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Kang HJ, Kim JW, Kim SW, Kim JT, Park MS, Kim MC, Ahn Y, Jeong MH, Kim JM. Association of life stressors and suicidal ideation with long-term outcomes in patients with acute coronary syndrome and stroke. Gen Hosp Psychiatry 2025; 93:32-39. [PMID: 39818126 DOI: 10.1016/j.genhosppsych.2025.01.004] [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: 10/24/2024] [Revised: 12/25/2024] [Accepted: 01/07/2025] [Indexed: 01/18/2025]
Abstract
BACKGROUND Life stressors are recognized as risk factors for the onset and prognosis of cardio-cerebrovascular events; however few studies have investigated the combined effect of life stressors and suicidal ideation (SI) on the long-term prognosis of patients with cardio- or cerebrovascular diseases. METHODS A total of 1152 acute coronary syndrome (ACS) patients and 396 stroke patients were recruited from a tertiary university hospital in Korea at two weeks post-disease onset. Life stressors were assessed using the List of Threatening Events Questionnaire, and SI was evaluated using the "suicidal thoughts" item of the Montgomery-Åsberg Depression Rating Scale. Long-term outcomes were examined, with major adverse cardiac event (MACE) assessed over 5-12 years following ACS, and cerebro-cardiovascular events (CCVEs) assessed over 8-14 years following stroke. Cox regression models, adjusted for a range of covariates affecting life stressor, SI and long-term outcomes, were employed. RESULTS In two independent cohorts, consistent associations were observed between life stressors and long-term outcomes. Life stressors were significantly associated with poor long-term composite outcomes, including MACE in ACS patients and CCVEs in stroke patients, particularly among those with SI at two weeks post-ACS or stroke. A significant interactive effect between life stressors and SI was observed only in ACS patients after adjustment for covariates. CONCLUSIONS Evaluating life stressors and SI during acute phase of cardio-cerebrovascular events can help identify high-risk patients for poor long-term cardio-cerebrovascular outcomes, enabling the implementation of intensive management strategies.
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Affiliation(s)
- Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Min-Chul Kim
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.
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Samuel LJ, Abshire Saylor M, Choe MY, Smith Wright R, Kim B, Nkimbeng M, Mena-Carrasco F, Beak J, Szanton SL. Financial strain measures and associations with adult health: A systematic literature review. Soc Sci Med 2025; 364:117531. [PMID: 39591796 DOI: 10.1016/j.socscimed.2024.117531] [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: 05/14/2024] [Revised: 10/01/2024] [Accepted: 11/18/2024] [Indexed: 11/28/2024]
Abstract
Despite growing attention to other social needs like food and housing insecurity, financial strain, defined as having difficulty making ends meet or lacking money for basic needs, is under-recognized. Inconsistent labels and measures have made the literature difficult to unify. We used many synonyms for financial strain to systematically identify 199 U.S. studies (316 papers) that used financial strain measures that were operationally consistent with our definition as predictors of health among adults. We thematically coded financial strain measures for content and synthesized evidence based on measure and methods. Financial strain was measured by self-reported lacking money for basic needs (119 studies) and/or difficulty making ends meet (n = 132), and less commonly additionally based on coping strategies (n = 23), satisfaction with finances (n = 14), worry about finances (n = 22), the anticipation of strain (n = 14), and/or lacking money for leisure (n = 29). Regardless of measure, financial strain was associated with poorer mental, physical, biological, and functional health, worse health behaviors and more social needs. Associations were found across diverse and population-based samples and when accounting for other socioeconomic factors and even intermediating health factors. Results demonstrate predictive validity for two different one-item screening tools. Furthermore, the vast evidence linking financial strain to health highlights an urgent need for policy action addressing financial strain to advance health equity.
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Affiliation(s)
- Laura J Samuel
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | | | - Monica Y Choe
- Veterans Affairs Maryland Health Care System, Division of Endocrinology, Baltimore, MD, USA.
| | | | - Boeun Kim
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Manka Nkimbeng
- University of Minnesota School of Public Health, Minneapolis, MN, USA.
