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Objectives: We examined whether an array of scleroderma autoantibodies associates with risk of cancer and could be useful tools for risk stratification. Methods: Scleroderma cancer cases and scleroderma controls without cancer from the Johns Hopkins Scleroderma Center and the University of Pittsburgh Scleroderma Center were studied. Sera were assayed by Lineblot and enzyme‐linked immunosorbent assay (ELISA) for autoantibodies against centromere, topoisomerase 1, RNA polymerase (POLR) 3, PM/Scl, Th/To, NOR90, U3 RNP, Ku, Ro52, U1RNP, and RNPC3. Logistic regression models were constructed to examine whether distinct autoantibodies associated with overall cancer at any time and cancer‐associated scleroderma (cancer occurring three years before and after scleroderma onset). The effects of having more than one autoantibody on cancer were further examined using random forest analysis. Results: A total of 676 cases and 687 controls were studied. After adjusting for relevant covariates, anti‐POLR3 (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.03–2.11) and monospecific anti‐Ro52 (OR 2.19, 95% CI 1.29–3.74) were associated with an increased overall cancer risk, whereas anticentromere (OR 0.69, 95% CI 0.51–0.93) and anti‐U1RNP (OR 0.63, 95% CI 0.43–0.93) were associated with lower risk. When examining risk of cancer‐associated scleroderma, these immune responses remained associated with increased or decreased risk: anti‐POLR3 (OR 2.28, 95% CI 1.33–3.91), monospecific anti‐Ro52 (OR 2.58, 95% CI 1.05–6.30), anticentromere (OR 0.39, 95% CI 0.20–0.74), and anti‐U1RNP (OR 0.32, 95% CI 0.11–0.93). Anti‐Ro52 plus anti‐U1RNP or anti‐Th/To was associated with decreased cancer risk compared with anti‐Ro52 alone. Conclusions: These data suggest that five distinct scleroderma immune responses, alone or in combination, may be useful tools to stratify the risk of cancer for scleroderma patients. Further study examining cancer risk in autoantibody subgroups relative to the general population is warranted. [ABSTRACT FROM AUTHOR]

Objectives Ectopic calcification (calcinosis) is a common complication of SSc, but a subset of SSc patients has a heavy burden of calcinosis. We examined whether there are unique risk factors for a heavy burden of calcinosis, as compared with a light burden or no calcinosis. Methods We reviewed the medical records of all patients in the Johns Hopkins Scleroderma Center Research Registry with calcinosis to quantify calcinosis burden using pre-specified definitions. We performed latent class analysis to identify SSc phenotypic classes. We used multinomial logistic regression to determine whether latent phenotypic classes and autoantibodies were independent risk factors for calcinosis burden. Results Of all patients, 29.4% (997/3388) had calcinosis, and 13.5% (130/963) of those with calcinosis had a heavy burden. The latent phenotypic class with predominantly diffuse skin disease and higher disease severity (characterized by pulmonary hypertension, interstitial lung disease, cardiomyopathy, severe RP, gastrointestinal involvement, renal crisis, myopathy and/or tendon friction rubs) was associated with an increased risk of both a heavy burden [odds ratio (OR) 6.92, 95% CI 3.66, 13.08; P  < 0.001] and a light burden (OR 2.88, 95% CI 2.11, 3.95; P  < 0.001) of calcinosis compared with the phenotypic class with predominantly limited skin disease. Autoantibodies to PM/Scl were strongly associated with a heavy burden of calcinosis (OR 17.31, 95% CI 7.72, 38.81; P  < 0.001) and to a lesser degree a light burden of calcinosis (OR 3.59, 95% CI 1.84, 7.00; P  < 0.001). Conclusions Calcinosis burden is associated with cumulative SSc-related tissue damage. Independent of disease severity, autoantibodies to PM/Scl are also associated with a heavy burden of calcinosis. [ABSTRACT FROM AUTHOR]

