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Huang Y, Lee D. Association between physical activity behaviors and hypertension with comorbid multiple chronic diseases in South Korean middle-aged and elderly: an analysis based on association rule. BMC Public Health 2025; 25:1586. [PMID: 40307710 PMCID: PMC12042632 DOI: 10.1186/s12889-025-22806-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Accepted: 04/15/2025] [Indexed: 05/02/2025] Open
Abstract
BACKGROUND The increasing prevalence of multiple chronic diseases in aging populations presents a serious public health concern. Hypertension, as one of the most common chronic conditions, is frequently observed alongside other chronic diseases such as diabetes, obesity, and dyslipidemia. Physical activity is widely acknowledged to be associated with the prevention and management of chronic diseases. However, few studies have examined how different Physical activity behaviors are associated with specific multimorbidity patterns involving hypertension. This study aimed to identify the patterns of association between physical activity status and co-occurring chronic conditions among hypertensive individuals in middle-aged and older adults in South Korea, using association rule analysis. METHODS Our study utilized data from the Korean National Health and Nutrition Examination Survey (2016-2021), involving 21,043 participants aged 45 years and older. A total of 25 chronic diseases were included as related variables for the analysis using association rule mining. RESULTS In the middle-aged and elderly population in South Korea, hypertension has the highest prevalence among all chronic diseases, with a rate of 45%. Our association rule analysis identified a total of nine chronic conditions as antecedents, with diabetes, obesity, and dyslipidemia being the most frequently observed. Furthermore, a subgroup comparison revealed that the number of association rules identified in the 'physically inactive' group (25 rules) was higher than that in the 'physically active' group (17 rules), and the overall confidence levels in the 'inactive' group were also higher. In terms of the frequency of antecedents, stroke, cardiovascular disease, and arthritis showed the largest increases. CONCLUSION Adequate physical activity is vital for preventing and managing hypertension and reducing its comorbidities, particularly high-mortality conditions like cardiovascular disease and stroke. Promoting lifestyle changes and monitoring metabolic indicators can significantly lower hypertension incidence, improve quality of life, and reduce mortality.
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Affiliation(s)
- Yingcheng Huang
- Department of sports science, Guangzhou College of Technology and Business, Guangzhou, China
| | - Daeyeon Lee
- Faculty of Liberal Arts, Kangnam University, Yongin, South Korea.
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Hao Z, Yang T, Pan X. Exploring risk and protective factors for anxiety in older adults living with chronic conditions: A longitudinal analysis. Geriatr Nurs 2025; 63:258-266. [PMID: 40220400 DOI: 10.1016/j.gerinurse.2025.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 01/27/2025] [Accepted: 03/26/2025] [Indexed: 04/14/2025]
Abstract
OBJECTIVE This longitudinal study aims to explore risk and protective factors associated with anxiety to tailor supportive services for older adults according to their changing needs. METHODS Utilizing rounds 5-9 of the National Health and Aging Trends Study (NHATS), 3541 older adults were studied. The Transactional Theory of Stress and Coping (TTSC) model was utilized to select predictors. Descriptive analysis was conducted and a Generalized Estimating Equation (GEE) was applied. RESULTS Age, gender, marital status, income, race and ethnicity, self-rated health, number of chronic conditions, cognitive capacity, frequency of negative feelings, self-realization, self-efficacy and resilience, activity participation, and technology use were significantly associated with anxiety. However, anxiety did not change over time. CONCLUSIONS The findings highlight the need to link resources to caregivers and call for efficient chronic condition management. Recommendations from healthcare providers, proper education of healthy lifestyle, and engaging in more physical activities can also make a difference.
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Affiliation(s)
- Zhichao Hao
- College of State Governance, Southwest University, Chongqing, China.
| | - Tingzhang Yang
- Guizhou Modern Research Institute of Urban and Rural Economic Development, Guiyang, China.
| | - Xiaofu Pan
- College of State Governance, Southwest University, Chongqing, China.
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Nair KS, Mughal YH, Albejaidi F, Alharbi AH. Healthcare Financing in Saudi Arabia: A Comprehensive Review. Healthcare (Basel) 2024; 12:2544. [PMID: 39765971 PMCID: PMC11675727 DOI: 10.3390/healthcare12242544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 11/06/2024] [Accepted: 12/12/2024] [Indexed: 01/11/2025] Open
Abstract
Saudi Vision 2030 is a game-changer for all aspects of the economy, including healthcare. This article provides a comprehensive overview of healthcare financing in the Kingdom of Saudi Arabia (KSA). It identifies key healthcare financing challenges that must be addressed to achieve the initiative's envisioned health system goals. The review also examines and demonstrates how healthcare funds in the KSA are allocated among different healthcare services, to offer a perspective on resource use efficiency at various healthcare levels. This research used a mixed-method design which includes a literature review and secondary data analysis. A literature review was conducted aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. The secondary data were gathered from the reports and websites of government agencies, international organizations, and non-governmental organizations. Despite implementing significant reforms in its healthcare system, the share of private healthcare expenditure in total healthcare spending has seen only marginal growth. The current healthcare financing system appears insufficient to adequately support the chronically ill and the poor. There is a significant imbalance in the allocation of government budgets between hospitals and primary care, with four-fifths of financial resources directed towards hospital services. The Ministry of Health's budget allocation prioritizes personnel compensation, potentially reducing the available budget for medicines and other essential healthcare supplies. Ongoing reforms in the health sector, including privatization, public-private partnership initiatives, and the government's commitment to developing a robust primary healthcare network, are expected to play a significant role in controlling rapidly increasing public healthcare expenditures in Saudi Arabia.
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Affiliation(s)
| | - Yasir Hayat Mughal
- Department of Health Informatics, College of Applied Medical Sciences, Qassim University, P.O. Box 6666, Buraidah 41542, Saudi Arabia; (K.S.N.); (F.A.); (A.H.A.)
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Fekih-Romdhane F, Al Mouzakzak F, Abilmona G, Moustafa A, Dahdouh O, Hallit S. Arabic translation and validation of the clinician administered Staden schizophrenia anxiety rating scale (S-SARS). Heliyon 2024; 10:e39792. [PMID: 39553570 PMCID: PMC11564944 DOI: 10.1016/j.heliyon.2024.e39792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 10/16/2024] [Accepted: 10/23/2024] [Indexed: 11/19/2024] Open
Abstract
Background Research on anxiety in patients with schizophrenia of Arab origin is surprisingly scarce, particularly given that expressions of both psychotic disorders and anxiety disorders can be largely shaped by cultural factors. This study proposes to complement previous research by exploring the psychometric characteristics of an Arabic translation of the Staden Schizophrenia Anxiety Rating Scale (S-SARS) in chronic, remitted patients diagnosed with schizophrenia. As the Arabic version of the Generalized Anxiety Disorder 7-Item Scale (GAD-7) has not been previously validated in Arabic in patients with schizophrenia, this study had as a secondary aim to investigate the psychometric properties of this scale before its use. Method This cross-sectional study was performed over a period of three months (August-October 2023). A total of 177 chronic inpatients diagnosed with schizophrenia (63.3 % males) who were remitted and clinically stable participated in the study. Results Confirmatory factor analyses showed that all 10 items loaded onto a single factor and had high factor loading values between .53 and .81. The reliability of the S-SARS in its Arabic version was excellent as attested by a McDonald's omega and a Cronbach's alpha coefficients of .90 and .89, respectively. The score of Arabic S-SARS correlated positively with the GAD-7 scores (r = .55; p < .001), thus supporting good convergent validity. As for discriminant validity, findings showed positive correlations between S-SARS and depression scores as assessed using the Calgary Depressive Symptoms Scale. In addition, the Arabic S-SARS correlated negatively with general functioning, further supporting the good validity and clinical relevance of the scale. Finally, measurement invariance was established in the sex subsamples (males vs. females) at the scalar, metric and configural levels, with females showing more anxiety than males. Conclusion Findings suggest that the Arabic S-SARS holds good psychometric properties, and is suitable for use among Arabic-speaking people diagnosed with schizophrenia in both research and clinical practice. The Arabic version of S-SARS will hopefully be widely applied to provide useful and timely clinical information for monitoring and adequately treating patients with schizophrenia, in order to improve the course and prognosis of the disease.
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Affiliation(s)
- Feten Fekih-Romdhane
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia
- The Tunisian Center of Early Intervention in Psychosis, Department of psychiatry "Ibn Omrane", Razi hospital, Manouba, 2010, Tunisia
| | | | | | - Ahmed Moustafa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, Queensland, Australia
- Department of Human Anatomy and Physiology, the Faculty of Health Sciences, University of Johannesburg, South Africa
- Centre for Data Analytics, Bond University, Gold Coast, Queensland, Australia
| | - Oussama Dahdouh
- Faculty of Science, Lebanese University, Fanar, Lebanon
- Research Department, Psychiatric Hospital of the Cross, P.O. Box 60096, Jal Eddib, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Psychology Department, College of Humanities, Effat University, 21478, Jeddah, Saudi Arabia
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
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Kumagai N, Jakovljević M. Random forest model used to predict the medical out-of-pocket costs of hypertensive patients. Front Public Health 2024; 12:1382354. [PMID: 39086805 PMCID: PMC11288809 DOI: 10.3389/fpubh.2024.1382354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/28/2024] [Indexed: 08/02/2024] Open
Abstract
Background Precise prediction of out-of-pocket (OOP) costs to improve health policy design is important for governments of countries with national health insurance. Controlling the medical expenses for hypertension, one of the leading causes of stroke and ischemic heart disease, is an important issue for the Japanese government. This study aims to explore the importance of OOP costs for outpatients with hypertension. Methods To obtain a precise prediction of the highest quartile group of OOP costs of hypertensive outpatients, we used nationwide longitudinal data, and estimated a random forest (RF) model focusing on complications with other lifestyle-related diseases and the nonlinearities of the data. Results The results of the RF models showed that the prediction accuracy of OOP costs for hypertensive patients without activities of daily living (ADL) difficulties was slightly better than that for all hypertensive patients who continued physician visits during the past two consecutive years. Important variables of the highest quartile of OOP costs were age, diabetes or lipidemia, lack of habitual exercise, and moderate or vigorous regular exercise. Conclusion As preventing complications of diabetes or lipidemia is important for reducing OOP costs in outpatients with hypertension, regular exercise of moderate or vigorous intensity is recommended for hypertensive patients that do not have ADL difficulty. For hypertensive patients with ADL difficulty, habitual exercise is not recommended.
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Affiliation(s)
| | - Mihajlo Jakovljević
- UNESCO-TWAS, Section of Social and Economic Sciences, Trieste, Italy
- Shaanxi University of Technology, Hanzhong, China
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
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Fekih-Romdhane F, Al Mouzakzak F, Abilmona G, Dahdouh O, Hallit S. Validation and optimal cut-off score of the World Health Organization Well-being Index (WHO-5) as a screening tool for depression among patients with schizophrenia. BMC Psychiatry 2024; 24:391. [PMID: 38783217 PMCID: PMC11112932 DOI: 10.1186/s12888-024-05814-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The utility of the World Health Organization Wellbeing Index (WHO-5) as rapid screening tool for depression has not yet been researched in the context of schizophrenia. The goals of this study were twofold: (1) to test the psychometric properties of the WHO-5 in a sample of Arabic-speaking patients with schizophrenia from Lebanon, with particular emphasis on validating the WHO-5 as a screening tool for wellbeing and depression in patients with schizophrenia; and (2) to determine the optimal cut-off point to identify schizophrenia patients with depression. METHODS Chronic, remitted patients with schizophrenia took part in this cross-sectional study between August and October 2023 (n = 117; mean age of 57.86 ± 10.88 years and 63.3% males). The Calgary Depression Scale for Schizophrenia (CDSS) was included as index of validity. For the validation of the WHO-5 scale, we performed a confirmatory factor analysis (CFA) using the original structure of the scale. To assess the discriminatory validity of the Arabic version of the WHO-5 as a screening tool for depression, we conducted a Receiver operating characteristic (ROC) curve analysis, taking the WHO-5 reversed score against the dichotomized CDSS score at a cut off value of 6. RESULTS The results of CFA supported the originally proposed unidimensional structure of the measure, with good internal consistency reliability (α = 0.80), concurrent validity, and cross-sex measurement invariance. The WHO-5 showed a sensitivity of 0.8 and a specificity of 0.7 in the detection of depression with a cut-off point of 9.5. The validity of the WHO-5 as a screening tool for depression was supported by the excellent discrimination AUC value of 0.838. Based on this WHO-5 cut-off value, 42.6% of the patients were screened as having a depression. CONCLUSION The study contributes to the field by showing that the WHO-5 is a concise and convenient self-report measure for quickly screening and monitoring depressive symptoms in patients with schizophrenia. It is therefore highly recommended to apply this cut-off point for screening and follow-up assessments. The current findings will hopefully encourage clinicians and researchers working in Arab settings, who are often confronted with significant time and resource constraints, to start using the WHO-5 to aid their efforts in mitigating depression in this vulnerable population and fostering research in this under-researched area.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
- The Tunisian Center of Early Intervention in Psychosis, Department of psychiatry "Ibn Omrane", Razi hospital, Manouba, 2010, Tunisia.
