@article {11463, title = {Food security status and breast cancer screening among women in the United States: Evidence from Health and Retirement Study and Health Care and Nutrition Study}, journal = {Research Square}, year = {2023}, abstract = {Purpose: To assesses the impact of food insecurity on biennial breast cancer screenings (i.e., mammography or breast x-ray) among older women in the United States (US). \<h4\>Methods: \</h4\> Data from the 2014 and 2016 waves of the Health and Retirement Study and the 2013 Health Care and Nutrition Study were used. The analyses were limited to a nationally representative sample of 2,861 women between 50 to 74 years of age, residing in the US. We employed a propensity score weighting method to balance observed confounders between food-secure and food-insecure women and fitted a binary logistic regression to investigate population-level estimates for the association between food security and breast cancer screening. \<h4\>Results: \</h4\>: Food insecurity was significantly associated with failure to obtain a mammogram or breast x-ray within the past two years. Food-insecure women had 54\% lower odds of reporting breast cancer screening in the past two years (OR=0.46; 95\% CI: 0.30-0.70, P-value \<.001) as compared to food-secure women. Additional factors associated with a higher likelihood of receiving breast cancer screenings included greater educational attainment, higher household income, regular access to health care/advice, not smoking, and not being physically disabled or experiencing depressive symptoms. \<h4\>Conclusion: \</h4\> Results demonstrate a socioeconomic gradient existing in regard to the utilization of regular breast cancer screenings among women. Those who tend to have lower education, lower-income and lack of reliable healthcare access are more likely to be food insecure. Thus, more likely to face the financial, logistical, or environmental barriers in obtaining screening services that accompany food insecurity.}, keywords = {breast cancer screening, Food security}, doi = {10.21203/rs.3.rs-176608/v1}, author = {Mahmood, Asos and Kedia, Satish and Dillon, Patrick and kim, Hyunmin and Arshad, Hassan and Ray, Meredith} } @article {12338, title = {Longitudinal associations between time-varying insomnia symptoms and all-cause health care services utilization among middle-aged and older adults in the United States.}, journal = {Health Services Research}, year = {2022}, abstract = {

OBJECTIVE: To examine longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakenings, and nonrestorative sleep) and all-cause health care services utilization (HSU), including overnight hospital stays, nursing home stays, and home health care services among middle-aged and older adults.

DATA SOURCES: The Health and Retirement Study (HRS), a nationwide, population-representative survey of primarily middle-aged and older adults in the United States.

STUDY DESIGN: This study is an analysis of prospective data from the HRS for a cohort of 13,168 adults (aged >=50 years; females~=~57.7\%). Study participants were followed for 16 years. This study focuses on the associations between time-varying insomnia symptoms, both cumulatively and independently, and repeated HSUs. A marginal structural modeling approach was used to capture time-varying biological, psycho-cognitive, and behavioral health factors, and to adjust for selection bias such as differential loss to follow-up. Generalized estimating equations were employed to compute average marginal effects and their 95\% confidence intervals.

DATA COLLECTION/EXTRACTION METHODS: We extracted longitudinal data from 2002 through 2018 waves of the HRS.

PRINCIPAL FINDINGS: Experiencing higher numbers of insomnia symptoms on a cumulative scale was associated with higher probabilities of HSU. For instance, the likelihood of overnight hospital stays for individuals reporting one symptom increased from 4.7 percentage points on average (95\% CI: 3.7-5.6, p < 0.001), to 13.9 percentage points (95\% CI: 10.3-17.5, p < 0.001) for those reporting four symptoms, relative to individuals experiencing no insomnia symptoms. Further, experiencing each of difficulty initiating and maintaining sleep, and nonrestorative sleep, as standalone symptoms, was associated with a higher likelihood of HSU when compared to those not experiencing the symptoms.

CONCLUSIONS: The results demonstrate the potential consequences and adverse impacts of insomnia symptoms on HSU among middle-aged and older adults. Future investigations should focus on the underlying causes and health systems pathways linking insomnia symptoms to HSU.

}, keywords = {health care services utilization, home health care services, Hospitalization, insomnia symptoms, nursing home stay}, issn = {1475-6773}, doi = {10.1111/1475-6773.13971}, author = {Mahmood, Asos and Kedia, Satish and Dobalian, Aram and Chang, Cyril F and Ahn, SangNam} }