Affiliates' Research in Medical Journals, Fall 2022

COVID-19 Booster Uptake among US Adults: Assessing the Impact of Vaccine Attributes, Incentives, and Context in a Choice-Based Experiment 
Raman S, Kriner D, Ziebarth N, Simon K, Kreps S. Social Science & Medicine 310, October 2022, 15277.

To assess the factors that affect individuals’ reported willingness to receive a COVID-19 vaccine booster, researchers surveyed 548 fully vaccinated US adults who had not yet received one. Participants were recruited in December 2021 — a time period when the Omicron variant was emerging — and evaluated five hypothetical vaccine boosters with attributes that were randomly assigned. Respondents were asked whether they would receive a booster with each profile, and their answers were the study’s outcome variables. The most important predictor of willingness to receive a booster was efficacy. For a booster that was 50 percent effective in preventing symptomatic infection, the marginal mean willingness to receive it was 0.49 (95 percent CI: 0.45–0.53). This increased to 0.59 for a booster that was 70 percent effective and to 0.73 for one that was 90 percent effective. Other important factors included the manufacturer and the size of a financial incentive. Protection duration and protection against future variants versus only the current variants had modest influence. The provision of contextual information — indicating that some public health experts believe the Omicron variant is more contagious but less lethal than prior variants — significantly increased favorability towards boosters. In addition, participant characteristics such as younger age, Democratic political affiliation, and not being in the workforce increased willingness to receive a booster. A sample of 619 respondents who reported not yet having received a single dose of a COVID-19 vaccine were also surveyed, with the hypothetical profiles describing vaccines rather than boosters. Most vaccine attributes had little effect on willingness to receive a vaccine among this unvaccinated group. The only exceptions were that a 90 percent effective vaccine significantly increased acceptance relative to a 50 percent effective one, a protection duration of two years significantly increased acceptance relative to six-months protection, and a $1,000 incentive increased uptake relative to a $10 incentive baseline.

Changes in the Relationship between Income and Life Expectancy before and during the COVID-19 Pandemic, California, 2015-2021 
Schwandt H, Currie J, von Wachter T, Kowarski J, Chapman D, Woolf SH. JAMA 328(4), July 2022, pp. 360–366.

Deaths from COVID-19 caused a large decrease in US life expectancy at birth in 2020, because life expectancy is a reflection of the prevailing age-specific mortality rates of the year in which it is measured. To determine whether a similar decrease occurred in 2021 and whether the relationship between income and life expectancy intensified during the pandemic, this study examined 1,988,606 deaths in California from 2015 to 2021, calculating life expectancy at the state and census tract levels. Tracts were grouped by median household income, obtained from the American Community Survey. Census tracts with low levels of median household income are often marginalized communities with a smaller tax base, limited municipal budgets, and weaker economies to provide and sustain health-supporting resources and infrastructure. The researchers found a decrease in life expectancy in both 2020 and 2021 — despite the availability of a highly effective vaccine — and an increase in the life expectancy gap by income level relative to the pre-pandemic period. This gap disproportionately affected some racial and ethnic minority populations. Mean life expectancy at birth declined from 81.4 years in 2019 to 79.2 years in 2020 and 78.4 years in 2021. People in low-income census tracts had larger decreases in life expectancy than people in higher income tracts: differences between the tracts in the highest and lowest income percentiles increased from 11.5 years in 2019 to 14.7 years in 2020 and 15.5 years in 2021. Within census tracts, these decreases in life expectancy were greater among Hispanics (5.7 years), non-Hispanic Blacks (3.8 years), and non-Hispanic Asians (3.0 years) than among non-Hispanic Whites (1.90 years), demonstrating the added health implications of race and ethnicity even within a given location.

Trends in Inequities in the Treatment of and Outcomes for Women and Minorities with Myocardial Infarction 
Montoy JC, Shen Y, Hsia RY. Annals of Emergency Medicine 80(2), June 2022, pp. 108−117.

Although overall mortality rates for acute myocardial infarction (AMI) have declined for both ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI), women and some racial minority groups have historically been less likely than men and Whites to undergo timely coronary angiography and percutaneous coronary intervention, and have had higher mortality rates. While there was some evidence from the early 2000s showing that these disparities were decreasing, this study examined whether the differences had changed between 2005 and 2015. The researchers conducted a retrospective analysis of 159,068 STEMI and 294,068 NSTEMI patients in California using the Office of Statewide Health Planning and Development dataset. They measured the baseline and change over time in the proportions of patients with STEMI or NSTEMI who underwent appropriately timed coronary angiography (day of admission and within three days of admission, respectively) and survived at one year. Females were less likely than males to get timely treatment, with the gaps decreasing slightly for STEMI from 14 percentage points in 2005 to 10 in 2015, and for NSTEMI from 12 to 10 percentage points. Females had significantly worse outcomes: 13 and 5 percentage points lower survival at one year for STEMI and NSTEMI respectively, with only slight narrowing of the gap over time. Blacks were less likely than Whites to get timely treatment, with the gap decreasing for STEMI from 14 percentage points in 2005 to 6 in 2015, but widening slightly for NSTEMI from 8 to 11 percentage points. Black, Hispanic, and Asian patients generally had equal or better one year survival rates as compared to White patients, with little change over time. Thus although most gaps narrowed, they persisted over the course of the study period. Multivariable linear regressions with county fixed effects revealed that a portion of the sex and race differences in treatment and outcomes were explained by comorbidities, patient insurance, and hospital characteristics, which highlights the importance of social factors that influence the ability to access care. However the gaps remained statistically significant and clinically meaningful in multivariate models.

