Evidence map›Paper›PMID 30649500›Full record

ArticleSleep2019

Untreated insomnia increases all-cause health care utilization and costs among Medicare beneficiaries.

Emerson M Wickwire, Sarah E Tom, Steven M Scharf, Aparna Vadlamani, Ilynn G Bulatao, Jennifer S Albrecht

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Sleep, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 71 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
71citing papers in PubMed, 3 pooled it
13.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

71 citing papers in PubMed, 3 syntheses or guidelines pooled it, 138 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Trial
  5. Trial
  6. Brief behavioral treatment for insomnia decreases trauma-related nightmare frequency in veterans.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2022
    Trial
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  11. Trial
  12. Article
  13. Sleep and Disorders of Gut-Brain Interaction.Gastroenterology & hepatology · 2026
    Article
  14. Article
  15. Review
  16. Insomnia disorder.Nature reviews. Disease primers · 2026
    Review
  17. Article
  18. Article
  19. Review
  20. Review

11 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Emerson M WickwireDepartment of Psychiatry, University of Maryland School of Medicine, Baltimore, MD.
Sarah E TomDepartment of Neurology, Columbia University, New York, NY.
Steven M ScharfSleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
Aparna VadlamaniDepartment of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
Ilynn G BulataoDepartment of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
Jennifer S AlbrechtDepartment of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
University of Maryland, Baltimore · USCalifornia Center for Sleep Disorders · USColumbia University · US

Funding

RESEARCH TRAINING IN THE EPIDEMIOLOGY OF AGINGT32AG000262 · NIA · UNIVERSITY OF MARYLAND BALTIMORE · PI ANN L GRUBER-BALDINI, DENISE L ORWIG · 1998 to 2026
$8.2M
Prioritizing Quality Improvement for the Treatment of Psychiatric Disturbances Following Traumatic Brain InjuryK01HS024560 · AHRQ · UNIVERSITY OF MARYLAND BALTIMORE · PI ALBRECHT, JENNIFER S. · 2016 to 2020
$735k
AHRQ HHS K01 HS024560NIA NIH HHS T32 AG000262
6 · The paper itself

Abstract

STUDY

objectivesTo examine the impact of untreated insomnia on health care utilization (HCU) among a nationally representative sample of Medicare beneficiaries.

methodsOur data source was a random 5% sample of Medicare administrative data for years 2006-2013. Insomnia was operationalized as the presence of at least one claim containing an insomnia-related diagnosis in any given year based on International Classification of Disease, Version 9, Clinical Modification codes or at least one prescription fill for an insomnia-related medication in Part D prescription drug files in each year. We compared HCU in the year prior to insomnia diagnosis to HCU among to non-sleep disordered controls during the same period.

resultsA total of 151 668 beneficiaries were found to have insomnia. Compared to controls (n = 333 038), beneficiaries with insomnia had higher rates of HCU across all point of service locations. Rates of HCU were highest for inpatient care (rate ratio [RR] 1.61; 95% confidence interval [CI] 1.59, 1.64) and lowest for prescription fills (RR 1.17; 95% CI 1.16, 1.17). Similarly, compared to controls, beneficiaries with insomnia demonstrated $63,607 (95% CI $60,532, $66,685) higher all-cause costs, which were driven primarily by inpatient care ($60,900; 95% CI $56,609, $65,191). Emergency department ($1,492; 95% CI $1,387, $1,596) and prescription costs ($486; 95% CI $454, $518) were also elevated among cases relative to controls.

conclusionsIn this randomly selected and nationally representative sample of older Medicare beneficiaries and compared to non-sleep disordered controls, individuals with untreated insomnia demonstrated increased HCU and costs across all points of service.

Indexed as

AgedCosts and Cost AnalysisFemaleHealth Care CostsHospitalizationHumansMaleMedicareMiddle AgedPatient Acceptance of Health CareSleep Initiation and Maintenance DisordersUnited Statescostshealth care utilizationhealth economicsinsomniaMedicareolder adultssleep

Identifiers

PMID30649500
PMCPMC6448286
OpenAlexW2910829126

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.