, Year = {2016}, Month = {November}, url = {http://dx.doi.org/10.1371/journal.pgen.1006314}, Abstract = {Gaining insights into genetic predisposition to age-related diseases and lifespan is a challenging task complicated by the elusive role of evolution in these phenotypes. To gain more insights, we combined methods of genome-wide and candidate-gene studies. Genome-wide scan in the Atherosclerosis Risk in Communities (ARIC) Study (N = 9,573) was used to pre-select promising loci. Candidate-gene methods were used to comprehensively analyze associations of novel uncommon variants in Caucasians (minor allele frequency~2.5%) located in band 2q22.3 with risks of coronary heart disease (CHD), heart failure (HF), stroke, diabetes, cancer, neurodegenerative diseases (ND), and mortality in the ARIC study, the Framingham Heart Study (N = 4,434), and the Health and Retirement Study (N = 9,676). We leveraged the analyses of pleiotropy, age-related heterogeneity, and causal inferences. Meta-analysis of the results from these comprehensive analyses shows that the minor allele increases risks of death by about 50% (p = 4.6×10-9), CHD by 35% (p = 8.9×10-6), HF by 55% (p = 9.7×10-5), stroke by 25% (p = 4.0×10-2), and ND by 100% (p = 1.3×10-3). This allele also significantly influences each of two diseases, diabetes and cancer, in antagonistic fashion in different populations. Combined significance of the pleiotropic effects was p = 6.6×10-21. Causal mediation analyses show that endophenotypes explained only small fractions of these effects. This locus harbors an evolutionary conserved gene-desert region with non-coding intergenic sequences likely involved in regulation of protein-coding flanking genes ZEB2 and ACVR2A. This region is intensively studied for mutations causing severe developmental/genetic disorders. Our analyses indicate a promising target region for interventions aimed to reduce risks of many major human diseases and mortality.}, Doi = {10.1371/journal.pgen.1006314}, Key = {fds320869} } @misc{fds326660, Title = {PARTITIONING OF TIME TRENDS IN PREVALENCE OF LUNG CANCER AMONG OLDER U.S. ADULTS}, Journal = {Gerontologist}, Volume = {56}, Number = {Suppl_3}, Pages = {705-705}, Publisher = {Oxford University Press (OUP)}, Year = {2016}, Month = {November}, url = {http://dx.doi.org/10.1093/geront/gnw162.2874}, Doi = {10.1093/geront/gnw162.2874}, Key = {fds326660} } @misc{fds326661, Title = {RELATIONSHIPS AMONG AGING HEALTH AND LONGEVITY IN HRS: CAUSAL ANALYSES USING MENDELIAN RANDOMIZATION}, Journal = {Gerontologist}, Volume = {56}, Number = {Suppl_3}, Pages = {181-181}, Publisher = {Oxford University Press (OUP)}, Year = {2016}, Month = {November}, url = {http://dx.doi.org/10.1093/geront/gnw162.707}, Doi = {10.1093/geront/gnw162.707}, Key = {fds326661} } @misc{fds326662, Title = {INTEGRATING GENETIC DATA INTO HEALTH AND MORTALITY FORECASTING USING THE HEALTH AND RETIREMENT STUDY}, Journal = {Gerontologist}, Volume = {56}, Number = {Suppl_3}, Pages = {660-660}, Publisher = {Oxford University Press (OUP)}, Year = {2016}, Month = {November}, url = {http://dx.doi.org/10.1093/geront/gnw162.2684}, Doi = {10.1093/geront/gnw162.2684}, Key = {fds326662} } @misc{fds326482, Title = {TRENDS IN DIABETES MELLITUS AND RELATED HEALTH OUTCOMES 1991–2013: ACHIEVEMENTS AND CHALLENGES}, Journal = {Gerontologist}, Volume = {56}, Number = {Suppl_3}, Pages = {705-706}, Publisher = {Oxford University Press (OUP)}, Year = {2016}, Month = {November}, url = {http://dx.doi.org/10.1093/geront/gnw162.2876}, Doi = {10.1093/geront/gnw162.2876}, Key = {fds326482} } @article{fds318191, Author = {Yashkin, AP and Hahn, P and Sloan, FA}, Title = {Introducing Anti-Vascular Endothelial Growth Factor Therapies for AMD Did Not Raise Risk of Myocardial Infarction, Stroke, and Death.