| | | | | | - Oussama Dahdouh
- Faculty of Science, Lebanese University, Fanar, Lebanon
- Research Department, Psychiatric Hospital of the Cross, P.O. Box 60096, Jal Eddib, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Department of Psychology, College of Humanities, Effat University, 21478 Jeddah, Saudi Arabia.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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Liao S, Zhao L, Huang C, Xiong A, Xiong W, He Y, Huang X, Hunter V, Luo B. One-year trajectories of nutritional status in perimenopausal women: a community-based multi-centered prospective study. BMC Public Health 2024; 24:914. [PMID: 38549103 PMCID: PMC10976711 DOI: 10.1186/s12889-024-18405-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/20/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Nutritional status is a modifiable factor associated with perimenopausal women's health and quality of life. Assessing body composition indicators helps to comprehensively understand nutritional status compared with using body mass index (BMI) only. However, few published studies measured the trends in body composition among perimenopausal women. OBJECTIVES To assess the one-year trajectory of the nutritional status of perimenopausal women and to explore its influential factors. METHODS A community-based observational study with 3-wave repeated measurements at 6-month intervals was carried out. The nutritional status indicators include weight, body mass index (BMI), and body composition variables. Bioelectrical impedance analysis was used to assess body composition. Repeated measures ANOVA and Chi-square test were used to calculate the changes in nutritional status and generalized estimating equations were performed to explore their influential factors. RESULTS 2760 participants completed the study. Increasing trajectories in weight (from 56.05 ± 7.55 to 57.02 ± 7.60), fat mass (from 17.99 ± 4.80 to 20.49 ± 4.90), and waist-hip ratio (from 0.86 ± 0.04 to 0.91 ± 0.15) were found (P < 0.001). Decreasing trajectories in skeletal muscle (from 20.30 ± 2.38 to 19.19 ± 2.46), protein level (from 7.39 ± 0.79 to 7.06 ± 0.81), and total body water (from 27.87 ± 2.92 to 27.00 ± 3.01) were found (P < 0.001). Being married/unmarried with a partner and without negative life events were associated with higher total body water, skeletal muscle, and protein level, while negatively associated with fat mass and waist-hip ratio. Age was positively associated with fat mass (P < 0.001). Participants with junior high school education were prone to increased fat mass (P = 0.018) compared with those holding primary school education and below. A per capita monthly income of 1500 to 3000 Yuan was associated with higher total body water, skeletal muscle, and protein level (P < 0.001) compared with a per capita monthly income of less than 1500 Yuan. CONCLUSION Worsening nutritional status exists in perimenopausal women, which is characterized by increased weight, fat mass, and waist-hip ratio, and decreased skeletal muscle, total body water, and protein level. For greater efficiency, precision nutritional interventions are needed, and recipients should be classified into different risk levels based on their sociodemographic background.
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Affiliation(s)
- Shujuan Liao
- Department of Nursing, West China Second University Hospital, Sichuan University, No. 20, Section 3, People's South Road, 610041, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuanya Huang
- Department of Nursing, West China Second University Hospital, Sichuan University, No. 20, Section 3, People's South Road, 610041, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Anqi Xiong
- Department of Nursing, West China Second University Hospital, Sichuan University, No. 20, Section 3, People's South Road, 610041, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Weijun Xiong
- Chengdu Zhongke Zhiyong Information Technology Co., LTD, Chengdu, Sichuan, China
| | - Yirong He
- Department of Nursing, West China Second University Hospital, Sichuan University, No. 20, Section 3, People's South Road, 610041, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | | | | | - Biru Luo
- Department of Nursing, West China Second University Hospital, Sichuan University, No. 20, Section 3, People's South Road, 610041, Chengdu, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China.
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Fekih-Romdhane F, Bitar Z, Al Mouzakzak F, Abilmona G, Dahdouh O, Hallit S. Psychometric evaluation of the Arabic language version of the Birchwood Insight Scale in patients with schizophrenia. BMC Psychiatry 2024; 24:233. [PMID: 38539115 PMCID: PMC10976762 DOI: 10.1186/s12888-024-05657-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/04/2024] [Indexed: 12/11/2024] Open
Abstract
BACKGROUND Clinical insight (i.e., impaired insight into illness) is increasingly recognized by the scientific community as a significant contributor to an array of psychological and clinical outcomes in schizophrenia. Therefore, its assessment using a reliable, rapid, easy and economic tool is important for clinical practice. This study proposes to investigate the psychometric properties of an Arabic translation of the Birchwood Insight Scale (BIS) in Arabic-speaking chronic patients with schizophrenia. Our objectives were to identify the most adequate factor structure of the BIS among the several measurement models previously proposed in the literature, verify the reliability and measurement invariance of the BIS across sex groups, and explore the concurrent validity of the BIS through examining its patterns of correlations with psychotic symptoms. METHOD One hundred seventeen Arabic-speaking chronic, remitted patients with schizophrenia took part in this study. An Arabic translated version of the BIS and the Positive and Negative Syndrome Scale (PANSS) were administered to participants. RESULTS Confirmatory factor analyses (CFA) showed that, after omitting two items with low loadings (items 1 and 2), the unidimensional factor model of the BIS showed good fit indices and a reliability of α = 0.68 and ω = 0.68. However, analyses failed to show good fit for the full-length one-, two-, and three-factor models of the BIS in its Arabic version. Measurement invariance of the Arabic 6-item one-factor BIS was established between males and females at the configural, metric and scalar levels; no statistically significant difference between males and females was found in terms of BIS scores. Finally, BIS scores correlated significantly with the PANSS scores in our sample, thus demonstrating adequate concurrent validity. CONCLUSION This study offers valuable additional psychometric information about the BIS based on results of CFA and other analyses in schizophrenia from a non-Western cultural environment. We believe that making the BIS available in Arabic might benefit clinicians working with Arabic-speaking patients with schizophrenia, open new avenues of research and gain a better knowledge into the nature of clinical insight and its relevance to psychopathology.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
- The Tunisian Center of Early Intervention in Psychosis, Department of psychiatry "Ibn Omrane", Razi hospital, Manouba, 2010, Tunisia.
| | - Zeinab Bitar
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Rennes, UMR_S 1085, F-35000, France
| | | | | | - Oussama Dahdouh
- Faculty of Science, Lebanese University, Fanar, Lebanon
- Department of Psychiatry, Psychiatric Hospital of the Cross, P.O. Box 60096, Jal Eddib, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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Jayawardena R, Kodithuwakku W, Sooriyaarachchi P. The impact of the Sri Lankan economic crisis on medication adherence: An online cross-sectional survey. DIALOGUES IN HEALTH 2023; 2:100137. [PMID: 38515479 PMCID: PMC10953977 DOI: 10.1016/j.dialog.2023.100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/20/2023] [Accepted: 05/11/2023] [Indexed: 03/23/2024]
Abstract
Background The economic crisis in Sri Lanka has disarrayed the country's healthcare services, posing a challenge to people with chronic diseases on routine care. This study investigated the changes in medication adherence during the economic crisis. Methods A web-based cross-sectional survey was undertaken in July-August 2022. It assessed socio-demographics, diseases, medication adherence, and reasons for changes in compliance of respondents and their family members during the economic crisis. Descriptive statistics and multivariable logistic regression analysis were used. Findings A total of 1214 respondents, aged ≥18 years were included in the survey. The majority were females (60%). The main finding was that 39%, 41%, and 37% of participants, their family members, or children respectively have changed medication use during the crisis. Among those who changed their medication practices, the most significant change was the change in the brand, reported by 44.7% of the respondents. A similar pattern was observed among other family members, with 61.3% of adults and 53.8% of children switching brands. Respondents who lived outside the Colombo district had a significantly increased risk of changing medication (OR = 1.425, 95% CI = 1.020-1.992, P = 0.038). Respondents with monthly incomes of less than 100,000 LKR had a twofold greater risk of medication nonadherence compared to participants who earned more than 100,000 LKR per month (OR = 2.278, 95% CI = 1.37-3.78, P = 0.001). The most stated reason for changing medication among adults was the high cost of drugs, whereas among, children, the lack of access to drugs in the public or private sector was the leading cause of non-compliance. Interpretation The population's adherence to medication is negatively impacted by the economic crisis in Sri Lanka.
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Affiliation(s)
- Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Sri Lanka
- Health and Wellness Unit, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Wasana Kodithuwakku
- Department of Physiology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Piumika Sooriyaarachchi
- Health and Wellness Unit, Faculty of Medicine, University of Colombo, Sri Lanka
- School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Australia
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Vallmark M, Brorsson AL, Sparud-Lundin C, Bratt EL, Moons P, Saarijärvi M, Mora MA. Development and psychometric evaluation of TEXP-Q: a questionnaire measuring transition and transfer experiences in emerging adults with type 1 diabetes. J Patient Rep Outcomes 2023; 7:111. [PMID: 37938469 PMCID: PMC10632333 DOI: 10.1186/s41687-023-00652-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND During transition to adulthood and transfer to adult healthcare, emerging adults with chronic conditions are at risk of deteriorating disease control, well-being, and acute, as well as long-term complications. Despite an increasing call for person-centred healthcare services attuned to young peoples' needs, few validated instruments exist pinpointing adolescents' and emerging adults' experiences of preparation for transition and transfer. Thus, the overarching purpose of this study was to develop a person-centred, clinically applicable instrument (Transitional care EXPeriences Questionnaire, TEXP-Q) adjustable to different chronic conditions, although the focus in the present study was Type 1 Diabetes. The specific aim was, therefore, to describe the development and psychometric evaluation of TEXP-Q in emerging adults with Type 1 Diabetes. METHODS Initial development of the TEXP-Q was inspired by existing research. Items were formulated in accordance with consensus recommendations for developing patient-reported measures, and extra consideration was taken to ensure person-centredness. Psychometric evaluation comprised two phases: In phase I, data from cognitive interviews, content validity indexing, and judgement of an expert panel provided information on face and content validity. In phase II, data from a cross-sectional study conducted at eight adult diabetes outpatient clinics in Sweden (n = 163) allowed for explorative factor analysis (EFA), as well as calculation of content validity, reliability and responsiveness. RESULTS Combining results from cognitive interviews, content validity index values and expert panel judgement, a test version of TEXP-Q was developed, the content and face validity of which were considered good. This version consisted of 17 items answered on a five-point Likert scale, and three open-ended questions answered in free text. During EFA, four items were removed, and a three-factor solution was recognised as most adequate, accounting for 60% cumulative variance and one single cross-loading. After EFA, the instrument comprised 13 questions, divided into three latent factors. Cronbach's alpha for the complete instrument was 0.866, which indicates good internal consistency. Crohnbach's alpha approximated to 0.8 for all factors respectively. CONCLUSION TEXP-Q is a newly developed, person-centred instrument which has proven to be both valid and reliable when applied to youths with T1D. The questionnaire fills a need for instruments focusing on emerging adults' experiences of preparation for transition and transfer.
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Affiliation(s)
- Mikaela Vallmark
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anna Lena Brorsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Gothenburg Centre for Person-Centred Care (GPCC) at University of Gothenburg, Gothenburg, Sweden
| | - Carina Sparud-Lundin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Gothenburg Centre for Person-Centred Care (GPCC) at University of Gothenburg, Gothenburg, Sweden
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Children's Heart Center, Gothenburg, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Markus Saarijärvi
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Gothenburg Centre for Person-Centred Care (GPCC) at University of Gothenburg, Gothenburg, Sweden
| | - Mariela Acuña Mora
- Institute of Healthcare Sciences, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Tong CYM, Koh RYV, Lee ES. A scoping review on the factors associated with the lost to follow-up (LTFU) amongst patients with chronic disease in ambulatory care of high-income countries (HIC). BMC Health Serv Res 2023; 23:883. [PMID: 37608296 PMCID: PMC10464417 DOI: 10.1186/s12913-023-09863-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/31/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Despite the importance of long term follow-up care for patients with chronic disease, many patients fail to adhere to their follow-ups, which increase their risk of further health complications. Therefore, the purpose of this scoping review was to find out the factors associated with lost to follow-up (LTFU) amongst patients with chronic disease in the ambulatory care setting of high-income countries (HICs) to gain insights for better quality of care. Understanding the definition of LTFU is imperative in informing patients, health professionals and researchers for clinical and research purposes. This review also provided an overview of the terms and definitions used to describe LTFU. METHODS The following databases: CINAHL, EMBASE, Medline, PsycINFO and Web of Science were searched for studies investigating the factors associated to LTFU from the date of inception until 07 January 2022. RESULTS Five thousand one hundred and seven records were obtained across the databases and 3,416 articles were screened after removing the duplicates. 25 articles met the inclusion criteria, of which 17 were cohort studies, five were cross-sectional studies and three were case-control studies. A total of 32 factors were found to be associated with LTFU and they were categorised into patient factors, clinical factors and healthcare provider factors. CONCLUSION Overall, the factors associated with LTFU were generally inconsistent across studies. However, some factors such as financial factors (i.e., no insurance coverage) and low accessibility of care were consistently associated with LTFU for both mental and physical chronic conditions. The operational definitions of LTFU also varied greatly across studies. Given the mixed findings, future research using qualitative aproaches would be pivotal in understanding LTFU for specific chronic diseases and the development of targeted interventions. Additionally, there is a need to standardise the operational definition of LTFU for research as well as clinical practice purposes.