| | | | - Jieun Beak
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Kostick-Quenet K, Kalwani L, Torgerson L, Muñoz K, Sanchez C, Storch EA, Blumenthal-Barby J, Lázaro-Muñoz G. Deep Brain Stimulation for Pediatric Dystonia: Clinicians' Perspectives on the Most Pressing Ethical Challenges. Stereotact Funct Neurosurg 2023; 101:301-313. [PMID: 37844562 PMCID: PMC10586720 DOI: 10.1159/000530694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/30/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Pediatric deep brain stimulation (pDBS) is commonly used to manage treatment-resistant primary dystonias with favorable results and more frequently used for secondary dystonia to improve quality of life. There has been little systematic empirical neuroethics research to identify ethical challenges and potential solutions to ensure responsible use of DBS in pediatric populations. METHODS Clinicians (n = 29) who care for minors with treatment-resistant dystonia were interviewed for their perspectives on the most pressing ethical issues in pDBS. RESULTS Using thematic content analysis to explore salient themes, clinicians identified four pressing concerns: (1) uncertainty about risks and benefits of pDBS (22/29; 72%) that poses a challenge to informed decision-making; (2) ethically navigating decision-making roles (15/29; 52%), including how best to integrate perspectives from diverse stakeholders (patient, caregiver, clinician) and how to manage surrogate decisions on behalf of pediatric patients with limited capacity to make autonomous decisions; (3) information scarcity effects on informed consent and decision quality (15/29; 52%) in the context of patient and caregivers' expectations for treatment; and (4) narrow regulatory status and access (7/29; 24%) such as the lack of FDA-approved indications that contribute to decision-making uncertainty and liability and potentially limit access to DBS among patients who may benefit from it. CONCLUSION These results suggest that clinicians are primarily concerned about ethical limitations of making difficult decisions in the absence of informational, regulatory, and financial supports. We discuss two solutions already underway, including supported decision-making to address uncertainty and further data sharing to enhance clinical knowledge and discovery.
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Affiliation(s)
- Kristin Kostick-Quenet
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Lavina Kalwani
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Laura Torgerson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Katrina Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Clarissa Sanchez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Gabriel Lázaro-Muñoz
- Center for Bioethics, Harvard Medical School, Cambridge, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Adinkrah E, Najand B, Rahmani A, Maharlouei N, Ekwegh T, Cobb S, Zare H. Social Determinants of Mental, Physical, and Oral Health of Middle-Aged and Older African Americans in South Los Angeles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16765. [PMID: 36554645 PMCID: PMC9779480 DOI: 10.3390/ijerph192416765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND A growing body of research suggests that financial difficulties could weaken the protective effects of socioeconomic status (SES) indicators, including education and income, on the health status of marginalized communities, such as African Americans. AIM We investigated the separate and joint effects of education, income, and financial difficulties on mental, physical, and oral self-rated health (SRH) outcomes in African American middle-aged and older adults. METHODS This cross-sectional study enrolled 150 middle-aged and older African Americans residing in South Los Angeles. Data on demographic factors (age and gender), socioeconomic characteristics (education, income, and financial difficulties), and self-rated health (mental, physical, and oral health) were collected. Three linear regression models were used to analyze the data. RESULTS Higher education and income were associated with a lower level of financial strain in a bivariate analysis. However, according to multivariable models, only financial difficulties were associated with poor mental, physical, and oral health. As similar patterns emerged for all three health outcomes, the risk associated with financial difficulties seems robust. CONCLUSIONS According to our multivariable models, financial strain is a more salient social determinant of health within African American communities than education and income in economically constrained urban environments such as South Los Angeles. While education and income lose some protective effects, financial strain continues to deteriorate the health of African American communities across domains.
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Affiliation(s)
- Edward Adinkrah
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Babak Najand
- Marginalization-Related Diminished Returns (MDRs) Center, Los Angeles, CA 90059, USA
| | - Arash Rahmani
- Marginalization-Related Diminished Returns (MDRs) Center, Los Angeles, CA 90059, USA
| | - Najmeh Maharlouei
- Marginalization-Related Diminished Returns (MDRs) Center, Los Angeles, CA 90059, USA
| | - Tavonia Ekwegh
- Mervyn M. Dymally School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Sharon Cobb
- Mervyn M. Dymally School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- School of Business, University of Maryland Global Campus (UMGC), Adelphi, Garden City, NY 20783, USA
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Malik AO, Jones PG, Mena-Hurtado C, Burg MM, Shishehbor MH, Hejjaji V, Tran A, Spertus JA, Smolderen KG. Derivation and validation of a predictive model for chronic stress in patients with cardiovascular disease. PLoS One 2022; 17:e0275729. [PMID: 36256655 PMCID: PMC9578618 DOI: 10.1371/journal.pone.0275729] [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: 04/19/2021] [Accepted: 09/22/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Chronic stress in patients with cardiovascular disease (CVD), including peripheral artery disease (PAD), is independently associated worse outcomes. A model that can reliably identify factors associated with risk of chronic stress in patients with CVD is needed. METHODS In a prospective myocardial infarction (MI) registry (TRIUMPH), we constructed a logistic regression model using 27 patient demographic, socioeconomic, and clinical factors, adjusting for site, to identify predictors of chronic stress over 1 year. Stress at baseline and at 1-, 6- and 12-month follow-up was measured using the 4-item Perceived Stress Scale (PSS-4) [range 0-16, scores ≥6 depicting high stress]. Chronic stress was defined as at least 2 follow-up PSS-4 scores ≥6. We identified and validated this final model in another prospective registry of patients with symptomatic PAD, the PORTRAIT study. RESULTS Our derivation cohort consisted of 4,340 patients with MI (mean age 59.1 ± 12.3 years, 33% females, 30% non-white), of whom 30% had chronic stress at follow-up. Of the 27 factors examined, female sex, current smoking, socioeconomic status, and economic burden due to medical care were positively associated with chronic stress, and ENRICHD Social Support Instrument (ESSI) score and age were inversely related to chronic stress. In the validation cohort of 797 PAD patients (mean age 68.6±9.7 years, 42% females, 28% non-white, 18% chronic stress) the c-statistic for the model was 0.77 and calibration was excellent. CONCLUSIONS We can reliably identify factors that are independently associated with risk of chronic stress in patients with CVD. As chronic stress is associated with worse outcomes in this population, our work identifies potential targets for interventions to as well as the patients that could benefit from these.