}, Journal = {Ophthalmology}, Volume = {123}, Number = {10}, Pages = {2225-2231}, Year = {2016}, Month = {October}, url = {http://dx.doi.org/10.1016/j.ophtha.2016.06.053}, Abstract = {<h4>Purpose</h4>To assess the effect of availability of anti-vascular endothelial growth factor (VEGF) therapy on mortality and hospitalizations for acute myocardial infarction (AMI) and stroke over a 5-year follow-up period in United States Medicare beneficiaries newly diagnosed with exudative age-related macular degeneration (AMD) in 2006 compared with control groups consisting of beneficiaries (1) newly diagnosed with exudative AMD at a time when anti-VEGF therapy was not possible and (2) newly diagnosed with nonexudative AMD.<h4>Design</h4>Retrospective cohort study.<h4>Participants</h4>Beneficiaries newly diagnosed with exudative and nonexudative AMD in 2000 and 2006 selected from a random longitudinal sample of Medicare 5% claims and enrollment files.<h4>Methods</h4>Beneficiaries with a first diagnosis of exudative AMD in 2006 were the treatment group; beneficiaries newly diagnosed with exudative AMD in 2000 or nonexudative AMD in 2000 or 2006 were control groups. To deal with potential selection bias, we designed an intent-to-treat study, which controlled for nonadherence to prescribed regimens. The treatment group consisted of patients with clinically appropriate characteristics to receive anti-VEGF injections given that the therapy is available, bypassing the need to monitor whether treatment was actually received. Control groups consisted of patients with clinically appropriate characteristics but first diagnosed at a time when the therapy was unavailable (2000) and similar patients but for whom the therapy was not clinically indicated (2000, 2006). We used a Cox proportional hazard model.<h4>Main outcome measures</h4>All-cause mortality and hospitalization for AMI and stroke during follow-up.<h4>Results</h4>No statistically significant changes in probabilities of death and hospitalizations for AMI and stroke within a 5-year follow-up period were identified in exudative AMD beneficiaries newly diagnosed in 2006, the beginning of widespread anti-VEGF use, compared with 2000. As an alternative to our main analysis, which excluded beneficiaries from nonexudative AMD group who received anti-VEGF therapies during follow-up, we performed a sensitivity analysis with this group of individuals reincluded (11% of beneficiaries newly diagnosed with nonexudative AMD in 2006). Results were similar.<h4>Conclusions</h4>Introduction of anti-VEGF agents in 2006 for treating exudative AMD has not posed a threat of increased risk of AMI, stroke, or all-cause mortality.}, Doi = {10.1016/j.ophtha.2016.06.053}, Key = {fds318191} } @article{fds318192, Author = {Mroz, TA and Picone, G and Sloan, F and Yashkin, AP}, Title = {Screening for a Chronic Disease: A Multiple Stage Duration Model With Partial Observability}, Journal = {International Economic Review}, Volume = {57}, Number = {3}, Pages = {915-934}, Publisher = {WILEY}, Year = {2016}, Month = {August}, url = {http://dx.doi.org/10.1111/iere.12180}, Doi = {10.1111/iere.12180}, Key = {fds318192} } @article{fds314534, Author = {Hahn, P and Yashkin, AP and Sloan, FA}, Title = {Effect of Prior Anti-VEGF Injections on the Risk of Retained Lens Fragments and Endophthalmitis after Cataract Surgery in the Elderly.}, Journal = {Ophthalmology}, Volume = {123}, Number = {2}, Pages = {309-315}, Year = {2016}, Month = {February}, ISSN = {0161-6420}, url = {http://dx.doi.org/10.1016/j.ophtha.2015.06.040}, Abstract = {<h4>Purpose</h4>To investigate the effect of prior intravitreal anti-vascular endothelial growth factor (VEGF) injections on surgical and postoperative complication rates associated with cataract surgery in a nationally representative longitudinal sample of elderly persons.<h4>Design</h4>Retrospective, longitudinal cohort analysis.