Risk management and the potential of cattle insurance in Tigray, Northern Ethiopia

This study explores the role of livestock insurance to complement existing risk management strategies adopted by smallholder farmers. Using survey data, first, it provides insights into farmers’ risk perception of livestock farming, in terms of likelihood and severity of risk, attitude to risk and their determinants. Second, it examines farmers’ risk management strategies and their determinants. Third, it investigates farmers’ potential engagement with a hypothetical cattle insurance decision and their intensity of participation. Factor analysis is used to analyse risk sources and risk management, multiple regressions are used to identify the determinants; a Heckman model was used to investigate cattle insurance participation and intensity of participation. The findings show different groups of farmers display different risk attitude in their decision-making related to livestock farming. Production risk (especially livestock diseases) was perceived as the most likely and severe source of risk. Disease control was perceived as the best strategy to manage risk overall. Disease control and feed management were important strategies to mitigate the production risks. Disease control and participation on safety net program were found to be important to counter households’ financial risks. With regard to the hypothetical cattle insurance scheme, 94.38% of households were interested to participate in cattle insurance. Of those households that accepted cattle insurance, 77.38% of the households were willing to pay the benchmark annual premium of 4% of the animal value while for the remaining households this was not affordable. The average number of cattle that farmers were willing to insure was 2.71 at this benchmark. Results revealed that income (log income) and education levels influenced positively and significantly farmers’ participation in cattle insurance and the number of cattle to insure. The findings prompt policy makers to consider livestock insurance as a complement to existing risk management strategies to reduce poverty in the long-run

Cattle farmers’ perceptions of risk and risk management strategies

This study analyzes cattle farmers’ perceptions of risk and risk management strategies in Tigray, Northern Ethiopia. We use survey data from a sample of 356 farmers based on multistage random sampling. Factor analysis is employed to classify scores of risk and management strategies, and multiple regression is then used to investigate the relationship of scores and farmers’ characteristics. The results demonstrate that shortage of family labor, high price of fodder and limited farm income were perceived as the most important risks. Use of veterinary services, parasite control and loan utilization were perceived as the most important strategies to manage risks. Livestock disease and labor shortage were perceived as less of a risk by farmers who adopted the practice of zero grazing compared to other farmers, pointing to the potential of this practice for risk reduction. We find strong evidence that farmers engage in multiple risk management practices in order to reduce losses due to cattle morbidity and mortality. The results suggest that government strategies that aim at reducing farmers’ risk need to be tailored to specific farm and farmer characteristics. Findings from this study have potentially important policy implications for risk management strategies in developing countries

Racial/Ethnic Differences in Glycemic Control in Older Adults with Type 2 Diabetes: United States 2003-2014

The aim of this study was to determine whether racial differences in HbA1c persist in older adults (≥65 years) living with type 2 diabetes. Data from The National Health and Nutrition Examination Survey (NHANES) 2003-2014 were used to examine the association between HbA1c and older adults (≥65 years) over time. Compared to non-Hispanic Whites, Mexican Americans had the greatest difference in average HbA1c among minority groups, followed by those with unspecified/mixed ethnicities and non-Hispanic Blacks. In the adjusted linear model, racial minorities had a statistically significant relationship with HbA1c. There was no relationship between HbA1c and older age and insulin use. Trends in mean HbA1c over time increased for non-Hispanic Blacks and Mexican Americans and decreased for non-Hispanic Whites. The findings suggest that racial differences in HbA1c persist into older age and compared to non-Hispanic Whites, non-Hispanic Blacks and Mexican Americans are at an increased risk of morbidity, mortality, and disability due to high HbA1c. Furthermore, alternate measures of glycemic control may be needed to screen and manage T2DM in racial minorities

Trends in healthcare expenditure among people living with HIV/AIDS in the United States: evidence from 10 Years of nationally representative data

