Research Roundup: COPD; Appendicitis; Orthodontics; And Artificial Intelligence
Each week, KHN compiles a selection of recently released health policy studies and briefs.
The American Journal of Medicine:
End-Of-Life Spending And Healthcare Utilization Among Older Adults With Chronic Obstructive Pulmonary Disease
End-of-life spending and healthcare utilization among older adults with COPD have not been previously described. We examined data on Medicare beneficiaries aged 65 years or older with chronic obstructive pulmonary disease (COPD) who died during the period of 2013-2014. End-of-life measures were retrospectively reviewed for 2 years prior to death. Hospital referral regions (HRRs) were categorized into quintiles of age-sex-race-adjusted overall spending during the last 2 years of life. Geographic quintile variation in spending and healthcare utilization was examined across the continuum. (Iyer et al, 7/1)
Association Of Nonoperative Management Using Antibiotic Therapy Vs Laparoscopic Appendectomy With Treatment Success And Disability Days In Children With Uncomplicated Appendicitis
Among children with uncomplicated appendicitis, an initial nonoperative management strategy with antibiotics alone had a success rate of 67.1% and, compared with urgent surgery, was associated with statistically significantly fewer disability days at 1 year. However, there was substantial loss to follow-up, the comparison with the prespecified threshold for an acceptable success rate of nonoperative management was not statistically significant, and the hypothesized difference in disability days was not met. (Minneci et al, 7/27)
Evidence And Orthodontics: Does Your Child Really Need Braces?
Orthodontics is largely considered a medical specialty, not just a cosmetic one. From small clinics to the American Association of Orthodontists (AAO), advertisements promise to prevent a host of ills ranging from cavities to jaw pain. Today, the AAO advises parents that all children should have an orthodontic consultation by age seven in order to identify potential problems and develop a treatment plan. According to the organization’s website, a lack of treatment can lead to tooth decay, gum disease, broken front teeth, and loss of bone tissue that holds teeth in place. Many orthodontic clinics additionally warn of persistent jaw pain and headaches. A small group of dentists and orthodontists across the globe have looked carefully at the evidence underpinning these claims and found it lacking. Although some individual studies suggest that orthodontic treatment improves oral health, such studies are often fraught with bias and often don’t control for variables like socioeconomic status. Further, when the results of multiple studies are analyzed together, they do not provide evidence that orthodontic treatment decreases one’s likelihood of developing conditions such as gum disease and jaw pain. (Whitcomb, 7/20)
Artificial Intelligence, Health Disparities, And Covid-19
The power of artificial intelligence has transformed health care by using massive datasets to improve diagnostics, treatment, records management, and patient outcomes. Complex decisions that once took hours — such as making a breast or lung cancer diagnosis based on imaging studies, or deciding when patients should be discharged — are now resolved within seconds by machine learning and deep learning applications.Any technology, of course, will have its limitations and flaws. And over the past few years, a steady stream of evidence has demonstrated that some of these AI-powered medical technologies are replicating racial bias and exacerbating historic health care inequities. Now, amid the SARS-CoV-2 pandemic, some researchers are asking whether these new technologies might be contributing to the disproportionately high rates of virus-related illness and death among African Americans. African Americans aged 35 to 44 experience Covid-19 mortality rates that are nine times higher than their White counterparts. Many African Americans also say they have limited access to Covid-19 testing. (McCullom, 7/27)