<h4>Participants</h4>A total of 203 643 Medicare beneficiaries who underwent cataract surgery from January 1, 2009, to December 31, 2013.<h4>Methods</h4>By using the 5% sample of Medicare claims data, the study assessed risks of 3 adverse outcomes after receipt of cataract surgery for beneficiaries with a history of intravitreal injections. Risks of these outcomes in beneficiaries with a history of intravitreal injections relative to those without were calculated using the Cox proportional hazard model.<h4>Main outcome measures</h4>The primary outcome was the risk of subsequent removal of retained lens fragments (RLFs) within 28 days after cataract surgery. Secondary outcomes were a new diagnosis of acute (<40 days) or delayed-onset (40+ days) endophthalmitis and risk of a new primary open-angle glaucoma (POAG) diagnosis within 365 days after cataract surgery.<h4>Results</h4>Prior intravitreal anti-VEGF injections were associated with a significantly increased risk of subsequent RLF removal within 28 days after cataract surgery (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.19-4.30). Prior injections were also associated with increased risk of both acute (HR, 2.29; 95% CI, 1.001-5.22) and delayed-onset endophthalmitis (HR, 3.65; 95% CI, 1.65-8.05). Prior injections were not a significant indicator of increased risk of a new POAG diagnosis.<h4>Conclusions</h4>A history of intravitreal injections may be a risk factor for cataract surgery-related intraoperative complications and endophthalmitis. Given the frequency of intravitreal injections and cataract surgery, increased preoperative assessment, additional intraoperative caution, and postoperative vigilance are recommended in patients with a history of intravitreal injections undergoing cataract extraction.}, Doi = {10.1016/j.ophtha.2015.06.040}, Key = {fds314534} } @article{fds314536, Author = {Yashin, AI and Arbeev, KG and Arbeeva, LS and Wu, D and Akushevich, I and Kovtun, M and Yashkin, A and Kulminski, A and Culminskaya, I and Stallard, E and Li, M and Ukraintseva, SV}, Title = {How the effects of aging and stresses of life are integrated in mortality rates: insights for genetic studies of human health and longevity.}, Journal = {Biogerontology}, Volume = {17}, Number = {1}, Pages = {89-107}, Year = {2016}, Month = {February}, ISSN = {1389-5729}, url = {http://dx.doi.org/10.1007/s10522-015-9594-8}, Abstract = {Increasing proportions of elderly individuals in developed countries combined with substantial increases in related medical expenditures make the improvement of the health of the elderly a high priority today. If the process of aging by individuals is a major cause of age related health declines then postponing aging could be an efficient strategy for improving the health of the elderly. Implementing this strategy requires a better understanding of genetic and non-genetic connections among aging, health, and longevity. We review progress and problems in research areas whose development may contribute to analyses of such connections. These include genetic studies of human aging and longevity, the heterogeneity of populations with respect to their susceptibility to disease and death, forces that shape age patterns of human mortality, secular trends in mortality decline, and integrative mortality modeling using longitudinal data. The dynamic involvement of genetic factors in (i) morbidity/mortality risks, (ii) responses to stresses of life, (iii) multi-morbidities of many elderly individuals, (iv) trade-offs for diseases, (v) genetic heterogeneity, and (vi) other relevant aging-related health declines, underscores the need for a comprehensive, integrated approach to analyze the genetic connections for all of the above aspects of aging-related changes. The dynamic relationships among aging, health, and longevity traits would be better understood if one linked several research fields within one conceptual framework that allowed for efficient analyses of available longitudinal data using the wealth of available knowledge about aging, health, and longevity already accumulated in the research field.