Financial Incentives to Facilities and Clinicians Treating Patients with End-Stage Kidney Disease and Use of Home Dialysis: A Randomized Clinical Trial 
Ji Y, Einav L, Mahoney N, Finkelstein A. JAMA Health Forum 3(10), October 2022, e223503.

Association of Insurance Mix and Diagnostic Coding Practices in New York State Hospitals 
Dragan KL, Desai SM, Billings J, Glied SA. JAMA Health Forum 3(9), September 2022, e222919.

Effect of Pharmacist Email Alerts on Concurrent Prescribing of Opioids and Benzodiazepines by Prescribers and Primary Care Managers: A Randomized Clinical Trial 
Sacarny A, Safran E, Steffel M, Dunham JR, Abili OD, Mohajeri L, Oh PT, Sim A, Brutcher RE, Spevak C. JAMA Health Forum 3(9), September 2022, e223378.

Evaluating the Accuracy of Medicare Risk Adjustment for Alzheimer’s Disease and Related Dementias 
Festa N, Price M, Weiss MR, Moura LMVR, Benson NM, Zafar S, Blacker D, Normand ST, Newhouse JP, Hsu J. Health Affairs 41(9), September 2022, pp. 1324−1332.

Changes in Emergency Department Visits for Cannabis Hyperemesis Syndrome following Recreational Cannabis Legalization and Subsequent Commercialization in Ontario, Canada 
Myran DT, Roberts R, Pugliese M, Taljaard M, Tanuseputro P, Pacula RL. JAMA Network Open 5(9), September 2022. 

Enrollment Brokers Did Not Increase Medicaid Enrollment, 2008–18 
Staiger B, Li A, Alexander D, Schnell M. Health Affairs 41(9), September 2022.

Trends in Out-of-Pocket Costs for Naloxone by Drug Brand and Payer in the US, 2010–2018 
Peet ED, Powell D, Pacula RL. JAMA Health Forum 3(8), August 2022, e222663.

Effect of an Intensive Nurse Home Visiting Program on Adverse Birth Outcomes in a Medicaid-Eligible Population: A Randomized Clinical Trial 
McConnell MA, Rokicki S, Ayers S, Allouch F, Perreault N, Gourevitch RA, Martin MW, Zhou RA, Zera C, Hacker MR, Chien A, Bates MA, Baicker K. JAMA 328(1), July 2022, pp. 27−37.

Changes in Insurance Coverage Continuity after Affordable Care Act Expansion of Medicaid Eligibility for Young Adults with Low Income in Massachusetts 
Fung V, Yang Z, Cook BL, Hsu J, Newhouse JP. JAMA Health Forum 3(7), July 2022, e221996.

Characterization of Cannabis Products Purchased for Medical Use in New York State 
Kritikos A, Pacula RL. JAMA Network Open 5(8), July 2022, e2227735.

Reforming Medicare Part D Benefit Design: Financial Implications for Beneficiaries, Private Plans, Drug Manufacturers, and the Federal Government 
Trish E, Kaiser KM, Celestin J, Joyce G. Journal of Health Politics, Policy and Law, July 2022, 10041233.

Structural Inequities for Historically Underserved Communities in the Adoption of Stroke Certification in the United States 
Shen Y, Sarkar N, Hsia RY. JAMA Neurology 79(8), June 2022, pp. 777−786.

The Impact of Facebook’s Vaccine Misinformation Policy on User Endorsements of Vaccine Content: An Interrupted Time Series Analysis 
Gu J, Dor A, Li K, Broniatowski DA, Hatheway M, Fritz L, Abroms LC. Vaccine 40(14), March 2022, pp. 2209–2214.

Trends in Cost Attributable to Kidney Transplantation Evaluation and Waiting List Management in the United States, 2012–2017 
Cheng XS, Han J, Braggs-Gresham JL, Held PJ, Busque S, Roberts JP, Tan JC, Scandling JD, Chertow GM, Dor A. JAMA Network Open 5(3), March 2022, e221847.

Acute Bacterial Infections and Longitudinal Risk of Readmissions and Mortality in Patients Hospitalized with Heart Failure 
Ng TMH, Oh EE, Bae-Shaaw YH, Minejima E, Joyce G. Journal of Clinical Medicine 11(3), January 2022, 740.