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Affiliation(s)
| | | | - Eng Sing Lee
- National Healthcare Group Polyclinics, Singapore, Singapore
- MOH Office for Healthcare Transformation, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Fekih-Romdhane F, Hajje R, Haddad C, Hallit S, Azar J. Exploring negative symptoms heterogeneity in patients diagnosed with schizophrenia and schizoaffective disorder using cluster analysis. BMC Psychiatry 2023; 23:595. [PMID: 37582728 PMCID: PMC10428523 DOI: 10.1186/s12888-023-05101-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Dissecting the heterogeneity of schizophrenia may help foster progress in understanding its etiology and lay the groundwork for the development of new treatment options for primary or enduring negative symptoms (NS). In this regard, the present study aimed to: (1) to use cluster analysis to identify subgroups of Lebanese patients diagnosed with either schizophrenia or schizoaffective disorder based on NS clusters, and (2) to relate the statistically-derived subgroups to clinically relevant external validators (including measures if state and trait depression, stigma, insight, loneliness, social support). METHOD A total of 202 adult long-stay, chronic, and clinically remitted patients (166 diagnosed with schizophrenia and 36 with schizoaffective disorder) were enrolled. A cluster analysis approach was adopted to classify patients based on the five NS domains social withdrawal, emotional withdrawal, alogia, avolition and anhedonia. RESULTS A three-cluster solution was obtained based on unique NS profiles, and divided patients into (1) low NS (LNS; 42.6%) which characterized by the lowest mean scores in all NS domains, (2) moderate NS (MNS; 25.7%), and (3) high NS (HNS; 31.7%). Post-hoc comparisons showed that depression (state and trait), loneliness and social support could accurately distinguish the schizophrenia subgroups. Additionally, individuals in the HNS cluster had longer duration of illness, longer duration of hospitalization, and were given higher dosages of antipsychotic medication compared to those in the other clusters, but these differences did not achieve the statistical significance. CONCLUSION Findings provide additional support to the categorical model of schizophrenia by confirming the existence of three alternate subtypes based on NS. The determination of distinct NS subgroups within the broad heterogeneous population of people diagnosed with schizophrenia may imply that each subgroup possibly has unique underlying mechanisms and necessitates different treatment approaches.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi hospital, Manouba, 2010 Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Romy Hajje
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - Chadia Haddad
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
| | - Souheil Hallit
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Jocelyne Azar
- School of Medicine, Lebanese American University, Byblos, Lebanon
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Weissman S, Aziz M, Bangolo AI, Ehrlich D, Forlemu A, Willie A, Gangwani MK, Waqar D, Terefe H, Singh A, Gonzalez DMC, Sajja J, Emiroglu FL, Dinko N, Mohamed A, Fallorina MA, Kosoy D, Shenoy A, Nanavati A, Feuerstein JD, Tabibian JH. Relationships of hospitalization outcomes and timing to endoscopy in non-variceal upper gastrointestinal bleeding: A nationwide analysis. World J Gastrointest Endosc 2023; 15:285-296. [PMID: 37138938 PMCID: PMC10150287 DOI: 10.4253/wjge.v15.i4.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/22/2023] [Accepted: 03/15/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The optimal timing of esophagogastroduodenoscopy (EGD) and the impact of clinico-demographic factors on hospitalization outcomes in non-variceal upper gastrointestinal bleeding (NVUGIB) remains an area of active research.
AIM To identify independent predictors of outcomes in patients with NVUGIB, with a particular focus on EGD timing, anticoagulation (AC) status, and demographic features.
METHODS A retrospective analysis of adult patients with NVUGIB from 2009 to 2014 was performed using validated ICD-9 codes from the National Inpatient Sample database. Patients were stratified by EGD timing relative to hospital admission (≤ 24 h, 24-48 h, 48-72 h, and > 72 h) and then by AC status (yes/no). The primary outcome was all-cause inpatient mortality. Secondary outcomes included healthcare usage.
RESULTS Of the 1082516 patients admitted for NVUGIB, 553186 (51.1%) underwent EGD. The mean time to EGD was 52.8 h. Early (< 24 h from admission) EGD was associated with significantly decreased mortality, less frequent intensive care unit admission, shorter length of hospital stays, lower hospital costs, and an increased likelihood of discharge to home (all with P < 0.001). AC status was not associated with mortality among patients who underwent early EGD (aOR 0.88, P = 0.193). Male sex (OR 1.30) and Hispanic (OR 1.10) or Asian (aOR 1.38) race were also independent predictors of adverse hospitalization outcomes in NVUGIB.
CONCLUSION Based on this large, nationwide study, early EGD in NVUGIB is associated with lower mortality and decreased healthcare usage, irrespective of AC status. These findings may help guide clinical management and would benefit from prospective validation.
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Affiliation(s)
- Simcha Weissman
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Muhammad Aziz
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Ayrton I Bangolo
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Dean Ehrlich
- Division of Digestive Diseases, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA 90095, United States
| | - Arnold Forlemu
- Department of Internal Medicine, Creighton University School of Medicine, Phoenix, AZ 85012, United States
| | - Anthony Willie
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Manesh K Gangwani
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Danish Waqar
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Hannah Terefe
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Amritpal Singh
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Diego MC Gonzalez
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Jayadev Sajja
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Fatma L Emiroglu
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Nicholas Dinko
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ahmed Mohamed
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Mark A Fallorina
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - David Kosoy
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ankita Shenoy
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Anvit Nanavati
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View- University of California at Los Angeles Medical Center, Sylmar, CA 91342, United States
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Thanakiattiwibun C, Siriussawakul A, Virotjarumart T, Maneeon S, Tantai N, Srinonprasert V, Chaiwat O, Sriswasdi P. Multimorbidity, healthcare utilization, and quality of life for older patients undergoing surgery: A prospective study. Medicine (Baltimore) 2023; 102:e33389. [PMID: 37000055 PMCID: PMC10063272 DOI: 10.1097/md.0000000000033389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/22/2023] [Accepted: 03/08/2023] [Indexed: 04/01/2023] Open
Abstract
Multimorbidity (≥2 chronic illnesses) is a worldwide healthcare challenge. Patients with multimorbidity have a reduced quality of life and higher mortality than healthy patients and use healthcare resources more intensively. This study investigated the prevalence of multimorbidity; examined the effects of multimorbidity on healthcare utilization; healthcare costs of multimorbidity; and compared the associations between the health-related quality of life (HRQoL) of older patients undergoing surgery and multimorbidity, the Charlson Comorbidity Index (CCI), the Simple Frailty Questionnaire (FRAIL), and the American Society of Anesthesiologists (ASA) physical status classifications. This prospective cohort study enrolled 360 patients aged > 65 years scheduled for surgery at a university hospital. Data were collected on their demographics, preoperative medical profiles, healthcare costs, and healthcare utilization (the quantification or description of the use of services, such as the number of preoperative visits, multiple-department consultations, surgery waiting time, and hospital length of stay). Preoperative-assessment data were collected via the CCI, FRAIL questionnaire, and ASA classification. HRQoL was derived using the EQ-5D-5L questionnaire. The 360 patients had a mean age of 73.9 ± 6.6 years, and 37.8% were men. Multimorbidity was found in 285 (79%) patients. The presence of multimorbidity had a significant effect on healthcare utilization (≥2 preoperative visits and consultations with ≥2 departments). However, there was no significant difference in healthcare costs between patients with and without multimorbidity. At the 3-month postoperative, patients without multimorbidity had significantly higher scores for HRQoL compared to those with multimorbidity (HRQoL = 1.00 vs 0.96; P < .007). While, patients with ASA Class > 2 had a significantly lower median HRQoL than patients with ASA Class ≤2 at postoperative day 5 (HRQoL = 0.76; P = .018), 1-month (HRQoL = 0.90; P = .001), and 3-months (HRQoL = 0.96; P < .001) postoperatively. Multimorbidity was associated with a significant increase in the healthcare utilization of the number of preoperative visits and a greater need for multiple-department consultations. In addition, multimorbidity resulted in a reduced HRQoL during hospital admission and 3-months postoperatively. In particular, the ASA classification > 2 apparently reduced postoperative HRQoL at day 5, 1-month, and 3-months lower than the ASA classification ≤2.
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Affiliation(s)
- Chayanan Thanakiattiwibun
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Arunotai Siriussawakul
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Satanun Maneeon
- Department of Pharmacy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narisa Tantai
- Department of Pharmacy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varalak Srinonprasert
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Geriatrics, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Onuma Chaiwat
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patcharee Sriswasdi
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Li X, Yan S, Lu J, Wang R, Ma X, Xiao X, Zhang Y, Jin H. Two new phenolic amides from Allium chinense with protective effect for myocardium cells. CHINESE HERBAL MEDICINES 2023. [DOI: 10.1016/j.chmed.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
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Huang C, Luo B, Wang J, Ao Y, Xiong W, Liao S. Depressive symptoms and physical activity among community-dwelling perimenopausal women: a prospective longitudinal study. BMC Psychiatry 2023; 23:93. [PMID: 36750920 PMCID: PMC9903548 DOI: 10.1186/s12888-023-04591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Women in perimenopause are vulnerable to depressive symptoms, and physical activity was reported to be a potential protective factor. The trajectories of physical activity and depressive symptoms over time and their longitudinal relationships in Chinese perimenopausal women have not been explored yet, leaving a research gap hindering us from better understanding and managing perimenopause depressive symptoms. METHODS A multi-center prospective longitudinal study was conducted in four cities in Sichuan Province, China. Depressive symptoms and physical activity in perimenopausal women were collected in March 2019, June 2019, September 2019, and December 2019, respectively. Multivariable linear regression by generalized estimation equation was used to identify the relevant factors associated with depressive symptoms and physical activity. A four-wave autoregressive and cross-lagged panel model was performed to explore their longitudinal relationships. RESULTS A total of 1875 women who completed the four-wave data collection were included in the data analysis. Depressive symptoms exacerbated over time and were associated with women's age, monthly income, marital status, chronic disease, and negative life events. Physical activity decreased over time and was associated with educational background and monthly income. According to the cross-lagged panel model, perimenopausal women with more severe depressive symptoms tended to be less physically active, and similarly, perimenopausal women with less physical activity were more prone to report more severe depressive symptoms. CONCLUSION The cross-lagged panel model disclosed longitudinal bidirectional relationships between depressive symptoms and physical activity in perimenopausal women. Appropriate physical activity should be recommended for perimenopausal women to improve their mental well-being. Tailored physical activity duration and maintenance measures should be proposed based on different sociodemographic statuses.
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Affiliation(s)
- Chuanya Huang
- grid.461863.e0000 0004 1757 9397Department of Nursing, West China Second University Hospital, Sichuan University / West China School of Nursing, Sichuan University, #No. 20, Section 3, People’s South Road, Wuhou District, Chengdu City, 610041 Sichuan Province P.R. China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041 China
| | - Biru Luo
- grid.461863.e0000 0004 1757 9397Department of Nursing, West China Second University Hospital, Sichuan University / West China School of Nursing, Sichuan University, #No. 20, Section 3, People’s South Road, Wuhou District, Chengdu City, 610041 Sichuan Province P.R. China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041 China
| | - Jing Wang
- grid.410635.5Ya’an Polytechnic College, Ya’an, 625000 Sichuan China
| | - Yiling Ao
- Sichuan University of Science and Technology, Meishan, 620000 Sichuan China
| | - Weijun Xiong
- Chengdu Zhiyong Technology Company Limited, Chengdu, 610041 China
| | - Shujuan Liao
- Department of Nursing, West China Second University Hospital, Sichuan University / West China School of Nursing, Sichuan University, #No. 20, Section 3, People's South Road, Wuhou District, Chengdu City, 610041, Sichuan Province, P.R. China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China.
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Al-Hanawi MK, Njagi P. Assessing the inequality in out-of-pocket health expenditure among the chronically and non-chronically ill in Saudi Arabia: a Blinder-Oaxaca decomposition analysis. Int J Equity Health 2022; 21:192. [PMID: 36585657 PMCID: PMC9804999 DOI: 10.1186/s12939-022-01810-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 12/17/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Many high-income countries have made significant progress towards achieving universal health coverage. Nevertheless, out-of-pocket (OOP) health expenditure continues to undermine the effectiveness of the universal healthcare system. In Saudi Arabia, due to the overburdened free public health services, many people opt for alternative healthcare services, risking high OOP payments. The presence of chronic illness further exacerbates this situation. However, there is limited evidence on the extent of the gap in OOP health expenditure between the chronically and non-chronically ill and the associated drivers contributing to this gap. The aim of this study was to assess inequalities in relative OOP health expenditure, estimated as the percentage of income spent on healthcare, between the chronically and non-chronically ill in Saudi Arabia and their associated drivers. METHODS Data from 10,785 respondents were obtained from a national cross-sectional survey conducted in Saudi Arabia as part of the 2018 Family Health Survey. Inequalities in relative OOP health expenditure were measured using concentration indices and curves. A Blinder-Oaxaca decomposition analysis was used to assess the differences in relative OOP health expenditure between the chronically and non-chronically ill. RESULTS The results showed that the chronically ill experience a higher financial burden due to healthcare services in absolute costs and relative to their income compared to the non-chronically ill. In addition, there was higher pro-poor inequality (-0.1985) in relative OOP health expenditure among the chronically ill compared to that (-0.1195) among the non-chronically ill. There was a 2.6% gap in relative OOP health expenditure among the chronically and non-chronically ill, of which 53.8% was attributable to unexplained factors, with explained factors accounting for the 46.2% difference. Factors that significantly contributed to the overall gap (i.e. both explained and non-explained factors) included employment status, insurance status, self-rated health, and periodic check-ups. CONCLUSION This study underscores the high financial burden due to OOP payments among the chronically ill and the existence of pro-poor inequalities. In addition, there is a significant gap in relative OOP health expenditure between the chronically and non-chronically ill, which is mainly attributable to differences in socio-economic characteristics. This indicates that the existing financial mechanisms have not been sufficient in cushioning the chronically ill and less well off in Saudi Arabia. This situation calls for health policymakers to integrate a social safety net into the health financing system and to prioritize the disadvantaged population, thereby ensuring access to health services without experiencing financial hardship.