}, Doi = {10.1007/s10522-015-9594-8}, Key = {fds314536} } @article{fds320870, Author = {He, L and Kernogitski, Y and Kulminskaya, I and Loika, Y and Arbeev, KG and Loiko, E and Bagley, O and Duan, M and Yashkin, A and Ukraintseva, SV and Kovtun, M and Yashin, AI and Kulminski, AM}, Title = {Pleiotropic Meta-Analyses of Longitudinal Studies Discover Novel Genetic Variants Associated with Age-Related Diseases.}, Journal = {Frontiers in Genetics}, Volume = {7}, Pages = {179}, Year = {2016}, Month = {January}, url = {http://dx.doi.org/10.3389/fgene.2016.00179}, Abstract = {Age-related diseases may result from shared biological mechanisms in intrinsic processes of aging. Genetic effects on age-related diseases are often modulated by environmental factors due to their little contribution to fitness or are mediated through certain endophenotypes. Identification of genetic variants with pleiotropic effects on both common complex diseases and endophenotypes may reveal potential conflicting evolutionary pressures and deliver new insights into shared genetic contribution to healthspan and lifespan. Here, we performed pleiotropic meta-analyses of genetic variants using five NIH-funded datasets by integrating univariate summary statistics for age-related diseases and endophenotypes. We investigated three groups of traits: (1) endophenotypes such as blood glucose, blood pressure, lipids, hematocrit, and body mass index, (2) time-to-event outcomes such as the age-at-onset of diabetes mellitus (DM), cancer, cardiovascular diseases (CVDs) and neurodegenerative diseases (NDs), and (3) both combined. In addition to replicating previous findings, we identify seven novel genome-wide significant loci (< 5e-08), out of which five are low-frequency variants. Specifically, from Group 2, we find rs7632505 on 3q21.1 in <i>SEMA5B</i>, rs460976 on 21q22.3 (1 kb from <i>TMPRSS2</i>) and rs12420422 on 11q24.1 predominantly associated with a variety of CVDs, rs4905014 in <i>ITPK1</i> associated with stroke and heart failure, rs7081476 on 10p12.1 in <i>ANKRD26</i> associated with multiple diseases including DM, CVDs, and NDs. From Group 3, we find rs8082812 on 18p11.22 and rs1869717 on 4q31.3 associated with both endophenotypes and CVDs. Our follow-up analyses show that rs7632505, rs4905014, and rs8082812 have age-dependent effects on coronary heart disease or stroke. Functional annotation suggests that most of these SNPs are within regulatory regions or DNase clusters and in linkage disequilibrium with expression quantitative trait loci, implying their potential regulatory influence on the expression of nearby genes. Our mediation analyses suggest that the effects of some SNPs are mediated by specific endophenotypes. In conclusion, these findings indicate that loci with pleiotropic effects on age-related disorders tend to be enriched in genes involved in underlying mechanisms potentially related to nervous, cardiovascular and immune system functions, stress resistance, inflammation, ion channels and hematopoiesis, supporting the hypothesis of shared pathological role of infection, and inflammation in chronic age-related diseases.}, Doi = {10.3389/fgene.2016.00179}, Key = {fds320870} } @article{fds322919, Author = {Yashin, AI and Zhbannikov, I and Arbeeva, L and Arbeev, KG and Wu, D and Akushevich, I and Yashkin, A and Kovtun, M and Kulminski, AM and Stallard, E and Kulminskaya, I and Ukraintseva, S}, Title = {Pure and Confounded Effects of Causal SNPs on Longevity: Insights for Proper Interpretation of Research Findings in GWAS of Populations with Different Genetic Structures.