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Importance:Alcohol use disorder (AUD) is a major public health concern; medications for AUD (MAUD) are an effective form of treatment but remain underused. Identifying MAUD access trends and the characteristics of counties with limited availability can inform targeted efforts to expand treatment capacity. Objective:To examine trends in geographic availability of MAUD at US substance use disorder treatment facilities (SUDTFs) from 2017 to 2023 and assess county characteristics associated with SUDTFs offering MAUD. Design, Setting, and Participants:This nationwide cross-sectional study used data from the Mental Health and Addiction Treatment Tracking Repository, which includes longitudinal data on licensed SUDTFs and whether they offer MAUD (acamprosate, disulfiram, or naltrexone), to quantify trends in MAUD availability at SUDTFs from January 2017 to December 2023. Main Outcomes and Measures:The primary outcome was a county-year indicator for whether at least 1 SUDTF in the county offered MAUD. Explanatory county variables included rurality, percentage of traffic fatalities involving alcohol, percentage of the population that drank excessively, percentage of uninsured individuals, poverty rate, percentage of individuals over age 65 years, and percentage of non-Hispanic White individuals. Univariate logistic regressions with state and year fixed effects were used to explore associations between county characteristics and the probability that a county had any SUDTFs offering MAUD. Results:Across 22 000 county-years in a total of 3153 counties, the mean (SD) percentage of counties with at least 1 SUDTF offering MAUD increased from 34.12% (47.42%) in 2017 to 43.88% (49.63%) in 2021, but growth plateaued after 2021. Lower MAUD presence in a county was associated with rural-adjacent (difference, -22.40 percentage points [pp]; 95% CI, -24.43 to -20.38 pp) and rural-remote (-23.64 pp; 95% CI, -25.72 to -21.56 pp) relative to metropolitan county status as well as with a higher poverty rate (-0.66 pp; 95% CI, -0.93 to -0.38 pp), greater percentage of individuals aged 65 years or older (-2.33 pp; 95% CI, -3.02 to -1.65 pp), and higher proportion of non-Hispanic White individuals (-0.58 pp; 95% CI, -0.71 to -0.46 pp), whereas greater prevalence of binge drinking (difference, 1.90 pp; 95% CI, 1.26-2.54 pp) and a higher percentage of college-educated individuals (1.28 pp; 95% CI, 1.13-1.43) were associated with higher MAUD presence. Conclusions and Relevance:In this cross-sectional study, the proportion of SUDTFs offering MAUD increased from 2017 to 2021, but growth then plateaued. Policies supporting the expansion of MAUD-providing facilities, particularly in underserved counties, may be needed to address persistent gaps in access.
This interim analysis of an ongoing retrospective cohort study uses data from 5 US health plans to assess safety of a bivalent prefusion F subunit-based respiratory syncytial virus (RSV) vaccine administered during pregnancy during the first full RSV season after US Food and Drug Administration approval (from September 22, 2023, through June 14, 2024).
During the COVID-19 pandemic, accurate measurement of vaccination status was important for guiding prevention efforts. We assessed the accuracy of electronic health record (EHR) COVID-19 vaccination compared with survey self-reported vaccination status using data from a cross-sectional study among pregnant women and non-pregnant adults in the Vaccine Safety Datalink between 2021 and 2022, where self-report was considered the reference standard. We measured the sensitivity and specificity of EHR vaccine data compared with the self-reported measure and estimated vaccination rates from EHR data. EHR data were obtained initially in November 2021, updated in April 2022, and record reviewed in July 2022. Vaccination coverage increased in pregnant/formerly pregnant women and non-pregnant adult respondents by 23.9% and 9.2%, respectively, over 9 months. Estimates of sensitivity based on initial EHR data were 66.0% and 77.3% for pregnant women and non-pregnant people overall and between 41% and 66% for pregnant, non-Hispanic Black, and Hispanic, Spanish-speaking respondents. With matured, chart reviewed EHR data from April 2022, the sensitivity and specificity of EHR vaccine status relative to self-report were > 93%. EHR data were a reasonable source of COVID-19 vaccination status during the pandemic and showed high accuracy with self-reported data after allowing EHR data to mature.
Objective:To compare the risk of incident cardiovascular disease (CVD) events following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).Background:Bariatric surgery is associated with reduced CVD risk, but the differential effect of contemporary bariatric procedures is unclear.Methods:We used insurance claims to conduct a retrospective cohort study of CVD outcomes for patients who underwent RYGB versus SG between 2010 and 2021. Patients were followed for up to 5 years for a primary composite major adverse cardiovascular event (MACE) outcome as well as individual outcomes, including myocardial infarction, stroke, heart failure, and arrhythmia. We compared cumulative risks of CVD events using multivariable Cox proportional hazards modeling in overall cohorts and subcohorts of older adults and those with type 2 diabetes (T2D) or pre-existing CVD and elevated morbidity.Results:Matched, weighted cohorts of 13,545 SG and RYGB patients were observed for an average of 2.5 years after surgery, with 26.2% not lost to follow-up by the end of 5 years. There was no difference in MACE risk between procedures [adjusted hazard ratio (aHR): 1.01 for RYGB vs. SG (95% CI: 0.90, 1.12)] in the overall cohort or among the subgroup of older adults [aHR: 0.97 for RYGB vs. SG (95% CI: 0.85, 1.10)]. Patients with T2D experienced a lower risk of MACE following RYGB compared with SG [aHR: 0.78 (95% CI: 0.66, 0.92)], as did those with pre-existing CVD or elevated morbidity before surgery [aHR: 0.81 (95% CI: 0.70, 0.93)].Conclusions:These findings further support the preferential use of RYGB over SG for patients with T2D or who have pre-existing CVD. However, among other groups of patients, including older adults, we did not observe a relative benefit of RYGB during the time horizon in this study.