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Affiliation(s)
- Mohammed Khaled Al-Hanawi
- grid.412125.10000 0001 0619 1117Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Health Economics Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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La DTV, Zhao Y, Arokiasamy P, Atun R, Mercer S, Marthias T, McPake B, Pati S, Palladino R, Lee JT. Multimorbidity and out-of-pocket expenditure for medicines in China and India. BMJ Glob Health 2022; 7:bmjgh-2021-007724. [DOI: 10.1136/bmjgh-2021-007724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 09/01/2022] [Indexed: 11/06/2022] Open
Abstract
IntroductionUsing nationally representative survey data from China and India, this study examined (1) the distribution and patterns of multimorbidity in relation to socioeconomic status and (2) association between multimorbidity and out-of-pocket expenditure (OOPE) for medicines by socioeconomic groups.MethodsSecondary data analysis of adult population aged 45 years and older from WHO Study on Global Ageing and Adult Health (SAGE) India 2015 (n=7397) and China Health and Retirement Longitudinal Study (CHARLS) 2015 (n=11 570). Log-linear, two-parts, zero-inflated and quantile regression models were performed to assess the association between multimorbidity and OOPE for medicines in both countries. Quantile regression was adopted to assess the observed relationship across OOPE distributions.ResultsBased on 14 (11 self-reported) and 9 (8 self-reported) long-term conditions in the CHARLS and SAGE datasets, respectively, the prevalence of multimorbidity in the adult population aged 45 and older was found to be 63.4% in China and 42.2% in India. Of those with any long-term health condition, 38.6% in China and 20.9% in India had complex multimorbidity. Multimorbidity was significantly associated with higher OOPE for medicines in both countries (p<0.05); an additional physical long-term condition was associated with a 18.8% increase in OOPE for medicine in China (p<0.05) and a 20.9% increase in India (p<0.05). Liver disease was associated with highest increase in OOPE for medicines in China (61.6%) and stroke in India (131.6%). Diabetes had the second largest increase (China: 58.4%, India: 91.6%) in OOPE for medicines in both countries.ConclusionMultimorbidity was associated with substantially higher OOPE for medicines in China and India compared with those without multimorbidity. Our findings provide supporting evidence of the need to improve financial protection for populations with an increased burden of chronic diseases in low-income and middle-income countries.
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Cheng BT, Kim AB, Nadimpalli S, Pineles SL, Kurup SP. Association of Pediatric Strabismus and Functional Impairment: A Cross-sectional Nationwide Analysis. J Pediatr Ophthalmol Strabismus 2022:1-9. [PMID: 36102269 DOI: 10.3928/01913913-20220728-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine the association of childhood strabismus with functional limitation to identify particular domains of impairment. METHODS The authors analyzed 201 children ages 5 to 17 years with strabismus enrolled in the 1996-2015 Medical Expenditure Panel Surveys, representative annual surveys of the U.S. POPULATION Functional impairment was assessed using the Columbia Impairment Scale (CIS), a validated measure of behavioral and psychosocial functioning. A CIS score of 16 or greater defined clinically significant functional impairment. Multivariate regression models adjusted for age, sex, race, ethnicity, household income, geographic location, and insurance type were constructed to examine the association of strabismus diagnosis with overall impairment and individual domains of function. RESULTS Children diagnosed as having strabismus had higher rates of clinically significant functional impairment compared to those without strabismus (15.1% vs 9.1%, adjusted odds ratio [95% CI]: 1.82 [1.11 to 2.97], P = .02). Moreover, strabismus diagnosis was associated with higher rates of problems with getting along with their mother (1.70 [1.21 to 2.40], P = .003) and father (1.66 [1.16 to 2.38], P = .006), getting along with other children (1.67 [1.16 to 2.40], P = .006), behavior at home (1.94 [1.37 to 2.74], P = .0002), staying out of trouble (1.52 [1.04 to 2.23], P = .03), nervousness (1.49 [1.05 to 2.11], P = .02), and getting involved with sports and hobbies (1.55 [1.03 to 2.34], P = .04). CONCLUSIONS Childhood strabismus is associated with 1.8-fold greater odds of clinically significant functional impairment, with greater dysfunction in specific relationship and behavioral domains. Functional burden may be an important consideration in management decisions. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].
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Adamowicz JL, Vélez-Bermúdez M, Thomas EB. Fatigue severity and avoidance among individuals with chronic disease: A meta-analysis. J Psychosom Res 2022; 159:110951. [PMID: 35665612 PMCID: PMC9629285 DOI: 10.1016/j.jpsychores.2022.110951] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fatigue is a common, debilitating symptom experienced by individuals with chronic disease. Avoidance, or the act of evading unwanted experiences, is associated with fatigue across chronic disease samples. The current study sought to determine the strength of association between fatigue severity and avoidance in individuals with chronic disease. METHODS PubMed, PsycINFO, CINAHL, and ProQuest Dissertations and Theses databases were searched. Eligible studies measured fatigue and avoidance in chronic disease samples. Sixty-six studies were included. Data analyses were conducted in Rstudio. A random effects model was employed, and a weighted mean effect size was computed for fatigue severity and avoidance. Mixed-effects meta-regression analyses were conducted to examine moderating variables, including patient, clinical, and measurement characteristics. Publication bias was examined using funnel plot, trim-and-fill, and p-curve. RESULTS The meta-analysis comprised of 71 unique patient samples from 66 studies. The total number of included participants was 13,024. A small, positive association was found between fatigue severity and avoidance, r(71) = 0.22, p < .001, 95% CI [0.18-0.27], SE = 0.02. There was also significant heterogeneity, Q(70) = 349.96, p < .001. Moderator analyses examining age, sex, illness duration, avoidance type, and disease sample were all non-significant. Regarding publication bias, trim-and-fill resulted in a modified weighted mean effect size (r(83) = 0.18, p < .001) and a p-curve analysis supported the evidential value of the current analysis. CONCLUSION Findings support that among individuals with chronic disease, fatigue severity and avoidance are positively associated, which has implications for behavioral interventions in this population.
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Affiliation(s)
| | - Miriam Vélez-Bermúdez
- University of Iowa, Department of Psychological and Brain Sciences, United States of America.
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21
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Vigod SN, Ray JG, Cohen E, Wilton AS, Saunders NR, Barker LC, Berard A, Dennis CL, Holloway AC, Morrison K, Oberlander TF, Hanley G, Tu K, Brown HK. Maternal Schizophrenia and the Risk of a Childhood Chronic Condition. Schizophr Bull 2022; 48:1252-1262. [PMID: 35900007 PMCID: PMC9673258 DOI: 10.1093/schbul/sbac091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND HYPOTHESIS Maternal schizophrenia heightens the risk for certain perinatal complications, yet it is not known to what degree future childhood chronic health conditions (Childhood-CC) might arise. STUDY DESIGN This population-based cohort study using health administrative data from Ontario, Canada (1995-2018) compared 5066 children of mothers with schizophrenia to 25 324 children of mothers without schizophrenia, propensity-matched on birth-year, maternal age, parity, immigrant status, income, region of residence, and maternal medical and psychiatric conditions other than schizophrenia. Cox proportional hazard models generated hazard ratios (HR) and 95% confidence intervals (CI) for incident Childhood-CCs, and all-cause mortality, up to age 19 years. STUDY RESULTS Six hundred and fifty-six children exposed to maternal schizophrenia developed a Childhood-CC (20.5/1000 person-years) vs. 2872 unexposed children (17.1/1000 person-years)-an HR of 1.18, 95% CI 1.08-1.28. Corresponding rates were 3.3 vs. 1.9/1000 person-years (1.77, 1.44-2.18) for mental health Childhood-CC, and 18.0 vs. 15.7/1000 person-years (1.13, 1.04-1.24) for non-mental health Childhood-CC. All-cause mortality rates were 1.2 vs. 0.8/1000 person-years (1.34, 0.96-1.89). Risk for children exposed to maternal schizophrenia was similar whether or not children were discharged to social service care. From age 1 year, risk was greater for children whose mothers were diagnosed with schizophrenia prior to pregnancy than for children whose mothers were diagnosed with schizophrenia postnatally. CONCLUSIONS A child exposed to maternal schizophrenia is at elevated risk of chronic health conditions including mental and physical subtypes. Future research should examine what explains the increased risk particularly for physical health conditions, and what preventive and treatment efforts are needed for these children.
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Affiliation(s)
- Simone N Vigod
- To whom correspondence should be addressed; Department of Psychiatry, Women’s College Hospital, 76 Grenville Street, Toronto, ON, Canada; tel: 416-323-6400, ext. 4080, e-mail:
| | - Joel G Ray
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,St. Michael’s Hospital, Toronto, ON, Canada,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Edwin S.H. Leong Centre for Healthy Children, Hospital for Sick Children, Toronto, ON, Canada,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Natasha R Saunders
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Edwin S.H. Leong Centre for Healthy Children, Hospital for Sick Children, Toronto, ON, Canada,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lucy C Barker
- Women’s College Hospital and Women’s College Research Institute, Toronto, ON, Canada,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada
| | - Anick Berard
- Universite de Montreal, Faculty of Pharmacy, Montreal, QC, Canada,CHU Ste-Justine, Montreal, QC, Canada
| | - Cindy-Lee Dennis
- Women’s College Hospital and Women’s College Research Institute, Toronto, ON, Canada,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Lawrence S. BloombergFaculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Alison C Holloway
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | | | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Gillian Hanley
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Karen Tu
- Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, North York General Hospital, Toronto Western Hospital Family Health Team-UHN, Toronto, ON, Canada
| | - Hilary K Brown
- Women’s College Hospital and Women’s College Research Institute, Toronto, ON, Canada,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Institute for Health Policy, Management and Evaluation, Toronto, ON, Canada,ICES, Toronto, ON, Canada,Department of Health and Society, University of Toronto, Scarborough, Toronto, ON, Canada
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22
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Psychological distress, multimorbidity and health services among older adults in rural South Australia. J Affect Disord 2022; 309:453-460. [PMID: 35490879 DOI: 10.1016/j.jad.2022.04.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Psychological distress may relate to higher health services use. However, data on psychological distress and health services use among rural older adults are limited. This study investigates psychological distress in older adults (aged ≥60) and evaluates the relationship between psychological distress, multimorbidity and health services utilization. DESIGN A cross-sectional design was adopted using data on older adults (≥60) (n = 5920) from the South Australia's 2013-2017 population health survey. The Modified Monash Model MM2-7 was used to designate rural areas. The dataset provides information on reported physical health conditions, psychological distress, and patterns of health services use. The Kessler Psychological Distress Scale (K10) was used to compute scores for reported mental health disorders in this population. RESULTS The mean (SD) age of the study participants was 72.1 (8.1) years. Women constituted 58.8% of the sample. The mean (SD) score for psychological distress was 12.5 (3.6). One-fourth (33.7%) report one-chronic condition, 20.4% reported 2 chronic conditions and 13% had more than 3 chronic conditions. High psychological distress was associated with female gender (χ2 = 14.4, p < 0.001), <80 years (χ2 = 11.7, p = 0.019), lower education (χ2 = 10.9, p = 0.027). Similarly, multimorbidity was associated with female gender (χ2 = 51.1, p < 001), increasing age (χ2 = 173.6, p < 0.001) and lower education (χ2 = 28.8 p < 0.001). Psychological distress and multimorbidity were independently associated with health service use. High psychological distress was associated with general practitioner (GP) visit (odds ratio 3.6 (95% CI 2.6-5.1), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.2-5.0), p < 0.001) and hospital admission (odds ratio 2.3 (95% CI 1.3-4.3), p < 0.001). Multimorbidity was associated with general practitioner (GP) visit (odds ratio 6.8 (95% CI 5.6-8.3), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.4-4.3), p < 0.001) and hospital admission (odds ratio 3.1 (95% CI 1.9-5.1), p < 0.001). Model included age, gender, education, number of chronic condition and psychological distress. CONCLUSION/IMPLICATION Psychological distress and multimorbidity were independently associated with health services use. Thus, psychological distress, particularly in the presence of multimorbidity, presents an opportunity for intervention by clinicians that may reduce the demand on rural health services.
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23
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Brucker DL, Lauer E, Boege S. Americans Aging With Disabilities Are More Likely to Have Multiple Chronic Conditions. JOURNAL OF DISABILITY POLICY STUDIES 2022. [DOI: 10.1177/10442073221107079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Using data from the 2010 to 2017 National Health Interview survey, bivariate and multivariate regression analyses were utilized to estimate the percentage and odds of having multiple chronic conditions (two or more, three or more) among U.S. adults ages 65 and over with and without disabilities, controlling for sociodemographic factors and presence of psychological distress. Older adults with and without disabilities in the United States most frequently reported having hypertension, arthritis, and diabetes. Regression results indicate that older adults with disabilities are significantly more likely to experience two or more and three or more chronic conditions than older adults without disabilities, controlling for sociodemographic factors and health behaviors. These findings highlight a need for improvement in coordinated care that considers both disability and multiple chronic conditions in the management of patient health to support well-being in aging.