}, Journal = {Frontiers in Genetics}, Volume = {7}, Pages = {188}, Year = {2016}, Month = {January}, url = {http://dx.doi.org/10.3389/fgene.2016.00188}, Abstract = {This paper shows that the effects of causal SNPs on lifespan, estimated through GWAS, may be confounded and the genetic structure of the study population may be responsible for this effect. Simulation experiments show that levels of linkage disequilibrium (LD) and other parameters of the population structure describing connections between two causal SNPs may substantially influence separate estimates of the effect of the causal SNPs on lifespan. This study suggests that differences in LD levels between two causal SNP loci within two study populations may contribute to the failure to replicate previous GWAS findings. The results of this paper also show that successful replication of the results of genetic association studies does not necessarily guarantee proper interpretation of the effect of a causal SNP on lifespan.}, Doi = {10.3389/fgene.2016.00188}, Key = {fds322919} } @article{fds370950, Author = {Worni, M and Akushevich, I and Greenup, R and Sarma, D and Ryser, MD and Myers, ER and Hwang, ES}, Title = {Trends in Treatment Patterns and Outcomes for Ductal Carcinoma In Situ.}, Journal = {J Natl Cancer Inst}, Volume = {107}, Number = {12}, Pages = {djv263}, Year = {2015}, Month = {December}, url = {http://dx.doi.org/10.1093/jnci/djv263}, Abstract = {BACKGROUND: Impact of contemporary treatment of pre-invasive breast cancer (ductal carcinoma in situ [DCIS]) on long-term outcomes remains poorly defined. We aimed to evaluate national treatment trends for DCIS and to determine their impact on disease-specific (DSS) and overall survival (OS). METHODS: The Surveillance, Epidemiology, and End Results (SEER) registry was queried for patients diagnosed with DCIS from 1991 to 2010. Treatment pattern trends were analyzed using Cochran-Armitage trend test. Survival analyses were performed using inverse probability weights (IPW)-adjusted competing risk analyses for DSS and Cox proportional hazard regression for OS. All tests performed were two-sided. RESULTS: One hundred twenty-one thousand and eighty DCIS patients were identified. The greatest proportion of patients was treated with lumpectomy and radiation therapy (43.0%), followed by lumpectomy alone (26.5%) and unilateral (23.8%) or bilateral mastectomy (4.5%) with significant shifts over time. The rate of sentinel lymph node biopsy increased from 9.7% to 67.1% for mastectomy and from 1.4% to 17.8% for lumpectomy. Compared with mastectomy, OS was higher for lumpectomy with radiation (hazard ratio [HR] = 0.79, 95% confidence interval [CI] = 0.76 to 0.83, P < .001) and lower for lumpectomy alone (HR = 1.17, 95% CI = 1.13 to 1.23, P < .001). IPW-adjusted ten-year DSS was highest in lumpectomy with XRT (98.9%), followed by mastectomy (98.5%), and lumpectomy alone (98.4%). CONCLUSIONS: We identified substantial shifts in treatment patterns for DCIS from 1991 to 2010. When outcomes between locoregional treatment options were compared, we observed greater differences in OS than DSS, likely reflecting both a prevailing patient selection bias as well as clinically negligible differences in breast cancer outcomes between groups.}, Doi = {10.1093/jnci/djv263}, Key = {fds370950} } @article{fds314535, Author = {Chen, Y and Sloan, FA and Yashkin, AP}, Title = {Adherence to diabetes guidelines for screening, physical activity and medication and onset of complications and death.}, Journal = {Journal of Diabetes and Its Complications}, Volume = {29}, Number = {8}, Pages = {1228-1233}, Year = {2015}, Month = {November}, ISSN = {1056-8727}, url = {http://dx.doi.org/10.1016/j.jdiacomp.2015.07.005}, Abstract = {<h4>Aims</h4>Analyze relationships between adherence to guidelines for diabetes care - regular screening; physical activity; and medication - and diabetes complications and mortality.