Background Prior observation has shown differences in COVID-19 hospitalization risk between SARS-CoV-2 variants, but limited information describes hospitalization outcomes. Methods Inpatients with COVID-19 at 5 hospitals in the eastern United States were included if they had hypoxia, tachypnea, tachycardia, or fever, and SARS-CoV-2 variant data, determined from whole-genome sequencing or local surveillance inference. Analyses were stratified by history of SARS-CoV-2 vaccination or infection. The average effect of SARS-CoV-2 variant on 28-day risk of severe disease, defined by advanced respiratory support needs, or death was evaluated using models weighted on propensity scores derived from baseline clinical features. Results Severe disease or death within 28 days occurred for 977 (29%) of 3369 unvaccinated patients and 269 (22%) of 1230 patients with history of vaccination or prior SARS-CoV-2 infection. Among unvaccinated patients, the relative risk of severe disease or death for Delta variant compared with ancestral lineages was 1.30 (95% confidence interval [CI]: 1.11–1.49). Compared with Delta, the risk for Omicron patients was.72 (95% CI:.59–.88) and compared with ancestral lineages was.94 (.78–1.1). Among Omicron and Delta infections, patients with history of vaccination or prior SARS-CoV-2 infection had half the risk of severe disease or death (adjusted hazard ratio:.40; 95% CI:.30–.54), but no significant outcome difference by variant. Conclusions Although risk of severe disease or death for unvaccinated inpatients with Omicron was lower than with Delta, it was similar to ancestral lineages. Severe outcomes were less common in vaccinated inpatients, with no difference between Delta and Omicron infections. [ABSTRACT FROM AUTHOR]

Purpose: Few have studied the relationship between employment and health in the Medicaid population. The purpose of this study is to estimate the impact of job loss on the mental health of working Medicaid beneficiaries. Design/methodology/approach: This study conducted a post hoc analysis of 1,538 adult Medicaid beneficiaries enrolled in a prospective cohort study. The authors matched participants who lost their job to participants who remained employed based on demographics, illness severity and social determinants of health. The authors estimated the effect of job loss on the odds of a diagnosis of depression and/or anxiety and self-reported mental health during a one-year follow-up period, stratified by prior history of depression and/or anxiety as documented in the Medicaid claims. Findings: Among participants with no preexisting depression or anxiety, the incidence of depression or anxiety was 17% versus 7% (aOR = 2.85; 95% confidence interval (CI): 1.88 to 4.34) between those who lost versus kept their job, respectively, and the mean difference in self-reported mental health was −4.3 (95% CI: −6.02 to −2.58). Self-reported mental health was also poorer between those who lost versus kept their job among participants with preexisting depression and/or anxiety (x = −4.78 (95% CI: −8.90 to −0.66). Research limitations/implications: Limitations of this study are as follows: we may not have matched on all factors that influence retaining a job; we do not distinguish between involuntary and voluntary job loss; generalizability is limited; and employment information is based on self-report. Practical implications: Our society should invest more resources into supporting low-wage workers such as Medicaid beneficiaries. Social implications: Active labor policies that connect people to jobs, help them retain their job and support skills training to secure a better quality job, could reduce health disparities in the Medicaid population. Originality/value: Use of both claims and self-reported mental health information to evaluate the impact of job loss on working Medicaid beneficiaries. [ABSTRACT FROM AUTHOR]

Policy PointsSocial determinants of health are an important predictor of future health care costs.Medicaid must partner with other sectors to address the underlying causes of its beneficiaries' poor health and high health care spending. Context: Social determinants of health are an important predictor of future health care costs but little is known about their impact on Medicaid spending. This study analyzes the role of social determinants of health (SDH) in predicting future health care costs for adult Medicaid beneficiaries with similar past morbidity burdens and past costs. Methods: We enrolled into a prospective cohort study 8,892 adult Medicaid beneficiaries who presented for treatment at an emergency department or clinic affiliated with two hospitals in Washington, DC, between September 2017 and December 31, 2018. We used SDH information measured at enrollment to categorize our participants into four social risk classes of increasing severity. We used Medicaid claims for a 2‐year period; 12 months pre‐ and post‐study enrollment to measure past and future morbidity burden according to the Adjusted Clinical Groups system. We also used the Medicaid claims data to characterize total annual Medicaid costs one year prior to and one year after study enrollment. Results: The 8,892 participants were primarily female (66%) and Black (91%). For persons with similar past morbidity burdens and past costs (p < 0.01), the future morbidity burden was significantly higher in the upper two social risk classes (1.15 and 2.04, respectively) compared with the lowest one. Mean future health care spending was significantly higher in the upper social risk classes compared with the lowest one ($2,713, $11,010, and $17,710, respectively) and remained significantly higher for the two highest social risk classes ($1,426 and $3,581, respectively), given past morbidity burden and past costs (p < 0.01). When we controlled for future morbidity burden (measured concurrently with future costs), social risk class was no longer a significant predictor of future health care costs. Conclusions: SDH are statistically significant predictors of future morbidity burden and future costs controlling for past morbidity burden and past costs. Further research is needed to determine whether current payment systems adequately account for differences in the care needs of highly medically and socially complex patients. [ABSTRACT FROM AUTHOR]