Abstract Background While previous studies have examined HIV cost expenditures within the United States, the majority of these studies focused on data collected prior to or shortly after the advent and uptake of antiretroviral therapy, focused only on a short time frame, or did not provide cost comparisons between HIV/AIDS and other chronic conditions. It is critical that researchers provide accurate and updated information regarding the costs of HIV care to assist key stakeholders with economic planning, policy development, and resource allocation. Methods We used data from the Medical Expenditure Panel Survey-Household Component for the years 2002–2011, which represents a nationally representative U.S. civilian non-institutionalized population. Using generalized linear modeling, we estimated the adjusted direct medical expenditures by HIV/AIDS status after controlling for confounding factors. Results Data were from 342,732 people living with HIV/AIDS. After adjusting for socio-demographic factors, comorbidities and time trend covariates, the total direct expenditures for HIV/AIDS was $31,147 (95$23,645–$38,648) or 800–900$10.7 billion higher than the costs for those without HIV/AIDS. Conclusions Our estimates of cost expenditures associated with HIV care over a 10-year period show a financial burden that exceeds previous estimates of direct medical costs. There is a strong need for investment in combination prevention and intervention programs, as they have the potential to reduce HIV transmission, and facilitate longer and healthier living thereby reducing the economic burden of HIV/AIDS

Decompressive hemicraniectomy for stroke by race/ethnicity in the United States

Objective: Racial and ethnic differences in the performance of indicated neurosurgical procedures have been reported. However, it is not clear whether there are racial or ethnic differences in the performance of decompressive hemicraniectomy (DHC) for acute ischemic stroke. This study evaluated the rate, trends, and independent association of race and ethnicity with DHC among hospitalized ischemic stroke patients in the United States. Materials and methods: We used the International Classification of Diseases, Clinical Modification (ICD-9-CM) to identify adult patients (18-year-old and older) with a primary discharge diagnosis of ischemic stroke, excluding those with a posterior circulation ischemic stroke in the Nationwide Inpatient Sample between 2006 and 2014. We computed the rate and trends of DHC. We then applied a multivariable logistic regression model to evaluate the independent association of race with DHC. Results: A total 715,649 patients had anterior ischemic stroke, including 1514 who underwent DHC (2.1 per 1000). The rate of DHC increased overall from 1 per 1000 in 2006 to 3 per 1000 in 2014. Similar upward trends were noted among Non-Hispanic Whites, Non-Hispanic Blacks, and Hispanics. Hispanics with anterior ischemic stroke were 1.28 times more likely than non-Hispanic Whites to have DHC but no difference was observed between Non-Hispanic Blacks and Non-Hispanic Whites. Conclusions: In this nationally representative sample of patients with anterior ischemic strokes, being of Hispanic ethnicity was independently associated with a higher frequency of receiving DHC compared to being Non-Hispanic White. Future studies should confirm this difference and explore the underlying reasons for it

Racial/Ethnic Differences in Glycemic Control in Older Adults with Type 2 Diabetes: United States 2003–2014

The aim of this study was to determine whether racial differences in HbA1c persist in older adults (≥65 years) living with type 2 diabetes. Data from The National Health and Nutrition Examination Survey (NHANES) 2003–2014 were used to examine the association between HbA1c and older adults (≥65 years) over time. Compared to non-Hispanic Whites, Mexican Americans had the greatest difference in average HbA1c among minority groups, followed by those with unspecified/mixed ethnicities and non-Hispanic Blacks. In the adjusted linear model, racial minorities had a statistically significant relationship with HbA1c. There was no relationship between HbA1c and older age and insulin use. Trends in mean HbA1c over time increased for non-Hispanic Blacks and Mexican Americans and decreased for non-Hispanic Whites. The findings suggest that racial differences in HbA1c persist into older age and compared to non-Hispanic Whites, non-Hispanic Blacks and Mexican Americans are at an increased risk of morbidity, mortality, and disability due to high HbA1c. Furthermore, alternate measures of glycemic control may be needed to screen and manage T2DM in racial minorities

Sex differences in healthcare expenditures among adults with diabetes: evidence from the medical expenditure panel survey, 2002–2011

Abstract Background The evidence assessing differences in medical costs between men and women with diabetes living in the United States is sparse; however, evidence suggests women generally have higher healthcare expenditures compared to men. Since little is known about these differences, the aim of this study was to assess differences in out-of-pocket (OOP) and total healthcare expenditures among adults with diabetes. Methods Data were used from 20,442 adults (≥18 years of age) with diabetes from the 2002–2011 Medical Expenditure Panel Survey. Dependent variables were OOP and total direct expenditures for multiple health services (prescription, office-based, inpatient, outpatient, emergency, dental, home healthcare, and other services). The independent variable was sex. Covariates included sociodemographic characteristics, comorbid conditions, and time. Sample demographics were summarized. Mean OOP and total direct expenditures for health services by sex status were analyzed. Regression models were performed to assess incremental costs of healthcare expenditures by sex among adults with diabetes. Results Fifty-six percent of the sample was composed of women. Unadjusted mean OOP costs were higher for women for prescriptions ($1177; 95$1117–$1237 vs.$959; 95% CI $918–$1000; p  $50 OOP for office-based visits (p$55 total expenditures for home healthcare (p = 0.041) compared to men after adjustments. Conclusions Our findings show women with diabetes have higher OOP and total direct expenditures compared to men. Additional research is needed to investigate this disparity between men and women and to understand the associated drivers and clinical implications. Policy recommendations are warranted to minimize the higher burden of costs for women with diabetes