<h4>Methods</h4>Outcomes were onset of congestive heart failure (CHF), stroke, renal failure, moderate complications of lower extremities, lower-limb amputation, proliferative diabetic retinopathy (PDR), and mortality during follow-up. Participants were persons aged 65+ in the Health and Retirement Study (HRS) 2003 Diabetes Study and had Medicare claims in follow-up period (2004-8).<h4>Results</h4>Adherence to screening recommendations decreased risks of developing CHF (odds ratio (OR)=0.83; 95% confidence interval (CI): 0.72-0.96), stroke (OR=0.80; 95% CI: 0.68-0.94); renal failure (OR=0. 82; 95% CI: 0.71-0.95); and death (OR=0.86; 95% CI: 0.74-0.99). Adherence to physical activity recommendation reduced risks of stroke (OR=0.64; 95% CI: 0.45-0.90), renal failure (OR=0.71; 95% CI: 0.52-0.97), moderate lower-extremity complications (OR=0.71; 95% CI: 0.51-0.99), having a lower limb amputation (OR=0.31, 95% CI: 0.11-0.85), and death (OR=0.56, 95% CI: 0.41-0.77). Medication adherence was associated with lower risks of PDR (OR=0.35, 95% CI: 0.13-0.93).<h4>Conclusions</h4>Adherence to screening, physical activity and medication guidelines was associated with lower risks of diabetes complications and death. Relative importance of adherence differed among outcome measures.}, Doi = {10.1016/j.jdiacomp.2015.07.005}, Key = {fds314535} } @misc{fds326663, Title = {TIME TRENDS OF DISEASE PREVALENCE AMONG OLDER U.S. ADULTS}, Journal = {Gerontologist}, Volume = {55}, Number = {Suppl_2}, Pages = {27-27}, Publisher = {Oxford University Press (OUP)}, Year = {2015}, Month = {November}, url = {http://dx.doi.org/10.1093/geront/gnv205.04}, Doi = {10.1093/geront/gnv205.04}, Key = {fds326663} } @misc{fds326664, Author = {Uemura, R and Akushevich, I and Kovtun, M and Yashkin, AP and Li, M and Arbeev, KG and Ukraintseva, S and Yashin, AI}, Title = {Lipofuscin: as an aging marker in nematodes, Caenorhabditis elegans}, Journal = {Gerontologist}, Volume = {55}, Pages = {1 pages}, Publisher = {OXFORD UNIV PRESS INC}, Year = {2015}, Month = {November}, Key = {fds326664} } @misc{fds326665, Title = {REGIONAL DISPARITIES IN LONGEVITY IN THE U.S.: AIR POLLUTION AND OTHER CONTRIBUTING FACTORS}, Journal = {Gerontologist}, Volume = {55}, Number = {Suppl_2}, Pages = {281-281}, Publisher = {Oxford University Press (OUP)}, Year = {2015}, Month = {November}, url = {http://dx.doi.org/10.1093/geront/gnv581.02}, Doi = {10.1093/geront/gnv581.02}, Key = {fds326665} } @article{fds314533, Author = {Abel, AS and Yashkin, AP and Sloan, FA and Lee, MS}, Title = {Effect of diabetes mellitus on giant cell arteritis.}, Journal = {Journal of Neuro Ophthalmology : the Official Journal of the North American Neuro Ophthalmology Society}, Volume = {35}, Number = {2}, Pages = {134-138}, Year = {2015}, Month = {June}, ISSN = {1070-8022}, url = {http://dx.doi.org/10.1097/wno.0000000000000218}, Abstract = {<h4>Background</h4>To determine if Type 2 diabetes mellitus (DM) is protective against giant cell arteritis (GCA) and to estimate the incidence of GCA diagnosis from Medicare claims.<h4>Methods</h4>Medicare 5% claims files from 1991 to 2011 were used to identify beneficiaries diagnosed with DM, but not GCA, within a 3-year ascertainment period. Propensity score matching was used to define a control group of nondiabetics with comparable demographic covariates. Competing risk regression was then used to assess the impact of DM diagnosis on GCA diagnosis. To allow for a 3-year ascertainment period, the analysis sample was limited to beneficiaries older than 68 years at baseline.<h4>Results</h4>A total of 151,041 beneficiaries diagnosed with DM were matched to an equal number of controls. Mean study follow-up was 67.75 months. GCA was diagnosed among 1116 beneficiaries with DM (0.73%) vs 465 (0.30%) controls. The risk of receiving a GCA diagnosis among patients with DM was increased by 100% (subhazard ratio, 2.00; 95% confidence interval, 1.78-2.25). The annual incidence of GCA diagnosis among claims for US Medicare beneficiaries older than 68 years old was 93 in 100,000.