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Affiliation(s)
| | - Eric Lauer
- University of New Hampshire, Durham, USA
- Point32Health, Canton, MA, USA
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24
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Forrest CB, Schuchard J, Bruno C, Amaral S, Cox ED, Flynn KE, Hinds PS, Huang IC, Kappelman MD, Krishnan JA, Kumar RB, Lai JS, Paller AS, Phipatanakul W, Schanberg LE, Sumino K, Weitzman ER, Reeve BB. Self-Reported Health Outcomes of Children and Youth with 10 Chronic Diseases. J Pediatr 2022; 246:207-212.e1. [PMID: 35247394 PMCID: PMC9232908 DOI: 10.1016/j.jpeds.2022.02.052] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To identify pediatric patient-reported outcomes (PROs) that are associated with chronic conditions and to evaluate the effects of chronic disease activity on PROs. STUDY DESIGN Participants (8-24 years old) and their parents were enrolled into 14 studies that evaluated Patient-Reported Outcome Measurement Information System PROs across 10 chronic conditions-asthma, atopic dermatitis, cancer, cancer survivors, chronic kidney disease, Crohn's disease, juvenile idiopathic arthritis, lupus, sickle cell disease, and type 1 diabetes mellitus. PRO scores were contrasted with the US general population of children using nationally representative percentiles. PRO-specific coefficients of variation were computed to illustrate the degree of variation in scores within vs between conditions. Condition-specific measures of disease severity and Cohen d effect sizes were used to examine PRO scores by disease activity. RESULTS Participants included 2975 child respondents and 2392 parent respondents who provided data for 3409 unique children: 52% were 5-12 years old, 52% female, 25% African American/Black, and 14% Hispanic. Across all 10 chronic conditions, children reported more anxiety, fatigue, pain, and mobility restrictions than the general pediatric population. Variation in PRO scores within chronic disease cohorts was equivalent to variation within the general population, exceeding between-cohort variation by factors of 1.9 (mobility) to 5.7 (anxiety). Disease activity was consistently associated with poorer self-reported health, and these effects were weakest for peer relationships. CONCLUSIONS Chronic conditions are associated with symptoms and functional status in children and adolescents across 10 different disorders. These findings highlight the need to complement conventional clinical evaluations with those obtained directly from patients themselves using PROs.
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Affiliation(s)
| | | | - Cortney Bruno
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sandra Amaral
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Elizabeth D. Cox
- University of Wisconsin-Madison Schools of Medicine and Public Health, Madison, WI
| | | | | | - I-Chan Huang
- St. Jude Children’s Research Hospital, Memphis, TN
| | | | | | - Rajesh B. Kumar
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Jin-Shei Lai
- Northwestern University Feinberg School of Medicine
| | | | | | | | - Kaharu Sumino
- Washington University School of Medicine, St. Louis, MO
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25
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Hu Y, Carr PR, Liew D, Broder J, Callander EJ, McNeil JJ. How does the onset of physical disability or dementia in older adults affect economic wellbeing and co-payments for health care? the impact of gender. BMC Health Serv Res 2022; 22:701. [PMID: 35614437 PMCID: PMC9131631 DOI: 10.1186/s12913-022-08017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/27/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Existing studies have illustrated how the onset of physical disability or dementia negatively impacts economic wellbeing and increases out of pocket costs. However, little is known about this relationship in older individuals. Consequently, this study aimed to identify how the onset of physical disability or dementia in older adults affects economic wellbeing and out of pocket costs, and to explore the impact of gender in the context of Australia. METHODS The data was collected from a large, randomized clinical study, ASPirin in Reducing Events in the Elderly (ASPREE). Two generalized linear models (with and without interaction effects) of total out of pocket costs for those who did and did not develop physical disability or dementia were generated, with adjustment for sociodemographic characteristics at baseline. RESULTS We included 8,568 older Australian individuals with a mean age of 74.8 years and 53.2% being females. After adjustment for the baseline sociodemographic characteristics, the onset of physical disability did statistically significantly raise out of pocket costs (cost ratio = 1.25) and costs among females were 13.1% higher than males. CONCLUSIONS This study highlights that classifying different types of health conditions to identify the drivers of out of pocket costs and to explore the gender differences in a long-term follow-up is of importance to examine the financial impact on the older population. These negative financial impacts and gender disparities of physical disability and dementia must be considered by policymakers.
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Affiliation(s)
- Yanan Hu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Prudence R. Carr
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jonathan Broder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Emily J. Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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26
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Barańska A, Religioni U, Kłak A, Merks P, Bogdan M, Firlej E, Sokołowska A, Kowalska W, Drop B. Coping Strategies Preferred by Patients Treated for Osteoporosis and Analysis of the Difficulties Resulting from the Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095677. [PMID: 35565072 PMCID: PMC9104136 DOI: 10.3390/ijerph19095677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/25/2022]
Abstract
Osteoporosis has been recognized as a civilization disease. This chronic condition needs a long-term management plan with a holistic approach to patients. The specificity of the patient’s response to the disease and coping strategies are very important in the treatment process. The aim of this research was to analyze the strategies of coping with disease preferred by patients treated for osteoporosis, and to determine the relationship between the self-assessment of patients’ health, time of treatment, sociodemographic variables, and strategies of coping with a chronic disease such as osteoporosis. The study was conducted from August 2016 to July 2018 at an osteoporosis clinic in eastern Poland. Coping Orientations to Problems Experienced (COPE) by C.S. Carver, M. F. Scheier, and J. K. Weintraub in the Polish adaptation and our own questionnaire were used. The study participants were 312 patients treated for osteoporosis. The respondents treated in the osteoporosis clinic used the strategies of seeking support and focusing on emotions to the greatest extent, and avoidance strategies the least. Sociodemographic features and self-assessment of health condition significantly differentiate the strategies of coping with the disease. The analysis showed that the higher the assessment of the individual perception of one’s own health, the more often the respondents used active coping strategies.
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Affiliation(s)
- Agnieszka Barańska
- Department of Medical Informatics and Statistics with e-Health Lab, Medical University of Lublin, 20-059 Lublin, Poland;
- Correspondence:
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, 01-826 Warsaw, Poland;
- Collegium of Business Administration, Warsaw School of Economics, 02-513 Warsaw, Poland
| | - Anna Kłak
- Department of Environmental Hazards Prevention, Allergology and Immunology, Warsaw Medical University, 02-091 Warsaw, Poland;
| | - Piotr Merks
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, 01-815 Warsaw, Poland;
| | - Magdalena Bogdan
- Department of Social Medicine and Public Health, Warsaw Medical University, 02-007 Warsaw, Poland;
| | - Ewelina Firlej
- Department of Cosmetology and Aesthetic Medicine, Medical University of Lublin, 20-090 Lublin, Poland; (E.F.); (A.S.)
| | - Anna Sokołowska
- Department of Cosmetology and Aesthetic Medicine, Medical University of Lublin, 20-090 Lublin, Poland; (E.F.); (A.S.)
| | - Wioleta Kowalska
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Bartłomiej Drop
- Department of Medical Informatics and Statistics with e-Health Lab, Medical University of Lublin, 20-059 Lublin, Poland;
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27
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Thompson DM, Booth L, Moore D, Mathers J. Peer support for people with chronic conditions: a systematic review of reviews. BMC Health Serv Res 2022; 22:427. [PMID: 35361215 PMCID: PMC8973527 DOI: 10.1186/s12913-022-07816-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/08/2022] [Indexed: 01/23/2023] Open
Abstract
Background People with chronic conditions experience functional impairment, lower quality of life, and greater economic hardship and poverty. Social isolation and loneliness are common for people with chronic conditions, with multiple co-occurring chronic conditions predicting an increased risk of loneliness. Peer support is a socially driven intervention involving people with lived experience of a condition helping others to manage the same condition, potentially offering a sense of connectedness and purpose, and experiential knowledge to manage disease. However, it is unclear what outcomes are important to patients across the spectrum of chronic conditions, what works and for whom. The aims of this review were to (1) collate peer support intervention components, (2) collate the outcome domains used to evaluate peer support, (3) synthesise evidence of effectiveness, and (4) identify the mechanisms of effect, for people with chronic conditions. Methods A systematic review of reviews was conducted. Reviews were included if they reported on formal peer support between adults or children with one or more chronic condition. Data were analysed using narrative synthesis. Results The search identified 6222 unique publications. Thirty-one publications were eligible for inclusion. Components of peer support were organised into nine categories: social support, psychological support, practical support, empowerment, condition monitoring and treatment adherence, informational support, behavioural change, encouragement and motivation, and physical training. Fifty-five outcome domains were identified. Quality of life, and self-efficacy were the most measured outcome domains identified. Most reviews reported positive but non-significant effects. Conclusions The effectiveness of peer support is unclear and there are inconsistencies in how peers are defined, a lack of clarity in research design and intervention reporting, and widely variable outcome measurement. This review presents a range of components of peer support interventions that may be of interest to clinicians developing new support programmes. However, it is unclear precisely what components to use and with whom. Therefore, implementation of support in different clinical settings may benefit from participatory action research so that services may reflect local need. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07816-7.
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Affiliation(s)
- Dean M Thompson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | | | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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28
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Sibbritt D, Hosseini M, Peng W, Bayes J, Adams J. The health care utilisation and out-of-pocket expenditure associated with Australian stroke survivors aged 55 and over. PLoS One 2022; 17:e0265907. [PMID: 35324963 PMCID: PMC8947389 DOI: 10.1371/journal.pone.0265907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/09/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Stroke is a major cause of mortality and disability worldwide. People with stroke have a number of options available to treat post-stroke related symptoms and challenges. The aim of this study was to assess the use of healthcare services, self-care practices and out-of-pocket expenses associated with post-stroke healthcare. Methods We retrospectively analysed data collected between April and October 2017 from a survey of 576 participants aged 55 to 96 from the 45 and Up Study, NSW (Australia), who had earlier reported a clinical diagnosis of stroke. Participants were asked about their use of health care services, including conventional medicine practitioners and medications, complementary medicine practitioners, practices and products and the respective associated out-of-pocket expenditure for each. Results Amongst the total of 576 individuals who participated in the study, 39% consulted a doctor, 18% consulted an allied health practitioner, and 8% consulted a complementary medicine practitioner in the previous year for their stroke. Participants’ average combined out-of-pocket expenditure for post-stroke related healthcare was AU$386.4 per annum. Extrapolated to all Australians with stroke, aged 55 years and over, the total out-of-pocket expenditure for post-stroke related healthcare is estimated to be AU$42 million per annum. Conclusions Post-stroke individuals used a wide range of health services and various self-care practices for stroke rehabilitation. Such healthcare utilisation is associated with significant annual out-of-pocket expenditure. Given the socioeconomic burden of stroke, further research is required to identify the barriers and facilitators of self-care among patients with stroke and explore the cost-effectiveness of the wide range of treatments(s) utilised for post-stroke care.
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Affiliation(s)
- David Sibbritt
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Mahdie Hosseini
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Wenbo Peng
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Jessica Bayes
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | - Jon Adams
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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29
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Briasoulis A, Ueyama H, Kuno T, Asleh R, Briasouli A, Doulamis I, Malik AH. Analysis of Trends and Outcomes of 90 and 180 Day Readmissions After Left Ventricular Assist Device Implantation. ASAIO J 2022; 68:356-362. [PMID: 34081419 DOI: 10.1097/mat.0000000000001486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Despite decreasing morbidity and mortality in left ventricular assist device (LVAD) recipients, readmission after implantation remains a major problem. Our aim was to investigate the trends and outcomes of 90 and 180 day readmission in this population. The National Readmission Database from 2012 to 2017 was queried to identify LVAD recipients. A total of 5,907 adults (90 day readmissions) and 3,653 adults (180 day readmissions) who survived LVAD implantation during the index admission were included in our analysis. Readmissions occurred in 45.6% and 65.1% by 90 and 180 days, respectively, with most readmissions occurring within the first 20 days. During the study period, mortality at index admission and readmission rate after discharge from index admission remained stable, whereas mortality during the readmission declined overtime both at 90 and 180 days. Heart failure was the most common cause for readmission (both 90 and 180 days), while its incidence also increased over the years. Among the reasons for readmission, intracranial bleeding, ischemic stroke, and device thrombosis were associated with highest mortality and gastrointestinal bleeding with the lowest. Intracranial bleeding, device thrombosis, and device infection were associated with longer length of stay. Multivariate logistic regression models identified gastrointestinal bleeding, length of stay during index admission, and end-stage renal disease requiring hemodialysis as risk factors of readmissions. Our study has unveiled several important factors associated with readmission and mortality. Approaches to identify and prevent readmissions early after LVAD implantation by addressing these factors may lead to lower morbidity, healthcare cost related to readmission, and improved quality of life.
