{
  "abstract": "Infections are the leading cause of hospitalization and mortality among patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Guidelines recommend Pneumocystis jirovecii pneumonia (PJP) prophylaxis during treatment with cyclophosphamide and/or rituximab, but prophylaxis use is low. We assessed associations of demographic, economic, and geographic factors with receipt of PJP prophylaxis among Medicare beneficiaries with AAV. Retrospective cohort study. Medicare fee-for-service beneficiaries with AAV initiating a new treatment episode involving cyclophosphamide and/or rituximab in 2016-2018. Individual-level demographic and insurance factors and county-level economic, geographic, and health care resource factors. Receipt of PJP prophylaxis, defined as trimethoprim/sulfamethoxazole, dapsone, atovaquone, or inhaled pentamidine overlapping the treatment episode start date or the following 30 days. Log-binomial regression was used to estimate prevalence ratios and 95% confidence intervals (CIs). A likelihood ratio test compared a full model including demographic, economic, geographic, and clinical factors with a reduced model including clinical factors only. Among 4,870 immunosuppressant treatment episodes, PJP prophylaxis was used in 26%. Prophylaxis was less common among females than males (24% vs 30%; adjusted prevalence ratio [aPR], 0.80; 95% CI, 0.70-0.91) and more common among beneficiaries in the Midwest than South (34% vs 24%; aPR, 1.39; 95% CI, 1.12-1.73). Prophylaxis was also less common among beneficiaries from counties with persistent poverty (22% vs 32%; aPR, 0.67; 95% CI, 0.44-1.02). Demographic, economic, and geographic factors improved model fit when added to clinical factors. Claims-based measures may be misclassified, and causal inference is limited. Among Medicare beneficiaries with AAV, sex, region, and county-level poverty were associated with receipt of guideline-recommended PJP prophylaxis. Strategies are needed to improve equitable receipt of infection prophylaxis among highly vulnerable patients with AAV.",
  "abstract_shown": true,
  "affiliations": [
    "University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC.",
    "Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.",
    "University of North Carolina Kidney Center, Chapel Hill, NC."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Binxin Cao"
    },
    {
      "affs": [
        0
      ],
      "name": "Ryan P Hickson"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Xinhua Zhao"
    },
    {
      "affs": [
        0
      ],
      "name": "Sherrie L Aspinall"
    },
    {
      "affs": [
        2
      ],
      "name": "Vimal K Derebail"
    },
    {
      "affs": [
        2
      ],
      "name": "Susan L Hogan"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Alexa Ehlert"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Joshua M Thorpe"
    },
    {
      "affs": [
        2
      ],
      "name": "Ronald J Falk"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Carolyn T Thorpe"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7dpj37xqchbwn.bib",
  "cited_by": 0,
  "doi": "10.1016/j.xkme.2026.101538",
  "fulltext_url": "https://europepmc.org/articles/PMC13744324",
  "id": "7dpj37xqchbwn",
  "issns": [
    "2590-0595"
  ],
  "landing_url": "https://europepmc.org/article/MED/42999880",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2713|Pneumocystis jirovecii pneumonia detection and treatment"
    ]
  ],
  "openalex": "W7213461966",
  "pdf_url": "https://europepmc.org/articles/PMC13744324?pdf=render",
  "pmcid": "PMC13744324",
  "pmid": "42999880",
  "published": "2026-09-17",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/7dpj37xqchbwn.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:41Z",
      "native_id": "MED:42999880",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42999880"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Pneumocystis jirovecii pneumonia detection and treatment",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Association of Demographic, Economic, and Geographic Factors With Guideline-Concordant Infection Prophylaxis in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.",
  "title_text": "Association of Demographic, Economic, and Geographic Factors With Guideline-Concordant Infection Prophylaxis in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:41Z",
  "url": "https://research.draconitic.com/paper/7dpj37xqchbwn",
  "venue": "Kidney medicine",
  "versions": []
}