Ahmed Arif PhD Associate Professor Department of Public Health Sciences November 12 2018 Claudio Owusu MA Doctoral Student Department of Geography and Center for Applied Geographic Information Science ID: 774991
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Spatial Analysis of Health Care Utilization among Medicare Beneficiaries with Coal Workers’ Pneumoconiosis and Other Related Pneumoconiosis
Ahmed Arif, PhDAssociate ProfessorDepartment of Public Health Sciences
November 12, 2018
Claudio Owusu
, MA
Doctoral Student
Department of Geography and Center for Applied Geographic Information Science
Slide2Coal
More than 7269 million tons (Mt) are produced worldwide
Top three coal producersChina – 3443 MtIndia – 708 MtU.S. – 672 MtIn the U.S. 30% of electricity is generated by coal
Slide3Slide4Lung diseases among coal miners
Chronic bronchitisEmphysemaPneumoconiosisAsbestosisSilicosisCoal workers’ pneumoconiosis (CWP)
Slide5What is Coal workers’ pneumoconiosis (CWP)?
CWP is an occupational lung disease caused by overexposure to respirable coal mine dustInhaled coal dust is deposited in the lung parenchyma leading to the formation of black nodules, inflammation and fibrosis
Slide6Source: https://emedicine.medscape.com/article/297887-overview
PMF
Normal
CWP
Simple
Slide7Prevalence of CWP in the U.S.
11.2% in 1970–1974 to 2.1% (2005-2015); Eastern region – 3.3%-3.9%Prevalence of PMF severe form of CWP is rising, especially in the central Appalachian region (KY, VA, and WV)
Slide8Purpose of the study
To assess the geographical distribution of health care utilization patterns among Medicare beneficiaries with CWP and other related pneumoconiosis.To conduct spatial analysis of health care utilization among Medicare beneficiaries with CWP and other related pneumoconiosis as they relate to the location of black lung clinics.
Slide9Medicare Limited Dataset (LDS) administrative claims data
Medicare beneficiaries represent 16% of the total U.S. population or approximately 51 million individuals covered under Part A (hospital) and B (outpatient services). The LDS includes a set random sample of 5% of the Medicare population
Slide10Inclusion Criteria
Diagnosis of ICD-9-CM 500.xx-505.xx Study period of January 1, 2011 through December 31, 2014. The date of first diagnosis of CWP served as the patient’s index date. If the patient did not have a diagnosis of CWP then the date of first diagnosis of 501-505 served as the index date.
ICD-9-CM CodeDescription500Coal workers’ pneumoconiosis501Asbestosis502Pneumoconiosis due to other silica or silicates503Pneumoconiosis you to other inorganic dust504Pneumonopathy due to inhalation of other dust505Pneumoconiosis, unspecified
Slide11Health Care Utilization
The total counts for the utilization for patients with ICD-500 or those with ICD-501 – 505 were calculated at the county-level by summingoffice visits (a)emergency room visits, (b) andHospitalizations (c).Denominator: Population 18 years and over that have health insurance coverage using the American Community Survey, 5-year estimates 2010-2014. To obtain an annual rate of utilization, the final results were divided by the number of years (t=4).