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Affiliation(s)
- Alexandros Briasoulis
- From the Division of Cardiovascular Medicine, Section of Heart failure and Transplantation, University of Iowa, Iowa City, Iowa
- National Kapodistrian University of Athens, Athens, Greece
| | - Hiroki Ueyama
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York City, New York
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York City, New York
| | - Rabea Asleh
- Heart Institute, Hadassah University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Artemis Briasouli
- Heart Institute, Hadassah University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ilias Doulamis
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York City, New York
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Bostons, Massachusetts
| | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center & New York Medical College, Valhalla, New York
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30
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Iloabuchi C, Dwibedi N, LeMasters T, Shen C, Ladani A, Sambamoorthi U. Low-value care and excess out-of-pocket expenditure among older adults with incident cancer - A machine learning approach. J Cancer Policy 2021; 30:100312. [PMID: 35559807 PMCID: PMC8916690 DOI: 10.1016/j.jcpo.2021.100312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/05/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the association of low-value care with excess out-of-pocket expenditure among older adults diagnosed with incident breast, prostate, colorectal cancers, and Non-Hodgkin's Lymphoma. METHODS We used a retrospective cohort study design with 12-month baseline and follow-up periods. We identified a cohort of older adults (age ≥ 66 years) diagnosed with breast, prostate, colorectal cancers, or Non-Hodgkin's lymphoma between January 2014 and December 2014. We assessed low-value care and patient out-of-pocket expenditure in the follow-up period. We identified relevant low-value services using ICD9/ICD10 and CPT/HCPCS codes from the linked health claims and patient out-of-pocket expenditure from Medicare claim files and expressed expenditure in 2016 USD. RESULTS About 29 % of older adults received at least one low-value care procedure during the follow-up period. Low-value care differed by gender, and rates were higher in women with colorectal cancer (32.7 %) vs. (28.8 %) and NHL (40 %) vs. (39 %) compared to men. Individuals who received one or more low-value care procedures had significantly higher mean out-of-pocket expenditure ($8,726 ± $7,214) vs. ($6,802 ± $6,102). XGBOOST, a machine learning algorithm revealed that low-value care was among the five leading predictors of OOP expenditure. CONCLUSION One in four older adults with incident cancer received low-value care in 12-months after a cancer diagnosis. Across all cancer populations, individuals who received low-value care had significantly higher out-of-pocket expenditure. Excess out-of-pocket expenditure was driven by low-value care, fragmentation of care, and an increasing number of pre-existing chronic conditions. POLICY STATEMENT This study focuses on health policy issues, specifically value-based care and its findings have important clinical and policy implications for Centers for Medicare and Medicaid Services (CMS) which has issued a roadmap for states to accelerate the adoption of value-based care, with the Department of Health and Human Services (HHS) setting a goal of converting 50 % of traditional Medicare payment systems to alternative payment models tied to value-based care by 2022.
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Affiliation(s)
- Chibuzo Iloabuchi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], P.O. Box 9510, Morgantown, WV, 26506-9510, USA.
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], P.O. Box 9510, Morgantown, WV, 26506-9510, USA.
| | - Traci LeMasters
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], P.O. Box 9510, Morgantown, WV, 26506-9510, USA.
| | - Chan Shen
- Division of Outcomes Research and Quality, Department of Surgery, College of Medicine, Pennsylvania State University, Hershey, PA, USA.
| | - Amit Ladani
- Department of Medicine, Division of Rheumatology, West Virginia University Medicine, Morgantown, WV, USA.
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, "Vashisht" Professor of Disparities, Health Education, Awareness & Research in Disparities (HEARD) Scholar, Texas Center for Health Disparities, University of North Texas Health Sciences Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
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Zhang C, Ding Y, Peng Q. Who determines United States Healthcare out-of-pocket costs? Factor ranking and selection using ensemble learning. Health Inf Sci Syst 2021; 9:22. [PMID: 34123374 PMCID: PMC8184979 DOI: 10.1007/s13755-021-00153-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/11/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Healthcare out-of-pocket (OOP) costs consist of the annual expenses paid by individuals or families that are not reimbursed by insurance. In the U.S, broadening healthcare disparities are caused by the rapid increase in OOP costs. With a precise forecast of the OOP costs, governments can improve the design of healthcare policies to better control the OOP costs. This study designs a purely data-driven ensemble learning procedure to achieve a collection of factors that best predict OOP costs. METHODS We propose a voting ensemble learning procedure to rank and select factors of OOP costs based on the Medical Expenditure Panel Survey dataset. The method involves utilizing votes from the base learners forward subset selection, backward subset selection, random forest, and LASSO. RESULTS The top-ranking factors selected by our proposed method are insurance type, age, asthma, family size, race, and number of physician office visits. The predictive models using these factors outperform the models that employ the factors commonly considered by the literature through improving the prediction error (test MSE of the OOP costs' log-odds) from 0.462 to 0.382. CONCLUSION Our results indicate a set of factors which best explain the OOP costs behavior based on a purely data-driven solution. These findings contribute to the discussions regarding demand-side needs for containing rapidly rising OOP costs. Instead of estimating the impact of a single factor on OOP costs, our proposed method allows for the selection of arbitrary-sized factors to best explain OOP costs.
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Affiliation(s)
- Chengcheng Zhang
- Claremont Graduate University, Department of Economic Sciences, 150 E. 10th Street, California Claremont, USA
| | - Yujia Ding
- Claremont Graduate University, Department of Economic Sciences, 150 E. 10th Street, California Claremont, USA
- Claremont Graduate University, Institute of Mathematical Sciences, 150 E. 10th Street, California Claremont, USA
| | - Qidi Peng
- Claremont Graduate University, Department of Economic Sciences, 150 E. 10th Street, California Claremont, USA
- Claremont Graduate University, Institute of Mathematical Sciences, 150 E. 10th Street, California Claremont, USA
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AKTURAN S, KARAHAN Ö, AKMAN M. The prevalence of multimorbidity among adults aged 40 years and above in primary care setting: a cross-sectional study. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.831767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yokoyama Y, Kuno T, Malik A, Briasoulis A. Outcomes of robotic coronary artery bypass versus nonrobotic coronary artery bypass. J Card Surg 2021; 36:3187-3192. [PMID: 34091953 DOI: 10.1111/jocs.15710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/19/2021] [Accepted: 05/17/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Robotic coronary artery bypass graft (CABG) has developed in recent decades, however, prior studies showed conflicting result of robotic CABG compared to nonrobotic CABG in terms of mortality, morbidity, and cost. Herein, we sought to analyze the in-hospital outcomes and health care utilization after robotic CABG compared to nonrobotic CABG, based on data from a nationally representative sample. METHODS Patients who underwent CABG were identified using the national inpatient sample. Endpoints were in-hospital outcomes, length of stay, and total cost. Procedure-related complications were identified via international classification of diseases (ICD)-9 and ICD-10 coding and propensity score matching analysis was performed. RESULTS A total of 1,204,125 weighted adults underwent nonrobotic CABG and 7355 underwent robotic CABG in the United States between 2012 and 2017. The comparison of 7330 pairs after propensity score matching showed that in-hospital mortality was higher for those who underwent nonrobotic CABG compared to those who underwent robotic CABG (2.1% vs. 1.1%, p = .029). Similarly, the rates of acute kidney injury, transfusion, postoperative hemorrhage, length of stay, and total cost were higher for nonrobotic CABG compared to robotic CABG (all p < .05). The proportions of routine discharges with (34.5% vs. 40.0%) or without (39.7% vs. 45.0%) home health care were higher among those who underwent robotic, whereas the proportion of transfer to skilled nursing facility/nursing home was more frequent for cases of nonrobotic CABG (22.4% vs. 13.4%). CONCLUSION Robotic CABG was associated with lower rates of in-hospital mortality, acute kidney injury, transfusion, postoperative hemorrhage, total cost, and shorter hospital stay compared to nonrobotic CABG.
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Affiliation(s)
- Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Toshiki Kuno
- Department of Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | - Aaqib Malik
- Department of Cardiology, Westchester Medical Center & New York Medical College, Valhalla, New York, USA
| | - Alexandros Briasoulis
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Arsanjani R, Khera N. Financial Toxicity in Cancer and Cardiovascular Disease: A Threat to Access and Quality of Care. JACC CardioOncol 2021; 3:247-249. [PMID: 34396330 PMCID: PMC8352244 DOI: 10.1016/j.jaccao.2021.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kyriopoulos I, Nikoloski Z, Mossialos E. Financial protection in health among the middle-aged and elderly: Evidence from the Greek economic recession. Health Policy 2021; 125:1256-1266. [PMID: 34226052 DOI: 10.1016/j.healthpol.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
Since the late 2000s, the Greek economy has entered a long period of recession, with reforms and retrenchment in health care being among the main public policy priorities. This study investigates the extent to which financial protection in health has changed among older households during the Greek crisis. We focus on the middle-aged and elderly, the heavy users of health services, who have faced a substantial health and financial burden during the crisis. Our analysis shows that the headcount and overshoot of catastrophic health expenditure (CHE) substantially increased from 2007 to 2015, suggesting that financial protection has eroded to a great extent. Prior to the crisis, CHE was mainly due to inpatient care, followed by outpatient care and medicines. However, the contribution of spending for outpatient medicines to CHE substantially increased during the study period. The headcount of CHE rose across all socioeconomic groups we examined, with low-income households and households with chronic patients being disproportionately affected. In 2007, we do not report signs of socioeconomic inequalities in the risk of CHE. On the contrary, our results show that households of low socioeconomic status are more likely to incur CHE in 2015, revealing substantial inequalities in the risk of CHE. This finding raises significant distributional and equity concerns. Strengthening financial protection among older households is an imperative challenge for the Greek health system, and several policy responses need to be adopted towards this direction.
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Affiliation(s)
- Ilias Kyriopoulos
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
| | - Zlatko Nikoloski
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
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Yashima F, Briasoulis A, Kuno T, Noguchi M, Ahmad H, Zaid S, Goldberg JB, Malik AH, Tang GHL. Cerebral embolic protection during transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:9-13. [PMID: 34024747 DOI: 10.1016/j.carrev.2021.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is controversial that cerebral embolic protection devices (CEPDs) reduce clinical stroke during transcatheter aortic valve replacement (TAVR). Herein, we investigated the impact of CEPDs on in-hospital clinical stroke using a nationally representative sample. METHODS AND RESULTS Using the National Inpatient Sample (NIS) database, 109,240 patients who underwent TAVR between 2017 and 2018 were included. They were categorized into 2 groups according to usage of CEPDs; the CEPD and non-CEPD groups. After propensity score matching, 3805 pairs were acquired. Our main outcome was in-hospital clinical stroke. Other outcomes were in-hospital mortality, acute kidney injury (AKI), AKI leading to hemodialysis, bleeding requiring transfusion, overall bleeding complications, infectious complications, length of stay, and total cost. In-hospital clinical stroke did not significantly differ between the 2 groups (0.7% versus 1.1%, p = 0.449). The CEPD group was associated with a significantly lower in-hospital mortality (0.5% versus 1.4%, p = 0.029) and reduced total cost ($49,047 ± 19,666 versus $50,051 ± 23,190, p < 0.001), compared with the non-CEPD group, whereas there were no significant differences in the other outcomes. CONCLUSIONS By using the NIS database with a large number of cases, TAVR with CEPDs was not associated with a lower incidence of in-hospital clinical stroke compared with no use of CEPDs after matching.
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Affiliation(s)
- Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, IA, USA.
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Hasan Ahmad
- Department of Cardiology, Westchester Medical Center & New York Medical College, NY, USA
| | - Syed Zaid
- Department of Cardiology, Westchester Medical Center & New York Medical College, NY, USA
| | - Joshua B Goldberg
- Department of Cardiology, Westchester Medical Center & New York Medical College, NY, USA
| | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center & New York Medical College, NY, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, NY, New York, USA
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Klein S, Jiang S, Morey JR, Pai A, Mancini DM, Lala A, Ferket BS. Estimated Health Care Utilization and Expenditures in Individuals With Heart Failure From the Medical Expenditure Panel Survey. Circ Heart Fail 2021; 14:e007763. [PMID: 33980040 DOI: 10.1161/circheartfailure.120.007763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure (HF) constitutes a growing burden for public health and the US health care system. While the prevalence of HF is increasing, differences in health care utilization and expenditures within various sociodemographic groups remain poorly defined. METHODS We used the Medical Expenditure Panel Survey to assess annual health care utilization and expenditures from 2012 to 2017. Health care utilization was based on the annual frequency of various health care encounters. Annual total and out-of-pocket expenditures were evaluated for hospital inpatient stays, emergency room visits, outpatient visits, office-based medical provider visits, prescribed medicines, dental visits, home health aid visits, and other medical expenses. We performed univariable and multivariable regression analysis based on patient characteristics including sociodemographic and comorbidity variables. RESULTS Our results showed that total health care expenditures among patients with HF were $21 177 (95% CI, $18 819-$24 736) per year as compared with $5652 (95% CI, $5469-$5837) in those without HF (P<0.001). Total expenditures within the population with HF were primarily being driven by expenditures associated with inpatient hospitalizations. Increasing number of comorbid conditions was associated with significant increases in total health care expenditures. Older age, female sex, earlier study years, number of comorbidities, higher level of education, and increasing family income brackets independently raised out-of-pocket expenditures. CONCLUSIONS Our findings of increased health care utilization and expenditures based on sex, age, increasing number of comorbidities, wealthier income status, and increased education attainment level may be used for efforts aimed at better distributing health care resources to improve health outcomes in HF.