<h4>Conclusions</h4>A DM diagnosis is not protective against a GCA diagnosis in the Medicare population. Our data suggest that a DM diagnosis increases the risk of GCA diagnosis within 5.7 years for Medicare beneficiaries older than 68 years.}, Doi = {10.1097/wno.0000000000000218}, Key = {fds314533} } @article{fds314531, Author = {Yashkin, AP and Picone, G and Sloan, F}, Title = {Causes of the change in the rates of mortality and severe complications of diabetes mellitus: 1992-2012.}, Journal = {Medical Care}, Volume = {53}, Number = {3}, Pages = {268-275}, Year = {2015}, Month = {March}, ISSN = {0025-7079}, url = {http://dx.doi.org/10.1097/mlr.0000000000000309}, Abstract = {<h4>Objective</h4>To quantify the causes of the changes in the rates of mortality and select severe complications of diabetes mellitus, type 2 (T2D) among the elderly between 1992 and 2012.<h4>Research design</h4>A retrospective cohort study design based on Medicare 5% administrative claims data from 1992 to 2012 was used. Traditional fee-for-service Medicare beneficiaries, age 65 and older, diagnosed with T2D and living in the United States between 1992 and 2012 were included in the study. Blinder-Oaxaca decomposition was used to quantify the potential causes of the change in the rates of death, congestive heart failure and/or acute myocardial infarction, stroke, amputation of lower extremity and end-stage renal disease between 1992 and 2012.<h4>Results</h4>The number of beneficiaries in the analysis sample diagnosed with T2D increased from 152,191 in 1992 to 289,443 in 2012. Over the same time period, rates of mortality decreased by 1.2, congestive heart failure and/or acute myocardial infarction by 2.6, stroke by 1.6, amputation by 0.6 while rates of end-stage renal disease increased by 1.5 percentage points. Improvements in the management of precursor conditions and utilization of recommended healthcare services, not population composition, were the primary causes of the change.<h4>Conclusions</h4>With the exception of end-stage renal disease, outcomes among Medicare beneficiaries diagnosed with T2D improved. Analysis suggests that persons diagnosed with T2D are living longer with fewer severe complications. Much of the improvement in outcomes likely reflects more regular contact with health professionals and better management of care.}, Doi = {10.1097/mlr.0000000000000309}, Key = {fds314531} } @article{fds314532, Author = {Gray, N and Picone, G and Sloan, F and Yashkin, A}, Title = {Relation between BMI and diabetes mellitus and its complications among US older adults.}, Journal = {Southern Medical Journal}, Volume = {108}, Number = {1}, Pages = {29-36}, Year = {2015}, Month = {January}, ISSN = {0038-4348}, url = {http://dx.doi.org/10.14423/smj.0000000000000214}, Abstract = {<h4>Objectives</h4>This study examined relations between elevated body mass index (BMI) and time to diagnosis with type 2 diabetes mellitus and its complications among older adults in the United States.<h4>Methods</h4>Data came from the Medicare Current Beneficiary Survey, 1991-2010. A Cox proportional hazard model was used to assess relations between excess BMI at the first Medicare Current Beneficiary Survey interview and time to diabetes mellitus diagnosis, complications, and insulin dependence among Medicare beneficiaries, older than 65 years of age with no prior diabetes mellitus diagnosis, and who were not enrolled in Medicare Advantage (N = 14,657).