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Affiliation(s)
- Ali O. Malik
- Saint Luke’s’ Mid America Heart Institute, Kansas City, MO, United States of America
- University of Missouri Kansas City, Kansas City, MO, United States of America
| | - Philip G. Jones
- Saint Luke’s’ Mid America Heart Institute, Kansas City, MO, United States of America
- University of Missouri Kansas City, Kansas City, MO, United States of America
| | | | - Matthew M. Burg
- Yale School of Medicine, New Haven, CO, United States of America
| | | | - Vittal Hejjaji
- Saint Luke’s’ Mid America Heart Institute, Kansas City, MO, United States of America
- University of Missouri Kansas City, Kansas City, MO, United States of America
| | - Andy Tran
- Saint Luke’s’ Mid America Heart Institute, Kansas City, MO, United States of America
- University of Missouri Kansas City, Kansas City, MO, United States of America
| | - John A. Spertus
- Saint Luke’s’ Mid America Heart Institute, Kansas City, MO, United States of America
- University of Missouri Kansas City, Kansas City, MO, United States of America
| | - Kim G. Smolderen
- Yale School of Medicine, New Haven, CO, United States of America
- * E-mail:
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Severe Mental Illness and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:918-933. [PMID: 36007991 DOI: 10.1016/j.jacc.2022.06.017] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022]
Abstract
People with severe mental illness, consisting of schizophrenia, bipolar disorder, and major depression, have a high burden of modifiable cardiovascular risk behaviors and conditions and have a cardiovascular mortality rate twice that of the general population. People with acute and chronic cardiovascular disease are at a higher risk of developing mental health symptoms and disease. There is emerging evidence for shared etiological factors between severe mental illness and cardiovascular disease that includes biological, genetic, and behavioral mechanisms. This state-of-the art review will describe the relationship between severe mental illness and cardiovascular disease, explore the factors that lead to poor cardiovascular outcomes in people with severe mental illness, propose strategies to improve the cardiovascular health of people with severe mental illness, and present areas for future research focus.
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Sasko B, Jaehn P, Müller R, Andresen H, Müters S, Holmberg C, Ritter O, Pagonas N. Understanding the importance of social determinants and rurality for the long-term outcome after acute myocardial infarction: study protocol for a single-centre cohort study. BMJ Open 2022; 12:e056888. [PMID: 35428636 PMCID: PMC9013987 DOI: 10.1136/bmjopen-2021-056888] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Acute myocardial infarction (AMI) is a major public health issue in Germany with considerable regional differences in morbidity and mortality. Possible reasons for regional differences include a higher prevalence of cardiovascular risk factors, infrastructural deficits, different levels of healthcare quality or social determinants. We aim to study associations of social determinants and of rural infrastructure with the quality of medical care (eg, time to reperfusion or medication adherence) and on the long-term outcome after myocardial infarction. METHODS AND ANALYSIS We will employ a prospective cohort study design. Patients who are admitted with AMI will be invited to participate. We aim to recruit a total of 1000 participants over the course of 5 years. Information on outpatient care prior to AMI, acute healthcare of AMI, healthcare-related environmental factors and social determinants will be collected. Baseline data will be assessed in interviews and from the electronic data system of the hospital. Follow-up will be conducted after an observation period of 1 year via patient interviews. The outcomes of interest are cardiac and all-cause mortality, changes in quality of life, changes in health status of heart failure, major adverse cardiovascular events and participation in rehabilitation programmes. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethics Committee of Brandenburg Medical School (reference: E-01-20200923). Research findings will be disseminated and shared in different ways and include presenting at international and national conferences, publishing in peer-reviewed journals and facilitating dissemination workshops within local communities with patients and healthcare professionals. TRIALS REGISTRATION NUMBER DRKS00024463.
