Differences in influenza testing and treatment in micropolitan versus metropolitan areas in the U.S. using medicare claims data from 2010 to 2016
Abstract Background To improve understanding of influenza and rurality, we investigated differences in influenza testing and anti-viral treatment rates between micropolitan (muSAs) and metropolitan statistical areas (MSAs) using national medical claims data over multiple influenza seasons. Methods U...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12889-025-21555-4 |
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| author | Alexia Couture F. Scott Dahlgren Hector S. Izurieta Richard A. Forshee Yun Lu Carrie Reed |
| author_facet | Alexia Couture F. Scott Dahlgren Hector S. Izurieta Richard A. Forshee Yun Lu Carrie Reed |
| author_sort | Alexia Couture |
| collection | DOAJ |
| description | Abstract Background To improve understanding of influenza and rurality, we investigated differences in influenza testing and anti-viral treatment rates between micropolitan (muSAs) and metropolitan statistical areas (MSAs) using national medical claims data over multiple influenza seasons. Methods Using billing data from the Centers for Medicare and Medicaid Services for those aged 65 years and older, we estimated weekly rates of ordered rapid influenza diagnostic tests (RIDT) and antivirals (AV) among Medicare enrollees by core-based statistical areas (CBSAs) during 2010–2016. We used Negative Binomial generalized mixed models to estimate adjusted rate ratios (aRR) between MSAs and muSAs, adjusting for clustering by CBSA plus explanatory variables. We ran models for all weeks and only high influenza activity weeks. Results For all weeks, the unadjusted rate of RIDTs was 1.97 per 10,000 people in MSAs compared with 2.69 in muSAs (Rate ratio (RR) = 0.73, 95% Confidence Interval (CI): 0.73–0.74) and of AVs was 1.85 in MSAs compared with 1.40 in muSAs (RR = 1.32, CI: 1.31–1.32). From the multivariate model, aRR for RIDTs was 0.82 (0.73–0.94) and for AVs was 1.12 (1.04–1.22) in MSAs versus muSAs. For high influenza activity weeks, aRR for RIDTs was 0.82 (0.73–0.92) and for AVs was 1.15 (1.06–1.24). All models found influenza testing rates higher in muSAs and treatment rates higher in MSAs. Conclusions Our study found lower testing and higher treatment in U.S. metropolitan versus micropolitan areas from 2010 to 2016 for those aged 65 years and older in our population. Identifying differences in influenza rates by rurality may improve public health response. Further research into the relationship of rurality and health disparities is needed. |
| format | Article |
| id | doaj-art-7e596ac9de58498d96a3baeda62b34eb |
| institution | Kabale University |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Public Health |
| spelling | doaj-art-7e596ac9de58498d96a3baeda62b34eb2025-01-26T12:56:33ZengBMCBMC Public Health1471-24582025-01-0125111010.1186/s12889-025-21555-4Differences in influenza testing and treatment in micropolitan versus metropolitan areas in the U.S. using medicare claims data from 2010 to 2016Alexia Couture0F. Scott Dahlgren1Hector S. Izurieta2Richard A. Forshee3Yun Lu4Carrie Reed5Epidemiology and Prevention Branch, Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and PreventionFaculty of Electrical Engineering, Mathematics and Computer Science, Delft University of TechnologyCenter for Biologics Evaluation and Research, Food and Drug AdministrationCenter for Biologics Evaluation and Research, Food and Drug AdministrationCenter for Biologics Evaluation and Research, Food and Drug AdministrationEpidemiology and Prevention Branch, Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and PreventionAbstract Background To improve understanding of influenza and rurality, we investigated differences in influenza testing and anti-viral treatment rates between micropolitan (muSAs) and metropolitan statistical areas (MSAs) using national medical claims data over multiple influenza seasons. Methods Using billing data from the Centers for Medicare and Medicaid Services for those aged 65 years and older, we estimated weekly rates of ordered rapid influenza diagnostic tests (RIDT) and antivirals (AV) among Medicare enrollees by core-based statistical areas (CBSAs) during 2010–2016. We used Negative Binomial generalized mixed models to estimate adjusted rate ratios (aRR) between MSAs and muSAs, adjusting for clustering by CBSA plus explanatory variables. We ran models for all weeks and only high influenza activity weeks. Results For all weeks, the unadjusted rate of RIDTs was 1.97 per 10,000 people in MSAs compared with 2.69 in muSAs (Rate ratio (RR) = 0.73, 95% Confidence Interval (CI): 0.73–0.74) and of AVs was 1.85 in MSAs compared with 1.40 in muSAs (RR = 1.32, CI: 1.31–1.32). From the multivariate model, aRR for RIDTs was 0.82 (0.73–0.94) and for AVs was 1.12 (1.04–1.22) in MSAs versus muSAs. For high influenza activity weeks, aRR for RIDTs was 0.82 (0.73–0.92) and for AVs was 1.15 (1.06–1.24). All models found influenza testing rates higher in muSAs and treatment rates higher in MSAs. Conclusions Our study found lower testing and higher treatment in U.S. metropolitan versus micropolitan areas from 2010 to 2016 for those aged 65 years and older in our population. Identifying differences in influenza rates by rurality may improve public health response. Further research into the relationship of rurality and health disparities is needed.https://doi.org/10.1186/s12889-025-21555-4InfluenzaAntiviralsRapid-testingRurality |
| spellingShingle | Alexia Couture F. Scott Dahlgren Hector S. Izurieta Richard A. Forshee Yun Lu Carrie Reed Differences in influenza testing and treatment in micropolitan versus metropolitan areas in the U.S. using medicare claims data from 2010 to 2016 BMC Public Health Influenza Antivirals Rapid-testing Rurality |
| title | Differences in influenza testing and treatment in micropolitan versus metropolitan areas in the U.S. using medicare claims data from 2010 to 2016 |
| title_full | Differences in influenza testing and treatment in micropolitan versus metropolitan areas in the U.S. using medicare claims data from 2010 to 2016 |
| title_fullStr | Differences in influenza testing and treatment in micropolitan versus metropolitan areas in the U.S. using medicare claims data from 2010 to 2016 |
| title_full_unstemmed | Differences in influenza testing and treatment in micropolitan versus metropolitan areas in the U.S. using medicare claims data from 2010 to 2016 |
| title_short | Differences in influenza testing and treatment in micropolitan versus metropolitan areas in the U.S. using medicare claims data from 2010 to 2016 |
| title_sort | differences in influenza testing and treatment in micropolitan versus metropolitan areas in the u s using medicare claims data from 2010 to 2016 |
| topic | Influenza Antivirals Rapid-testing Rurality |
| url | https://doi.org/10.1186/s12889-025-21555-4 |
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