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Affiliation(s)
- Sharon Klein
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY (S.K.)
| | - Shangqing Jiang
- The Comparative Health Outcomes, Policy and Economics Institute, School of Pharmacy, University of Washington, Seattle, WA (S.J.)
| | - Jacob R Morey
- Department of Population Health Science and Policy (J.R.M, A.P., D.M.M., A.L, B.S.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Akila Pai
- Department of Population Health Science and Policy (J.R.M, A.P., D.M.M., A.L, B.S.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Donna M Mancini
- The Zena and Michael A. Wiener Cardiovascular Institute (D.M.M., A.L.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Population Health Science and Policy (J.R.M, A.P., D.M.M., A.L, B.S.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anuradha Lala
- The Zena and Michael A. Wiener Cardiovascular Institute (D.M.M., A.L.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Population Health Science and Policy (J.R.M, A.P., D.M.M., A.L, B.S.F.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bart S Ferket
- Institute for Healthcare Delivery Science (B.S.F.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Population Health Science and Policy (J.R.M, A.P., D.M.M., A.L, B.S.F.), Icahn School of Medicine at Mount Sinai, New York, NY
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Abstract
PURPOSE This study aimed to measure treatment burden in adults diagnosed with multiple chronic conditions transitioning from a skilled nursing facility to home. DESIGN Prospective, two-time point, cohort design utilizing convenience sampling from one skilled nursing facility in Northeast, Ohio. METHODS Seventy-four men and women participated answering self-report questions measuring treatment burden at two time points: prior to discharge and 30 days after discharge. RESULTS t-test analysis determined treatment burden was not statistically different between time points (p > .05). Multivariate analysis explained 23% of treatment burden's variance, with the severity of multiple chronic conditions and the presence of a caregiver predicting treatment burden (p < .05). CONCLUSION Findings were contrary to our hypothesis of this population being at risk for high treatment burden. CLINICAL RELEVANCE Moderate, fluctuating levels of treatment burden suggest that it is possible to estimate demands of treatment prior to discharge from the skilled nursing facility to better inform discharge planning.
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Hamad AF, Vasylkiv V, Yan L, Sanusi R, Ayilara O, Delaney JA, Wall-Wieler E, Jozani MJ, Hu P, Banerji S, Lix LM. Mapping three versions of the international classification of diseases to categories of chronic conditions. Int J Popul Data Sci 2021; 6:1406. [PMID: 34007901 PMCID: PMC8104065 DOI: 10.23889/ijpds.v6i1.1406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Administrative health data capture diagnoses using the International Classification of Diseases (ICD), which has multiple versions over time. To facilitate longitudinal investigations using these data, we aimed to map diagnoses identified in three ICD versions - ICD-8 with adaptations (ICDA-8), ICD-9 with clinical modifications (ICD-9-CM), and ICD-10 with Canadian adaptations (ICD-10-CA) - to mutually exclusive chronic health condition categories adapted from the open source Clinical Classifications Software (CCS). METHODS We adapted the CCS crosswalk to 3-digit ICD-9-CM codes for chronic conditions and resolved the one-to-many mappings in ICD-9-CM codes. Using this adapted CCS crosswalk as the reference and referring to existing crosswalks between ICD versions, we extended the mapping to ICDA-8 and ICD-10-CA. Each mapping step was conducted independently by two reviewers and discrepancies were resolved by consensus through deliberation and reference to prior research. We report the frequencies, agreement percentages and 95% confidence intervals (CI) from each step. RESULTS We identified 354 3-digit ICD-9-CM codes for chronic conditions. Of those, 77 (22%) codes had one-to-many mappings; 36 (10%) codes were mapped to a single CCS category and 41 (12%) codes were mapped to combined CCS categories. In total, the codes were mapped to 130 adapted CCS categories with an agreement percentage of 92% (95% CI: 86%-98%). Then, 321 3-digit ICDA-8 codes were mapped to CCS categories with an agreement percentage of 92% (95% CI: 89%-95%). Finally, 3583 ICD-10-CA codes were mapped to CCS categories; 111 (3%) had a fair or poor mapping quality; these were reviewed to keep or move to another category (agreement percentage = 77% [95% CI: 69%-85%]). CONCLUSIONS We developed crosswalks for three ICD versions (ICDA-8, ICD-9-CM, and ICD-10-CA) to 130 clinically meaningful categories of chronic health conditions by adapting the CCS classification. These crosswalks will benefit chronic disease studies spanning multiple decades of administrative health data.
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Affiliation(s)
- Amani F. Hamad
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, R3E0T6
| | - Viktoriya Vasylkiv
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, R3E0T6
| | - Lin Yan
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, R3E0T6
| | - Ridwan Sanusi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, R3E0T6
| | - Olawale Ayilara
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, R3E0T6
| | - Joseph A. Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada, R3E0T5; Department of Epidemiology, University of Washington, Seattle, Washington, USA, WA 98195
| | - Elizabeth Wall-Wieler
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, R3E0T6
| | | | - Pingzhao Hu
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada, R3E0J9
| | - Shantanu Banerji
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada, R3A1R9; Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada, R3E0V9
| | - Lisa M. Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, R3E0T6
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Briasoulis A, Ueyama H, Kuno T, Asleh R, Alvarez P, Malik AH. Trends and outcomes of device-related 30-day readmissions after left ventricular assist device implantation. Eur J Intern Med 2021; 84:56-62. [PMID: 33039191 DOI: 10.1016/j.ejim.2020.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Left ventricular assist devices (LVAD) improve morbidity and mortality in end-stage heart failure patients, but high rates of readmissions remain a problem after implantation. We aimed to assess the incidence, trends, outcomes, and predictors of device-related 30-day readmissions after LVAD implantation. METHODS The National Readmission Database was used to identify patients who underwent LVAD implantation between 2012 and 2017 and those with 30-day readmissions. RESULTS The analysis included a total of 16499 adults who survived the index hospitalization for LVAD implantation. Among those, 28.1% were readmitted at 30 days, and the readmission rate has been grossly stable during the study period. Most of the readmissions occurred in the first 15 days after discharge from the index admission. The most frequent cause of readmissions was gastrointestinal bleeding (14.9% of readmissions), followed by heart failure, arrhythmias, device infection, and device thrombosis. Among reasons for readmission, intracranial bleeding was associated with highest mortality (37.6%), followed by device thrombosis (13.1%), and ischemic stroke (7.6%). Intracranial bleeding and device thrombosis were associated with lengthier stay (20.4 and 15.5 days, respectively). Readmission rates for gastrointestinal bleeding decreased, whereas device infection increased. Multivariate logistic regression model revealed the length of stay, oxygen dependence, gastrointestinal bleeding at index admission, depression and ECMO, private insurance as independent predictors of 30-day readmission. CONCLUSION Over one-fourth of LVAD recipients have 30-day readmissions, with most of them occurring within 15 days. Most frequent cause of readmission was gastrointestinal bleeding, which was associated with the lowest in-hospital mortality among other complications.
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Affiliation(s)
- Alexandros Briasoulis
- Division of Cardiovascular medicine, Section of Heart failure and Transplantation, University of Iowa, IA, USA.
| | - Hiroki Ueyama
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - Rabea Asleh
- Division of Cardiovascular medicine, Section of Heart failure and Transplantation, University of Iowa, IA, USA; Department of Cardiology, Hadassah University Medical Center, Jerusalem, Israel
| | | | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center & New York Medical College, NY, USA
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Briasoulis A, Chehab O, Alvarez P. In-hospital Outcomes of Left Ventricular Assist Devices (LVAD) Patients Undergoing Noncardiac Surgery. ASAIO J 2021; 67:144-148. [PMID: 32501823 DOI: 10.1097/mat.0000000000001205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
An increasing number of stage D heart failure patients are supported with left ventricular assist devices (LVADs), and the management of LVAD patients who require noncardiac surgery (NCS) presents unique challenges. Using the 2010-2014 National Inpatient Sample, we identified all adult cases of LVAD patients undergoing noncardiac surgeries using ICD-9-CM codes. We estimated inpatient mortality, bleeding complications, stroke, length of stay (LOS), and cost of hospitalization of the admissions related to NCS using mixed effects logistic and linear mixed regressions, respectively. A total of 30,323 patients with LVADs underwent 3,216 noncardiac surgeries (73.5% urgent) during the study period. LVAD recipients undergoing NCS had higher burden of certain comorbidities such as history of end-stage renal disease, pulmonary circulation disorders, peripheral vascular disease, and obesity. The most frequent NCS were general surgery, which included breast, endocrine, skin/burn, noncardiac transplantation, and abdominal surgeries (47.9%). In-hospital mortality was 7.7% with the highest rates observed among cases of neurologic surgeries. Vascular surgeries had the highest rates of ischemic stroke and gastrointestinal bleeding. Patients who underwent NCS had higher LOS and cost of hospitalization compared with LVAD recipients admitted to reasons other than NCS. Although bleeding complication trends have decreased, ischemic stroke and in-hospital mortality rates have increased overall during the study period. Urgent or emergency surgery was an independent predictor of mortality (OR 3.1, 95% CI 1.9-5). A significant burden of complications occurs after noncardiac surgeries in LVAD recipients.
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Affiliation(s)
- Alexandros Briasoulis
- From the Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Omar Chehab
- Division of Cardiology, Wayne State university/Detroit Medical Center, Detroit, Michigan
| | - Paulino Alvarez
- From the Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Yousif AO, Idris AKM, Awad MM, El-Samani EFZ. Out-of-pocket payments by end-stage kidney disease patients on regular hemodialysis: Cost of illness analysis, experience from Sudan. Hemodial Int 2020; 25:123-130. [PMID: 33145981 DOI: 10.1111/hdi.12895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/21/2020] [Accepted: 09/27/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION In Sudan, the number of end-stage kidney disease (ESKD) patients receiving hemodialysis (HD) is growing. Patients and their families incur a high out-of-pocket expenditure (OOPE), given that HD treatment is expensive. There are limited data about OOP spending on HD in the country. This study aims to explore patients' OOP expense on direct medical and nonmedical goods and services and to which extent they can be predicted from sociodemographic characteristics, health insurance status, comorbidity, and accommodation change. METHODS This is descriptive a cross-sectional study conducted in Ibn Sina Hospital. One hundred and thirty patients undergo regular HD were randomly selected. FINDINGS Among the study participants (130), the median of the overall total OOP (direct medical and direct nonmedical) spending per patients per year was found to be US$ 3859.1 (interquartile range [IQR]: 2298.1-6261.1). As for the medians OOP expenditure on direct medical and nonmedical costs, they were found to be US$ 2327.6 (IQR: 1421.5-3804.8) and US$ 1096 (IQR: 715.2-2345.2), respectively. The direct medical expenditure (355,586 US$) accounted for 60% of the overall total expenses. DISCUSSION Medications and investigations were the primary drivers of direct medical spending. Higher OOPE rates were found among those with one or more of these factors; uninsured patients, patient with comorbidity, female gender, and over 40 years aged. The multivariate analysis showed that the significant predictors of direct medical expenditure were health insurance and comorbid conditions, where as the predictors for direct nonmedical expenditure were accommodation change and gender. This study results in a better understanding of OOP spending on direct medical and nonmedical services and its associated predictors among HD patients within the context of Sudan. Further research is needed in this area.
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Affiliation(s)
- Aisha Osman Yousif
- Directorate General of Quality Development and Accreditation, Federal Ministry of Health, Khartoum, Sudan
| | | | | | - El-Fatih Z El-Samani
- Department of Community Medicine and Epidemiology, Ahfad University for Women, Omdurman, Sudan
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Mayfield CA, Sparling A, Hardeman G, de Hernandez BU, Pasupuleti N, Carr J, Coltman K, Neuwirth Z. Development, Implementation, and Results from a COVID-19 Messaging Campaign to Promote Health Care Seeking Behaviors Among Community Clinic Patients. J Community Health 2020; 46:728-739. [PMID: 33128160 PMCID: PMC7598235 DOI: 10.1007/s10900-020-00939-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2020] [Indexed: 12/02/2022]
Abstract
Care-delays can further exacerbate racial and ethnic health disparities in novel coronavirus disease 2019 (COVID-19) related complications. The purpose of our study was to describe and evaluate a Patient Engagement Messaging campaign (PEM campaign) promoting health care seeking behaviors among community and rural clinic patients in North Carolina. Text and voice messages were delivered over 3-weeks. Messages encouraged patients to call a regional operation call center (ROC) line for information related to health care appointments and testing. A cross-sectional evaluation was conducted on the total population (n = 48,063) and a sample without recent health care contact (n = 29,214). Among the sample, logistic regression was used to model determinants of calls to the ROC-line and associations between calling the ROC-line and health care seeking behaviors (scheduling any health care appointment or receiving a COVID-19 test). 69.9% of text messages and 89% of voice messages were delivered. Overall, 95.4% of the total population received at least 1 message. Successful delivery was lower among Black patients and higher among patients with moderate health-risk comorbidities. Among the sample, 7.4% called the ROC-line, with higher odds of calling among minority patients (vs. White) and among Medicaid and uninsured (vs. private insurance). Calling the ROC-line was associated with higher odds of scheduling any health care appointment (OR: 4.14; 95% CI 2.93–5.80) and receiving a COVID-19 test (OR: 2.39; 95% CI 1.64–3.39). Messaging campaigns may help disconnected patients access health care resources and reduce disparities, but are likely still limited by existing barriers.