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Affiliation(s)
- Benjamin Sasko
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Philipp Jaehn
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Rhea Müller
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Henrike Andresen
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Stephan Müters
- Department of Epidemiology and Health Monitoring, Robert Koch Institut, Berlin, Germany
| | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Oliver Ritter
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Nikolaos Pagonas
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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Kotwal AA, Barnes DE, Volow A, Li B, Boscardin J, Sudore RL. Engaging Diverse Older Adults With Cognitive Impairment and Caregivers in Advance Care Planning: A Pilot Study of the Interactive PREPARE Website. Alzheimer Dis Assoc Disord 2021; 35:342-349. [PMID: 34310443 PMCID: PMC8604734 DOI: 10.1097/wad.0000000000000465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/05/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Engaging patients with cognitive impairment in advance care planning (ACP), including completing advance directives and naming health care proxies, before they lose decision-making capacity is important. METHODS We determined the feasibility of the PREPAREforYourCare.org ACP program among 20 diverse older adults with mild-to-moderate cognitive impairment and their caregivers in a 1-week, pre-post pilot. We examined ease-of-use, satisfaction, and feasibility using validated scales, and change in ACP Engagement scores, including knowledge, contemplation, self-efficacy, and readiness subscales (5-point scales), from baseline to 1-week. RESULTS Participants were on average 70 years old (SD=9.0), 45% Spanish-speaking, 60% had limited health literacy, and 15% felt comfortable using the internet. Patients and caregivers rated PREPARE a mean of 8.6 (SD=1.6) and 9.4 (SD=1.1) on the 10-point ease-of-use scale, 4.7 (SD=0.4) and 4.7 (SD=0.3) on the 5-point satisfaction scale, and 4.9 (SD=0.4) and 4.8 (SD=0.6) on the 5-point feasibility scale, respectively. ACP engagement scores increased for 16 of 20 (80%) patients (P=0.03) and 16 of 20 (80%) caregivers (P=0.18). Caregivers experienced increased knowledge (3.8 to 4.7, P=0.002) and self-efficacy (3.6 to 4.5, P=0.034) for ACP. DISCUSSION The PREPARE website was feasible and may facilitate ACP engagement among diverse older adults with cognitive impairment and their caregivers.
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Affiliation(s)
- Ashwin A. Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical, San Francisco, CA, USA
| | - Deborah E. Barnes
- Weill Institute for Neurosciences, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Aiesha Volow
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical, San Francisco, CA, USA
| | - Brookelle Li
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical, San Francisco, CA, USA
| | - John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical, San Francisco, CA, USA
| | - Rebecca L. Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical, San Francisco, CA, USA
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Kotwal AA, Holt-Lunstad J, Newmark RL, Cenzer I, Smith AK, Covinsky KE, Escueta DP, Lee JM, Perissinotto CM. Social Isolation and Loneliness Among San Francisco Bay Area Older Adults During the COVID-19 Shelter-in-Place Orders. J Am Geriatr Soc 2020; 69:20-29. [PMID: 32965024 PMCID: PMC7536935 DOI: 10.1111/jgs.16865] [Citation(s) in RCA: 223] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES Physical distancing during the COVID‐19 pandemic may have unintended, detrimental effects on social isolation and loneliness among older adults. Our objectives were to investigate (1) experiences of social isolation and loneliness during shelter‐in‐place orders, and (2) unmet health needs related to changes in social interactions. DESIGN Mixed‐methods longitudinal phone‐based survey administered every 2 weeks. SETTING Two community sites and an academic geriatrics outpatient clinical practice. PARTICIPANTS A total of 151 community‐dwelling older adults. MEASUREMENTS We measured social isolation using a six‐item modified Duke Social Support Index, social interaction subscale, that included assessments of video‐based and Internet‐based socializing. Measures of loneliness included self‐reported worsened loneliness due to the COVID‐19 pandemic and loneliness severity based on the three‐item University of California, Los Angeles (UCLA) Loneliness Scale. Participants were invited to share open‐ended comments about their social experiences. RESULTS Participants were on average aged 75 years (standard deviation = 10), 50% had hearing or vision impairment, 64% lived alone, and 26% had difficulty bathing. Participants reported social isolation in 40% of interviews, 76% reported minimal video‐based socializing, and 42% minimal Internet‐based socializing. Socially isolated participants reported difficulty finding help with functional needs including bathing (20% vs 55%; P = .04). More than half (54%) of the participants reported worsened loneliness due to COVID‐19 that was associated with worsened depression (62% vs 9%; P < .001) and anxiety (57% vs 9%; P < .001). Rates of loneliness improved on average by time since shelter‐in‐place orders (4–6 weeks: 46% vs 13–15 weeks: 27%; P = .009), however, loneliness persisted or worsened for a subgroup of participants. Open‐ended responses revealed challenges faced by the subgroup experiencing persistent loneliness including poor emotional coping and discomfort with new technologies. CONCLUSION Many older adults are adjusting to COVID‐19 restrictions since the start of shelter‐in‐place orders. Additional steps are critically needed to address the psychological suffering and unmet medical needs of those with persistent loneliness or barriers to technology‐based social interaction.