Trends in healthcare expenditure in United States adults with chronic kidney disease: 2002–2011

Abstract Background This study examines trends in healthcare expenditure in adults with chronic kidney disease (CKD) and other kidney diseases (OKD) in the U.S. from 2002 to 2011. Methods One hundred and eighty-seven thousand, three hundred and fourty-one adults aged ≥18 from the Medical Expenditure Panel Survey (MEPS) Household Component were analyzed. CKD and OKD were based on ICD-9 or CCC codes. A novel two-part model was used to estimate the likelihood of any healthcare use and total expenditures. Covariates included individual demographics and comorbidities. Results Approximately 711 adults surveyed from 2002 to 2011 had CKD and 3693 had OKD. CKD was more likely among Non-Hispanic Blacks (NHB), Midwest and Western residents while OKD was more likely among Non-Hispanic Whites (NHW), Hispanics, married and Northeast residents. Both CKD and OKD were more likely in ≥45 years, males, widowed/divorced/single, ≤high school educated, publicly insured, Southern residents, poor and low income individuals. All comorbidities were more likely among people with CKD and OKD. Unadjusted analysis for mean expenditures for CKD and OKD vs. no kidney disease was $39,873 and$13,247 vs. $5411 for the pooled sample. After adjusting for covariates as well as time, individuals with CKD had$17,472 and OKD $5014 higher expenditures, while adjusted mean expenditures increased by$293 to $658 compared to the reference year group. Unadjusted yearly expenditures for CKD and OKD in the US population were approximately$24.6 and $48.1 billion, while adjusted expenditures were approximately$10.7 and $18.2 billion respectively. Conclusion CKD and OKD are significant cost-drivers and impose a profound economic burden to the US population

Trends in sex differences in the receipt of quality of care indicators among adults with diabetes: United States 2002-2011

Abstract Background Evidence suggests disparities in quality of care (QoC) indicators based on sex exist in adults diagnosed with diabetes; however, this research is limited. Therefore, the objective of this research study was to assess differences in QOC indicators in a nationally representative sample of men and women with diabetes. Methods Cross-sectional study of 17,702 men and women (≥18 years of age) with diabetes from the 2002–2011 Medical Expenditure Panel Survey Household Component. Sex was the main predictor variable, and the dependent variables were five binary indicators to measure QOC, which included testing of hemoglobin A1c, examining feet annually, getting eyes dilated, checking blood pressure, and visiting the doctor annually. Sample demographics by sex were assessed. Unadjusted analyses were computed for descriptive statistics by sex and proportions of QOC indicators over time. Logistic regression evaluated associations between QOC indicators and sex, while controlling for sociodemographic characteristics, time, and comorbid conditions. Results Approximately 44% and 56% of the sample was comprised of men and women, respectively. Unadjusted analyses showed significant differences in A1c testing (p < 0.001) and foot examinations (p = 0.002) for the entire sample, and significant differences in A1c testing (p = 0.027), foot examinations (p = 0.01), and dilated eye exams (p = 0.026) among men and A1c testing (p < 0.001) among women overtime. Adjusted analyses found women to be significantly more likely to have dilated eye examinations during a given year (OR = 1.14; 95% CI 1.04, 1.24), to get their blood pressure checked by a doctor in a given year (OR = 1.44; 95% CI 1.13, 1.84), and to visit a doctor annually (OR = 1.39; 95% CI 1.22, 1.58) compared to men. Conclusions In this sample of adults with diabetes, women had significantly higher odds of receiving quality of care compared to men. These findings suggest the importance of educating patients about appropriate metrics of diabetes management, especially men, and the need for continuous empowerment of women to receive proper and optimal care. Additional research is needed to identify causes and reduce sex and gender disparities associated with diabetes quality of care