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Affiliation(s)
- Carlene A Mayfield
- Department of Community Health, Atrium Health, 4135 South Stream Boulevard, Charlotte, NC, 28217, USA.
| | - Alica Sparling
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC, USA
| | - Grady Hardeman
- Atrium Health Employer Solutions, Atrium Health, Charlotte, NC, USA
| | | | - Nisha Pasupuleti
- Enterprise Population Health, CommonSpirit Health, San Francisco, CA, USA
| | - Jewell Carr
- Department of Family Medicine, Atrium Health, Charlotte, NC, USA
| | - Kinneil Coltman
- Community & External Affairs Division, Atrium Health, Charlotte, NC, USA
| | - Zeev Neuwirth
- Care Transformation Strategy & Transformation Office, Atrium Health, Charlotte, NC, USA
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Tang S, Zhang R, Si Y, Cheng Y, Gong Y. Measurement of the Equality of the Drug Welfare Induction Level of Chinese Patients With Chronic Diseases in Gansu, Sichuan, Hebei, and Zhejiang Based on the Bivariate Theil-T Index Method. Front Public Health 2020; 8:581533. [PMID: 33194987 PMCID: PMC7655781 DOI: 10.3389/fpubh.2020.581533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives: This study aimed to measure the induction level of drug welfare in Chinese patients with chronic diseases using a bivariate Theil index. Design: The bivariate Theil-T index was used to hierarchically decompose the relevant survey data, and the contribution rate of the intragroup gap and the intergroup gap to the total gap was investigated to better understand the current drug welfare induction level of Chinese patients with chronic diseases. Setting: The study was based in Gansu, Sichuan, Hebei, and Zhejiang provinces in China. Participants: Survey data was from patients with chronic diseases in 20 hospitals in four provinces. Primary and secondary outcome measures: Data was collected through a questionnaire designed by the research team after expert consultation. Using the variables represented by the index system to decompose the Theil index from the two dimensions of the region and urban and rural areas. SPSS 22.0 was used for reliability and validity analysis and Theil index calculation. Results: The overall level of drug welfare induction in Chinese patients with chronic diseases had a high degree of equalization. The overall Theil index was 0.0003, but there were still some differences among groups. Conclusions: To improve the drug welfare equalization induction level of patients with chronic diseases in China, the government should start from western rural areas, and policy should target the provinces that were in a disadvantaged position within the region to promote the equalization of drug welfare induction level for patients with chronic diseases in China.
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Affiliation(s)
- Shaoliang Tang
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ruxia Zhang
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yinghang Si
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yan Cheng
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ying Gong
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
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Briasoulis A, Yokoyama Y, Kuno T, Ueyama H, Shetty S, Alvarez P, Malik AΗ. In-Hospital Outcomes of Left Ventricular Assist Device Implantation and Concomitant Valvular Surgery. Am J Cardiol 2020; 132:87-92. [PMID: 32753267 DOI: 10.1016/j.amjcard.2020.06.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
Valvular heart disease is common among left ventricular assist device (LVAD) recipients. However, its management at the time of LVAD implantation remains controversial. Patients who underwent LVAD implantation and concomitant aortic (AVR), mitral (MVR), or tricuspid valve (TVR) repair or replacement from 2010 to 2017 were identified using the national inpatient sample. End points were in-hospital outcomes, length of stay, and cost. Procedure-related complications were identified via ICD-9 and ICD-10 coding and analysis was performed via mixed effect models. A total of 25,171 weighted adults underwent LVAD implantation without valvular surgery, 1,329 had isolated TVR, 1,021 AVR, 377 MVR, and 615 had combined valvular surgery (411 had TVR + AVR, 115 TVR + MVR, 62 AVR + MVR, 25 AVR + MVR + TVR). During the study period, rates of AVR decreased and combined valvular surgeries increased. Patients who underwent TVR or combined valvular surgery had overall higher burden of co-morbidities than LVAD recipients with or without other valvular procedures. Postoperative bleeding was higher with AVR whereas acute kidney injury requiring dialysis was higher with TVR or combined valvular surgery. In-hospital mortality was higher with AVR, MVR, or combined surgery without differences in the rates of stroke. Length of stay did not differ significantly among groups but cost of hospitalization and nonroutine discharge rates were higher for cases of TVR and combined surgery. Approximately 1 in 9 LVAD recipients underwent concomitant valvular surgery and TVR was the most frequently performed procedure. In-hospital mortality and cost were lower among those who did not undergo valvular surgery.
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Aubert CE, Schnipper JL, Fankhauser N, Marques-Vidal P, Stirnemann J, Auerbach AD, Zimlichman E, Kripalani S, Vasilevskis EE, Robinson E, Metlay J, Fletcher GS, Limacher A, Donzé J. Patterns of multimorbidity in medical inpatients: a multinational retrospective cohort study. Intern Emerg Med 2020; 15:1207-1217. [PMID: 32180102 DOI: 10.1007/s11739-020-02306-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/26/2020] [Indexed: 11/27/2022]
Abstract
Multimorbidity is frequent and represents a significant burden for patients and healthcare systems. However, there are limited data on the most common combinations of comorbidities in multimorbid patients. We aimed to describe and quantify the most common combinations of comorbidities in multimorbid medical inpatients. We used a large retrospective cohort of adults discharged from the medical department of 11 hospitals across 3 countries (USA, Switzerland, and Israel) between 2010 and 2011. Diseases were classified into acute versus chronic. Chronic diseases were grouped into clinically meaningful categories of comorbidities. We identified the most prevalent combinations of comorbidities and compared the observed and expected prevalence of the combinations. We assessed the distribution of acute and chronic diseases and the median number of body systems in relationship to the total number of diseases. Eighty-six percent (n = 126,828/147,806) of the patients were multimorbid (≥ 2 chronic diseases), with a median of five chronic diseases; 13% of the patients had ≥ 10 chronic diseases. Among the most frequent combinations of comorbidities, the most prevalent comorbidity was chronic heart disease. Other high prevalent comorbidities included mood disorders, arthropathy and arthritis, and esophageal disorders. The ratio of chronic versus acute diseases was approximately 2:1. Multimorbidity affected almost 90% of patients, with a median of five chronic diseases. Over 10% had ≥ 10 chronic diseases. This identification and quantification of frequent combinations of comorbidities among multimorbid medical inpatients may increase awareness of what should be taken into account when treating such patients, a growth in the need for special care considerations.
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Affiliation(s)
- Carole Elodie Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Jeffrey Lawrence Schnipper
- BWH Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Niklaus Fankhauser
- CTU Bern, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Pedro Marques-Vidal
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jérôme Stirnemann
- Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | | | | | - Sunil Kripalani
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, TN, USA
| | - Eduard Eric Vasilevskis
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research Education and Clinical Center, VA Tennessee Valley, Nashville, TN, USA
| | | | - Joshua Metlay
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, USA
| | - Grant Selmer Fletcher
- Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Andreas Limacher
- CTU Bern, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Department of Internal Medicine, Hôpital neuchâtelois, Neuchâtel, Switzerland
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Abstract
BACKGROUND Little is known about the impact of multimorbidity in childhood atopic dermatitis (AD). OBJECTIVE We sought to determine the likelihood and predictors of chronic disease multimorbidity in childhood AD. METHODS Data were examined for children (<18 years) in the 1996-2015 Medical Expenditure Panel Survey, an annual, representative sample of United States households. Multimorbidity was assessed using Charlson Comorbidity Index (CCI), Healthcare Utilization Project Chronic Comorbidity Indicator (HCUP-CCI) and frequency of atopic comorbidities. RESULTS Young children with mild-moderate and severe AD, and adolescents with mild-moderate AD had higher CCI scores. Similarly, young children and adolescents with mild-moderate and severe AD had increased HCUP-CCI scores. Children with AD and atopic disease had higher CCI and HCUP-CCI scores than children with either alone. Young children and adolescents with mild-moderate and severe AD had more atopic comorbidities. CONCLUSIONS Pediatric AD is associated with increased atopic and non-atopic multimorbidity. Comorbid atopic disease may identify a subset of children with AD who particularly benefit from enhanced screening and management of multimorbidity.
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Dallmeyer S, Wicker P, Breuer C. The relationship between physical activity and out-of-pocket health care costs of the elderly in Europe. Eur J Public Health 2020; 30:628-632. [PMID: 32155251 DOI: 10.1093/eurpub/ckaa045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Increasing health care costs represent an economic burden placed on individuals across many European countries. Against this backdrop, the aim of this study was to examine the relationship between participation in physical activity and out-of-pocket health care costs in Europe. METHODS Individual data from the cross-national Survey of Health, Ageing and Retirement (n = 94 267) including 16 European countries were utilized. Two-part models were estimated to investigate how different levels of participation frequency in physical activity are related to out-of-pocket costs (OOPC) for people aged 50 years and older. RESULTS Only participation in physical activity more than once a week significantly decreases the probability of incurring any OOPC. However, all frequencies of physical activity significantly reduce the level of costs, with the highest savings being generated by participation once a week. The results reveal higher savings for men compared to women. CONCLUSION Physical activity can be a useful policy instrument to reduce the economic burden of out-of-pocket health care costs for an aging population in Europe. Public officials should primarily promote physical activity interventions targeting older people who are not active at all.
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Affiliation(s)
- Sören Dallmeyer
- Department of Sport Economics and Sport Management, German Sport University Cologne, Cologne, Germany
| | - Pamela Wicker
- Department of Sports Sciences, Bielefeld University, Bielefeld, Germany
| | - Christoph Breuer
- Department of Sport Economics and Sport Management, German Sport University Cologne, Cologne, Germany
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van Schelven F, Boeije H, Mariën V, Rademakers J. Patient and Public Involvement of young people with a chronic condition in projects in health and social care: A scoping review. Health Expect 2020; 23:789-801. [PMID: 32372423 PMCID: PMC7495073 DOI: 10.1111/hex.13069] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/18/2020] [Accepted: 04/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The involvement of young people with a chronic condition in research and implementation projects in health and social care receives growing attention. Yet, there is a lack of conceptual clarity of this so-called 'Patient and Public Involvement' (PPI) and methods to systematically evaluate it are absent. This scoping review aimed to gain insight into developments in the existing literature on PPI of young people with a chronic condition by mapping reported definitions, goals, activities, experiences and impact. METHODS We conducted searches in Cinahl, Embase, PsycINFO, PubMed and Scopus. Included articles described involvement of young people with a chronic condition in research and implementation projects, contained empirical data, were written in English and were published after 1990. Two researchers independently carried out the data extraction. RESULTS Twenty-three studies out of 4993 initial hits met the inclusion criteria. We found great variation in definitions and operationalizations of PPI. Reflections of authors on the process of PPI and its impact were similar and did not change over the years. DISCUSSION AND CONCLUSION Limited progress in the evidence base of the impact of PPI with young people with a chronic condition was found. Over the years, studies continue to report similar experiences and challenges. In order to move forward, we suggest future research to make connections to existing work instead, to include thorough descriptions of what is understood by PPI and how this is translated into activities, and to use systematic and objective, but also flexible, methods to measure its impact.
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Affiliation(s)
- Femke van Schelven
- Netherlands Institute for Health Services ResearchUtrechtThe Netherlands
| | - Hennie Boeije
- Netherlands Institute for Health Services ResearchUtrechtThe Netherlands
| | - Veerle Mariën
- Netherlands Institute for Health Services ResearchUtrechtThe Netherlands
| | - Jany Rademakers
- Netherlands Institute for Health Services ResearchUtrechtThe Netherlands
- Department of Family MedicineCare and Public Health Research Institute (CAPHRI)Maastricht UniversityMaastrichtThe Netherlands
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Ueyama H, Malik A, Kuno T, Yokoyama Y, Briasouli A, Shetty S, Briasoulis A. Racial disparities in in-hospital outcomes after left ventricular assist device implantation. J Card Surg 2020; 35:2633-2639. [PMID: 32667085 DOI: 10.1111/jocs.14859] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies of patients undergoing various cardiac surgeries demonstrated worse outcomes among African-American (AA) patients. It remains unclear if the race is a predictor of outcomes among left ventricular assist device (LVAD) recipients. METHODS Patients who underwent LVAD implantation between 2010 and 2017 were identified using the National Inpatient Sample. The race was classified as Caucasians vs AA vs Hispanics, and endpoints were in-hospital outcomes, length of stay, and cost. Procedure-related complications were identified via the International Classification of Diseases-9 (ICD-9) and ICD-10 coding and analysis performed via mixed-effect models. RESULTS A total of 27 132 adults (5114 unweighted) underwent LVAD implantation in the U.S. between 2010 and 2017, including Caucasians (63.8%), AA (23.8%), and Hispanics (6%). The number of LVAD implantations increased in both Caucasians and AA during the study period. AA LVAD recipients were younger, with higher rates of females and mostly comorbidities, but lower rates of coronary artery disease and bypass grafting compared to Caucasians and Hispanics. Medicaid and median income at the lowest quartile were more frequent among AA LVAD recipients. We did not identify differences in stroke, bleeding complications, tamponade, infectious complications, acute kidney injury requiring hemodialysis, and in-hospital mortality among racial groups. AA LVAD recipients had lower rates of routine discharge than Caucasians and Hispanics, longer length of stay than Caucasians, but similar cost of hospitalization. After adjustment for clinical comorbidities, race was not a predictor of in-hospital mortality. CONCLUSION We identified differences in clinical characteristics but not in in-hospital complications among LVAD recipients of a different races.
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Affiliation(s)
- Hiroki Ueyama
- Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel, New York City, New York
| | - Aaqib Malik
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine, Mount Sinai Beth Israel, New York City, New York
| | - Yujiro Yokoyama
- Department of Surgery, Easton Hospital, Easton, Pennsylvania
| | - Artemis Briasouli
- Section of Heart Failure and Transplantation, Division of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
| | - Suchith Shetty
- Section of Heart Failure and Transplantation, Division of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
| | - Alexandros Briasoulis
- Section of Heart Failure and Transplantation, Division of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
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