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Affiliation(s)
- Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | | | - Rebecca L Newmark
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Irena Cenzer
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, , California, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Kenneth E Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Danielle P Escueta
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Jina M Lee
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Carla M Perissinotto
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
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10
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Chou SC, Hong AS, Weiner SG, Wharam JF. High-deductible health plans and low-value imaging in the emergency department. Health Serv Res 2020; 56:709-720. [PMID: 33025604 DOI: 10.1111/1475-6773.13569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To examine the effect of an employer-mandated switch to high-deductible health plans (HDHP) on emergency department (ED) low-value imaging. DATA SOURCES Claims data of a large national insurer between 2003 and 2014. STUDY DESIGN Difference-in-differences analysis with matched control groups. DATA COLLECTION/EXTRACTION METHODS The primary outcome is low-value imaging during ED visits for syncope, headache, or low back pain. We included members aged 19-63 years whose employers offered only low-deductible (≤$500) plans for one (baseline) year and, in the next (follow-up) year, offered only HDHPs (≥$1000). Contemporaneous members whose employers offered only low-deductible plans for two consecutive years served as controls. The groups were matched by person and employer propensity for HDHP switch, employer size, baseline calendar year, and baseline year quarterly number of total and imaged ED visits for each condition. We modeled the visit-level probability of low-value imaging using multivariable logistic regression with member-clustered standard errors. We also calculated population level monthly cumulative ED visit rates and modeled their trends using generalized linear regression adjusting for serial autocorrelation. PRINCIPAL FINDINGS After matching, we included 524 998 members in the HDHP group and 5 448 803 in the control group with a mean age of approximately 42 years and 48% female in both groups. On visit-level analyses, there were no significant differential changes in the probability of low-value imaging use in the HDHP and control groups. In population-level analyses, compared with control group members, members who switched to HDHPs experienced a relative decrease of 5.9% (95% CI - 10.3, -1.6) in ED visits for the study conditions and a relative decrease of 5.1% (95%CI -9.6, -0.6) in the subset of ED visits with low-value imaging. CONCLUSION Though HDHP switches decreased ED utilization, they had no significant effect on low-value imaging use after patients have decided to seek ED care.
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Affiliation(s)
- Shih-Chuan Chou
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Arthur S Hong
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Scott G Weiner
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J Frank Wharam
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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11
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Muñoz KA, Blumenthal-Barby J, Storch EA, Torgerson L, Lázaro-Muñoz G. Pediatric Deep Brain Stimulation for Dystonia: Current State and Ethical Considerations. Camb Q Healthc Ethics 2020; 29:557-573. [PMID: 32892777 PMCID: PMC9426302 DOI: 10.1017/s0963180120000316] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Dystonia is a movement disorder that can have a debilitating impact on motor functions and quality of life. There are 250,000 cases in the United States, most with childhood onset. Due to the limited effectiveness and side effects of available treatments, pediatric deep brain stimulation (pDBS) has emerged as an intervention for refractory dystonia. However, there is limited clinical and neuroethics research in this area of clinical practice. This paper examines whether it is ethically justified to offer pDBS to children with refractory dystonia. Given the favorable risk-benefit profile, it is concluded that offering pDBS is ethically justified for certain etiologies of dystonia, but it is less clear for others. In addition, various ethical and policy concerns are discussed, which need to be addressed to optimize the practice of offering pDBS for dystonia. Strategies are proposed to help address these concerns as pDBS continues to expand.
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Affiliation(s)
- Katrina A. Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
| | | | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Laura Torgerson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
| | - Gabriel Lázaro-Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
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12
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Assari S, Cobb S, Saqib M, Bazargan M. Economic Strain Deteriorates While Education Fails to Protect Black Older Adults Against Depressive Symptoms, Pain, Self-rated Health, Chronic Disease, and Sick Days. ACTA ACUST UNITED AC 2020; 4:49-62. [PMID: 32724902 DOI: 10.29245/2578-2959/2020/2.1203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background A large body of empirical evidence on Minorities' Diminished Returns (MDRs) suggests that educational attainment shows smaller health effects for Blacks compared to Whites. At the same time, economic strain may operate as a risk factor for a wide range of undesired mental and physical health outcomes in Black communities. Aim The current study investigated the combined effects of education and economic strain on the following five health outcomes in Black older adults in underserved areas of South Los Angeles: depressive symptoms, number of chronic diseases, pain intensity, self-rated health, and sick days. Methods This cross-sectional study included 619 Black older adults residing in South Los Angeles. Data on demographic factors (age and gender), socioeconomic characteristics, economic strain, health insurance, living arrangement, marital status, health behaviors, depressive symptoms, pain intensity, number of chronic diseases, sick days, and self-rated health were collected. Five linear regressions were used to analyze the data. Results Although high education was associated with less economic strain, it was the economic strain, not educational attainment, which was universally associated with depressive symptoms, pain intensity, self-rated health, chronic diseases, and sick days, independent of covariates. Similar patterns emerged for all health outcomes suggesting that the risk associated with economic strain and lack of health gain due to educational attainment are both robust and independent of type of health outcome. Conclusion In economically constrained urban environments, economic strain is a more salient social determinant of health of Black older adults than educational attainment. While education loses some of its protective effects, economic strain deteriorates health of Black population across domains. There is a need for bold economic and social policies that increase access of Black communities to cash at times of emergency. There is also a need to improve the education quality in the Black communities.
