Little is known about what drives gender disparities in health care and related social insurance benefits. Using data and variation from the Texas workers’ compensation program, we study the impact of gender match between doctors and patients on medical evaluations and associated disability benefits. Compared to differences among their male patient counterparts, female patients randomly assigned a female doctor rather than a male doctor are 5.2 percent more likely to be evaluated as disabled and receive 8.6 percent more subsequent cash benefits on average. There is no analogous gender-match effect for male patients. Our estimates indicate that increasing the share of female patients evaluated by female doctors may substantially shrink gender gaps in medical evaluations and associated outcomes. (JEL H75, I11, I12, J14, J16, J28)
- Award ID(s):
- 1735095
- NSF-PAR ID:
- 10180163
- Date Published:
- Journal Name:
- Journal of Medical Internet Research
- Volume:
- 22
- Issue:
- 7
- ISSN:
- 1438-8871
- Page Range / eLocation ID:
- e14455
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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Background The purpose of this retrospective review was to determine how patient‐related factors and culture data affect neo‐osteogenesis in patients with chronic rhinosinusitis (CRS) and patients with cystic fibrosis (CF) with CRS.
Methods Information from a database associated with a large tertiary medical center was used to assess adult patients with CF CRS and non‐CF CRS (total, n = 102; CF CRS, n = 31; non‐CF CRS, n = 71). Radiologic evidence of neo‐osteogenesis was measured using the Global Osteitis Scoring Scale (GOSS), and mucosal disease was assessed using the Lund‐Mackay score (LMS) by 2 independent reviewers who were blinded to the patient's disease state. Bacterial cultures were obtained endoscopically. Multiple logistic regression models were used to evaluate the effect of age, sex, number of previous surgeries, CF, and culture species on the odds of neo‐osteogenesis.
Results Fifty‐one of the 102 patients (50%) met radiologic criteria for neo‐osteogenesis. Sixty‐nine patients (67.6%) with CF CRS and non‐CF CRS had culture data. In the multiple logistic regression model, male gender was significantly associated with neo‐osteogenesis (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.68‐17.86;
p = 0.006).Pseudomonas aeruginosa was not associated with neo‐osteogenesis (OR, 3.12; 95% CI, 0.84‐12.80;p = 0.097). Age, number of surgeries, CF,Staphylococcus aureus , and coagulase‐negativeStaphylococcus were not statistically significant.Conclusion To our knowledge, this is the first study to assess risk factors associated with neo‐osteogenesis and patients with CF CRS. Interestingly, male gender was the only significant predictor of neo‐osteogenesis.
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Importance Screening with low-dose computed tomography (CT) has been shown to reduce mortality from lung cancer in randomized clinical trials in which the rate of adherence to follow-up recommendations was over 90%; however, adherence to Lung Computed Tomography Screening Reporting & Data System (Lung-RADS) recommendations has been low in practice. Identifying patients who are at risk of being nonadherent to screening recommendations may enable personalized outreach to improve overall screening adherence.
Objective To identify factors associated with patient nonadherence to Lung-RADS recommendations across multiple screening time points.
Design, Setting, and Participants This cohort study was conducted at a single US academic medical center across 10 geographically distributed sites where lung cancer screening is offered. The study enrolled individuals who underwent low-dose CT screening for lung cancer between July 31, 2013, and November 30, 2021.
Exposures Low-dose CT screening for lung cancer.
Main Outcomes and Measures The main outcome was nonadherence to follow-up recommendations for lung cancer screening, defined as failing to complete a recommended or more invasive follow-up examination (ie, diagnostic dose CT, positron emission tomography–CT, or tissue sampling vs low-dose CT) within 15 months (Lung-RADS score, 1 or 2), 9 months (Lung-RADS score, 3), 5 months (Lung-RADS score, 4A), or 3 months (Lung-RADS score, 4B/X). Multivariable logistic regression was used to identify factors associated with patient nonadherence to baseline Lung-RADS recommendations. A generalized estimating equations model was used to assess whether the pattern of longitudinal Lung-RADS scores was associated with patient nonadherence over time.
Results Among 1979 included patients, 1111 (56.1%) were aged 65 years or older at baseline screening (mean [SD] age, 65.3 [6.6] years), and 1176 (59.4%) were male. The odds of being nonadherent were lower among patients with a baseline Lung-RADS score of 1 or 2 vs 3 (adjusted odds ratio [AOR], 0.35; 95% CI, 0.25-0.50), 4A (AOR, 0.21; 95% CI, 0.13-0.33), or 4B/X, (AOR, 0.10; 95% CI, 0.05-0.19); with a postgraduate vs college degree (AOR, 0.70; 95% CI, 0.53-0.92); with a family history of lung cancer vs no family history (AOR, 0.74; 95% CI, 0.59-0.93); with a high age-adjusted Charlson Comorbidity Index score (≥4) vs a low score (0 or 1) (AOR, 0.67; 95% CI, 0.46-0.98); in the high vs low income category (AOR, 0.79; 95% CI, 0.65-0.98); and referred by physicians from pulmonary or thoracic-related departments vs another department (AOR, 0.56; 95% CI, 0.44-0.73). Among 830 eligible patients who had completed at least 2 screening examinations, the adjusted odds of being nonadherent to Lung-RADS recommendations at the following screening were increased in patients with consecutive Lung-RADS scores of 1 to 2 (AOR, 1.38; 95% CI, 1.12-1.69).
Conclusions and Relevance In this retrospective cohort study, patients with consecutive negative lung cancer screening results were more likely to be nonadherent with follow-up recommendations. These individuals are potential candidates for tailored outreach to improve adherence to recommended annual lung cancer screening.
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Abstract Background Breast reconstruction (BR) is the reconstructive surgical technique that focuses on restoring normal form and function to the breast following oncologic resection. The goal of this study was to determine if BR disparities exist among rural female patients in Kentucky.
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