<h4>Results</h4>Among individuals diagnosed as having diabetes mellitus, elevated BMIs were associated with a progressively higher risk of complications from diabetes mellitus. For women with a BMI ≥40, the risk of insulin dependence (hazard ratio [HR] 3.57; 95% confidence interval [CI] 2.36-5.39) was twice that for women with 25 ≤ BMI < 27.5 (HR 1.77; 95% CI 1.33-2.33). A similar pattern was observed in risk of cardiovascular (25 ≤ BMI < 27.5: HR 1.34; 95% CI 1.15-1.54; BMI ≥40: HR 2.45; 95% CI 1.92-3.11), cerebrovascular (25 ≤ BMI < 27.5: HR 1.30; 95% CI 1.06-1.57; BMI ≥40: HR 2.00; 95% CI 1.42-2.81), renal (25 ≤ BMI < 27.5: HR 1.31; 95% CI 1.04-1.63; BMI ≥40: HR 2.23; 95% CI 1.54-3.22), and lower extremity complications (25 ≤ BMI < 27.5: HR 1.41; 95% CI 1.22-1.61; BMI ≥40: HR 2.95; 95% CI 2.35-3.69).<h4>Conclusions</h4>Any increase in BMI above normal weight levels is associated with an increased risk of being diagnosed as having complications of diabetes mellitus. For men, the increased risk of these complications occurred at higher BMI levels than in women. Ocular complications occurred at higher BMI levels than other complication types in both men and women.}, Doi = {10.14423/smj.0000000000000214}, Key = {fds314532} } @article{fds315201, Author = {Sloan, FA and Yashkin, AP and Chen, Y}, Title = {Gaps in receipt of regular eye examinations among medicare beneficiaries diagnosed with diabetes or chronic eye diseases.}, Journal = {Ophthalmology}, Volume = {121}, Number = {12}, Pages = {2452-2460}, Year = {2014}, Month = {December}, ISSN = {0161-6420}, url = {http://dx.doi.org/10.1016/j.ophtha.2014.07.020}, Abstract = {<h4>Objective</h4>To examine a wide range of factors associated with regular eye examination receipt among elderly individuals diagnosed with glaucoma, age-related macular degeneration, or diabetes mellitus (DM).<h4>Design</h4>Retrospective analysis of Medicare claims linked to survey data from the Health and Retirement Study (HRS).<h4>Participants</h4>The sample consisted of 2151 Medicare beneficiaries who responded to the HRS.<h4>Methods</h4>Medicare beneficiaries with ≥ 1 of the 3 study diagnoses were identified by diagnosis codes and merged with survey information. The same individuals were followed for 5 years divided into four 15-month periods. Predictors of the number of periods with an eye examination evaluated were beneficiary demographic characteristics, income, health, cognitive and physical function, health behaviors, subjective beliefs about longevity, the length of the individual's financial planning horizon, supplemental health insurance coverage, eye disease diagnoses, and low vision/blindness at baseline. We performed logit analysis of the number of 15-month periods in which beneficiaries received an eye examination.<h4>Main outcome measures</h4>The primary outcome measure was the number of 15-month periods with an eye examination.<h4>Results</h4>One third of beneficiaries with the study's chronic diseases saw an eye care provider in all 4 follow-up periods despite having Medicare. One quarter only obtained an eye examination at most during 1 of the four 15-month follow-up periods. Among the 3 groups of patients studied, utilization was particularly low for persons with diagnosed DM and no eye complications. Age, marriage, education, and a higher score on the Charlson index were associated with more periods with an eye examination. Male gender, being limited in instrumental activities of daily living at baseline, distance to the nearest ophthalmologist, and low cognitive function were associated with a reduction in frequency of eye examinations.<h4>Conclusions</h4>Rates of eye examinations for elderly persons with DM or frequently occurring eye diseases, especially for DM, remain far below recommended levels in a nationally representative sample of persons with health insurance coverage. Several factors, including limited physical and cognitive function and greater distance to an ophthalmologist, but not health insurance coverage, account for variation in regular use.}, Doi = {10.1016/j.ophtha.2014.07.020}, Key = {fds315201} } | |
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