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Affiliation(s)
- Shervin Assari
- Departments of Family Medicine, Charles R Drew University of Medicine and Science
| | - Sharon Cobb
- School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Mohammed Saqib
- University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Mohsen Bazargan
- Departments of Family Medicine, Charles R Drew University of Medicine and Science.,Departments of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
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13
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Bahall M, Legall G, Khan K. Quality of life among patients with cardiac disease: the impact of comorbid depression. Health Qual Life Outcomes 2020; 18:189. [PMID: 32552773 PMCID: PMC7302374 DOI: 10.1186/s12955-020-01433-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with cardiac disease with or without depression may also have major physical and mental problems. This study assesses and compares the quality of life (QOL) of patients with cardiac disease with and without depression and accompanying comorbidities. METHODS A cross-sectional study was conducted with a convenience sample of 388 patients with cardiac disease. The 12-item Short-Form (SF-12)-patient was used to measure physical component scale (PCS) and mental component scale (MCS) QOL, and the Patient Health Questionnaire (PHQ-9) was used to measure depression. The Charlson Comorbidity Index was used to estimate 10-year survival probability. Descriptive statistics, analysis of covariance (ANCOVA), chi-square tests, and binary logistic regression were used for analysis. RESULTS The prevalence of minimal to mild depression was 65.7% [(95% CI (60.8, 70.4)] and that of moderate to severe depression was 34.3% [95% CI (29.6, 39.2)]. There was no significant association between the level of PHQ-categorised depression and age (p = 0.171), sex (p = 0.079), or ethnicity (p = 0.407). The overall mean PCS and MCS QOL was 32.5 [95% CI (24.4, 40.64)] and 45.4 [95% CI (44.4, 46.4)], respectively, with no significant correlation between PCS and MCS [r (Pearson's) = 0.011; p = 0.830)]. There were QOL differences among the five PHQ categories (PCS: p = 0.028; MCS: p ≤ 0.001) with both MCS and PCS decreasing with increasing depression. ANCOVA (with number of comorbidities as the covariate) showed a significant age × ethnicity interaction for PCS (p = 0.044) and MCS (p = 0.039), respectively. Young Indo-Trinidadians had significantly lower PCS than did Afro-Trinidadians, while the converse was true for MCS. Depression, age, and number of comorbidities were predictors of PCS, while depression, age, and sex were predictors of MCS. CONCLUSIONS Increasing severity of depression worsened both PCS and MCS QOL. Age and level of clinical depression predicted QOL, with number of comorbidities predicting only PCS and sex predicting only MCS. Efforts must be made to treat depression in all age groups of patients with cardiac disease.
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Affiliation(s)
- Mandreker Bahall
- School of Medicine, Faculty of Medical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Mt Hope, House #57 LP 62, Calcutta Road Number 3, Mc Bean, Couva, Trinidad, Trinidad and Tobago.
| | - George Legall
- School of Medicine, Faculty of Medical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Mt Hope, House #57 LP 62, Calcutta Road Number 3, Mc Bean, Couva, Trinidad, Trinidad and Tobago
| | - Katija Khan
- School of Medicine, Faculty of Medical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Mt Hope, House #57 LP 62, Calcutta Road Number 3, Mc Bean, Couva, Trinidad, Trinidad and Tobago
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14
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Assari S, Smith JL, Saqib M, Bazargan M. Binge Drinking among Economically Disadvantaged African American Older Adults with Diabetes. Behav Sci (Basel) 2019; 9:bs9090097. [PMID: 31514373 PMCID: PMC6769764 DOI: 10.3390/bs9090097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 01/02/2023] Open
Abstract
Purpose. This study investigated the effect of demographic, socioeconomic, and psychological factors as well as the role of health determinants on alcohol consumption and binge drinking among economically disadvantaged African American older adults with type 2 diabetes mellites (T2DM). Methods. This survey recruited 231 African Americans who were older adults (age 65+ years) and had T2DM. Participants were selected from economically disadvantaged areas of South Los Angeles. A structured face-to-face interview was conducted to collect data on demographic factors, objective and subjective socioeconomic status (SES) including education and financial difficulty, living arrangement, marital status, health, and drinking behaviors (drinking and binge drinking). Results. Age, gender, living alone, pain, comorbid conditions, and smoking were associated with drinking/binge drinking. Male gender, pain, and being a smoker were associated with higher odds of drinking/binge drinking, while individuals with more comorbid medical conditions had lower odds of binge drinking. Conclusion. In economically constrained urban environments, gender, pain, and smoking but not age, SES, depression, and health may predict binge drinking for African American older adults with T2DM. African Americans older adult men with T2DM with comorbid pain should be screened for binge drinking.