Slide12Mapping
County-level counts and annual rates of utilization for Medicare beneficiaries with CWP and other related pneumoconiosis were mapped.Cluster-outlier analysis to determine counties with significantly high clustering of health care utilization for CWP and other related pneumoconiosis.ArcGIS 10.5
Slide13Results
86.6% were male
89.7% ≥ 65
89.6% were white
Slide14Results
Slide15All Patients
Patients with ICD-9-CM: 500
Patients with ICD-9-CM: 501-505
Patients
8713
1673
7040
All Visits (n)
All Visits (n)
All Visits (n)
Total Office Visits
113,525
20,749
92,776
Total Hospitalizations
18,566
3,585
14,981
Total ER visits
58,312
11,781
46,531
Slide16Black Lung Clinic Program Locations in the U.S. (N=55)
Slide17https://tabsoft.co/2JyzE4o
United States Energy Information Administration, (2016). Coal Mines, Surface and Underground Layer. Retrieved from: https://www.eia.gov/maps/layer_info-m.php
Active Mine Locations in the U.S. (N=710)
Slide1855 Black Lung Clinics program
https://tabsoft.co/2OkuFoM
Slide19Counts of Beneficiaries for CWP (ICD-9 CM 500), 2011-2014, Contiguous United States
Slide20Annual Rates of Health Care Utilization for CWP (ICD-9 CM 500), 2011-2014, Relative to BL Clinic Locations, Contiguous United States
Slide21Counts of Beneficiaries and Annual Rates of Health Care Utilization for CWP (ICD-9 CM 500), 2011-2014, Relative to BL Clinic Locations, Contiguous United States
https://tabsoft.co/2Q4Vv5X
Slide22Cluster-outlier Analysis of Annual Rate of Health Care Utilization for CWP (ICD-9 CM 500), 2011-2014
https://tabsoft.co/2zs5fjZ
Slide23Counts of Beneficiaries with Other Related Pneumoconiosis (ICD-9 CM 501–505), 2011-2014, Contiguous United States
Slide24Annual Rates of Health Care Utilization for Other Related Pneumoconiosis (ICD-9 CM 501–505), 2011-2014, Relative to BL Clinic Locations, Contiguous United States
Slide25Counts of Beneficiaries and Annual Rates of Health Care Utilization for Other Related Pneumoconiosis (ICD-9 CM 501–505), 2011-2014, Relative to BL Clinic Locations, Contiguous United States
https://tabsoft.co/2qjCP7g
Slide26Cluster-outlier Analysis of Annual Rate of Health Care Utilization for Other Related Pneumoconiosis (ICD-9 CM 501–505), 2011-2014
Slide27Cluster-outlier Analysis of Annual Rate of Health Care Utilization for Other Related Pneumoconiosis (ICD-9 CM 501–505), 2011-2014
https://tabsoft.co/2Oim0DA
Slide28Conclusions
The spatial analysis shows that rates of health care utilization for CWP are higher in counties with a high number of active mines, particularly in the Appalachian region. Cluster analysis revealed some challenges in access to health care for individuals with CWP, particularly in some counties in Illinois and Kentucky. The significance of clusters of health care utilization rates among beneficiaries with other related pneumoconiosis is unknown. Since CWP and lung diseases that are part of other related pneumoconiosis can coexist, there is a need for further studies to understand the characteristics of these beneficiaries and underlying disease etiology.
Slide29Acknowledgement
Dr. Christopher BlanchetteRipsi PatelDr. Joshua NooneDr. Tyrone Borders
The Rural & Underserved Health Research Center is supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under cooperative agreement # U1CRH30041. The information, conclusions and opinions expressed in this presentation are those of the authors and no endorsement by FORHP, HRSA, HHS, or the University of Kentucky is intended or should be inferred.
Slide30References
U.S. Bureau of Labor Statistics. Occupational Employment Statistics, May 2017. National Industry-Specific Occupational Employment and Wage Estimates, NAICS 212100 - Coal Mining. Washington, DC; 2018. Retrieved from
https://www.bls.gov/oes/current/naics4_212100.htm
United States Energy Information System. Which states produce the most coal? Washington, DC; 2017. Retrieved from
https://www.eia.gov/tools/faqs/faq.php?id=69&t=2
U.S. Census Bureau. Health Insurance Coverage, 2010-2014. American Community Survey (Summary File: B27001). Suitland, MD; 2014.
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United States Energy Information System. Coal Mines, Surface and Underground Layer. Washington, DC; 2016. Retrieved from
https://www.eia.gov/maps/layer_info-m.php
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United States Office of Surface Mining Reclamation and Enforcement. Abandoned Mine Land Inventory System. Washington, DC: Office of the Interior; 2017. Retrieved from
https://www.osmre.gov/programs/AMLIS.shtm
Blackley
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Halldin
CN, Laney AS. Continued Increase in Prevalence of Coal Workers' Pneumoconiosis in the United States, 1970-2017.
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DJ, Reynolds LE, Short C, et al. Progressive Massive Fibrosis in Coal Miners From 3 Clinics in Virginia.
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Slide31Questions?