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Affiliation(s)
- Shervin Assari
- Departments of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, 118th St, Los Angeles, CA 90059, USA.
| | - James L Smith
- Departments of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, 118th St, Los Angeles, CA 90059, USA
| | - Mohammed Saqib
- Department of Health Behavior and Health Education, University of Michigan, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mohsen Bazargan
- Departments of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, 118th St, Los Angeles, CA 90059, USA
- Departments of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
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Substance Use among Economically Disadvantaged African American Older Adults; Objective and Subjective Socioeconomic Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101826. [PMID: 31126049 PMCID: PMC6572418 DOI: 10.3390/ijerph16101826] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/11/2019] [Accepted: 05/17/2019] [Indexed: 12/17/2022]
Abstract
Purpose. This study investigated the effects of objective and subjective socioeconomic status (SES) indicators on two health behaviors, cigarette smoking and alcohol drinking, among African American older adults. Methods. This community-based study recruited 619 economically disadvantaged African American older adults (age ≥ 65 years) residing in South Los Angeles. Structured face-to-face interviews were conducted to collect data. Data on demographic factors (age and gender), subjective SES (financial difficulties), objective SES (educational attainment), living arrangement, marital status, healthcare access (insurance), and health (number of chronic medical conditions, self-rated health, sick days, depression, and chronic pain) and health behaviors (cigarette smoking and alcohol drinking) were collected from participants. Logistic regressions were used to analyze the data. Results. High financial difficulties were associated with higher odds of smoking cigarettes and drinking alcohol, independent of covariates. Educational attainment did not correlate with our outcomes. Similar patterns emerged for cigarette smoking and alcohol drinking. Conclusion. Subjective SES indicators such as financial difficulties may be more relevant than objective SES indicators such as educational attainment to health risk behaviors such as cigarette smoking and alcohol drinking among African American older adults in economically constrain urban environments. Smoking and drinking may serve as coping mechanisms with financial difficulty, especially among African American older adults. In line with the minorities' diminished returns (MDR) theory, and probably due to discrimination against racial minorities, educational attainment has a smaller protective effect among economically disadvantaged African American individuals against health risk behaviors.
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16
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Graham GN, Jones PG, Chan PS, Arnold SV, Krumholz HM, Spertus JA. Racial Disparities in Patient Characteristics and Survival After Acute Myocardial Infarction. JAMA Netw Open 2018; 1:e184240. [PMID: 30646346 PMCID: PMC6324589 DOI: 10.1001/jamanetworkopen.2018.4240] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Black patients experience worse outcomes than white patients following acute myocardial infarction (AMI). OBJECTIVE To examine the degree to which nonrace characteristics explain observed survival differences between white patients and black patients following AMI. DESIGN, SETTING, AND PARTICIPANTS This cohort study used the extensive socioeconomic and clinical characteristics from patients recovering from an AMI that were prospectively collected at 31 hospitals across the contiguous United States between 2003 and 2008 for the Prospective Registry Evaluating Myocardial Infarction: Events and Recovery registry and the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status registry. Survival was assessed using data from the National Death Index. Data were analyzed from December 2016 to July 2018. MAIN OUTCOMES AND MEASURES Patient characteristics were categorized into 8 domains, and the degree to which each domain discriminated self-identified black patients from white patients was determined by calculating propensity scores associated with black race for each domain as well as cumulatively across all domains. The final propensity score was associated with 1- and 5-year mortality rates. RESULTS Among 6402 patients (mean [SD] age, 60 [13] years; 2127 [33.2%] female; 1648 [25.7%] black individuals), the 5-year mortality rate following AMI was 28.9% (476 of 1648) for black patients and 18.0% (856 of 4754) for white patients (hazard ratio, 1.72; 95% CI, 1.54-1.92; P < .001). Most categories of patient characteristics differed substantially between black patients and white patients. The cumulative propensity score discriminated race, with a C statistic of 0.89, and the propensity scores were associated with 1- and 5-year mortality rates (hazard ratio for the 75th percentile of the propensity score vs 25th percentile, 1.72; 95% CI, 1.43-2.08; P < .001). Patients in the lowest propensity score quintile associated with being a black individual (regardless of whether they were of white or black race) had a 5-year mortality rate of 15.5%, while those in the highest quintile had a 5-year mortality rate of 31.0% (P < .001). After adjusting for the propensity associated with being a black patient, there was no significant mortality rate difference by race (adjusted hazard ratio, 1.09; 95% CI, 0.93-1.26; P = .37) and no statistical interaction between race and propensity score (P = .42). CONCLUSIONS AND RELEVANCE Characteristics of black patients and white patients differed significantly at the time of admission for AMI. Those characteristics were associated with an approximately 3-fold difference in 5-year mortality rate following AMI and mediated most of the observed mortality rate difference between the races.
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Affiliation(s)
- Garth N Graham
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City
| | - Philip G Jones
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City
| | - Paul S Chan
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City
| | - Suzanne V Arnold
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - John A Spertus
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City
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17
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Tang KL, Pilote L, Behlouli H, Godley J, Ghali WA. An exploration of the subjective social status construct in patients with acute coronary syndrome. BMC Cardiovasc Disord 2018; 18:22. [PMID: 29409448 PMCID: PMC5801903 DOI: 10.1186/s12872-018-0759-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 01/26/2018] [Indexed: 03/21/2023] Open
Abstract
Background Perception of low subjective social status (SSS) relative to others in society or in the community has been associated with increased risk of cardiovascular disease. Our objectives were to determine whether low SSS in society was associated with barriers to access to care or hospital readmission in patients with established cardiovascular disease, and whether perceptions of discordantly high SSS in the community modified this association. Methods We conducted a prospective cohort study from 2009 to 2013 in Canada, United States, and Switzerland in patients admitted to hospital with acute coronary syndrome (ACS). Data on access to care and SSS variables were obtained at baseline. Readmission data were obtained 12 months post-discharge. We conducted multivariable logistic regression to model the odds of access to care and readmission outcomes in those with low versus high societal SSS. Results One thousand ninety patients admitted with ACS provided both societal and community SSS rankings. The low societal SSS cohort had greater odds of reporting that their health was affected by lack of health care access (OR 1.48, 95% CI 1.11, 1.97) and of experiencing cardiac readmissions (1.88, 95% CI 1.15, 3.06). Within the low societal SSS cohort, there was a trend toward fewer access to care barriers for those with discordantly high community SSS though findings varied based on the outcome variable. There were no statistically significant differences in readmissions based on community SSS rankings. Conclusion Low societal SSS is associated with increased barriers to access to care and cardiac readmissions. Though attenuated, these trends remained even when adjusting for clinical and sociodemographic factors, suggesting that perceived low societal SSS has health effects above and beyond objective socioeconomic factors. Furthermore, high community SSS may potentially mitigate the risk of experiencing barriers to access to health care in those with low societal SSS, though these associations were not statistically significant. Subjective social status relative to society versus relative to the community seem to represent distinct concepts. Insight into the differences between these two SSS constructs is imperative in the understanding of cardiovascular health and future development of public health policies. Electronic supplementary material The online version of this article (10.1186/s12872-018-0759-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen L Tang
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Louise Pilote
- Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, 687 Pine Ave West, Montreal, Quebec, H3A 1A1, Canada.,Division of General Internal Medicine, McGill University Health Centre, 687 Pine Ave West, Montreal, Quebec, H3A 1A1, Canada
| | - Hassan Behlouli
- Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, 687 Pine Ave West, Montreal, Quebec, H3A 1A1, Canada
| | - Jenny Godley
- Department of Sociology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.,O' Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - William A Ghali
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.,O' Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
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18
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Mollon L, Bhattacharjee S. Health related quality of life among myocardial infarction survivors in the United States: a propensity score matched analysis. Health Qual Life Outcomes 2017; 15:235. [PMID: 29202758 PMCID: PMC5716338 DOI: 10.1186/s12955-017-0809-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/23/2017] [Indexed: 12/30/2022] Open
Abstract
Background Little is known regarding the health-related quality of life among myocardial infarction (MI) survivors in the United States. The purpose of this population-based study was to identify differences in health-related quality of life domains between MI survivors and propensity score matched controls. Methods This retrospective, cross-sectional matched case-control study examined differences in health-related quality of life (HRQoL) among MI survivors of myocardial infarction compared to propensity score matched controls using data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey. Propensity scores were generated via logistic regression for MI survivors and controls based on gender, race/ethnicity, age, body mass index (BMI), smoking status, and comorbidities. Chi-square tests were used to compare differences between MI survivors to controls for demographic variables. A multivariate analysis of HRQoL domains estimated odds ratios. Life satisfaction, sleep quality, and activity limitations were estimated using binary logistic regression. Social support, perceived general health, perceived physical health, and perceived mental health were estimated using multinomial logistic regression. Significance was set at p < 0.05. Results The final sample consisted of 16,729 MI survivors matched to 50,187 controls (n = 66,916). Survivors were approximately 2.7 times more likely to report fair/poor general health compared to control (AOR = 2.72, 95% CI: 2.43–3.05) and 1.5 times more likely to report limitations to daily activities (AOR = 1.46, 95% CI: 1.34–1.59). Survivors were more likely to report poor physical health >15 days in the month (AOR = 1.63, 95% CI: 1.46–1.83) and poor mental health >15 days in the month (AOR = 1.25, 95% CI: 1.07–1.46) compared to matched controls. There was no difference in survivors compared to controls in level of emotional support (rarely/never: AOR = 0.75, 95% CI: 0.48–1.18; sometimes: AOR = 0.73, 95% CI: 0.41–1.28), hours of recommended sleep (AOR = 1.14, 95% CI: 0.94–1.38), or life satisfaction (AOR = 1.62, 95% CI: 0.99–2.63). Conclusion MI survivors experienced lower HRQoL on domains of general health, physical health, daily activity, and mental health compared to the general population.
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Affiliation(s)
- Lea Mollon
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 North Martin Avenue, Tucson, AZ, 85721, USA
| | - Sandipan Bhattacharjee
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 North Martin Avenue, Tucson, AZ, 85721, USA.
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Work stress and the risk of recurrent coronary heart disease events: A systematic review and meta-analysis. Int J Occup Med Environ Health 2016; 28:8-19. [PMID: 26159942 DOI: 10.2478/s13382-014-0303-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Though much evidence indicates that work stress increases the risk of incident of coronary heart disease (CHD), little is known about the role of work stress in the development of recurrent CHD events. The objective of this study was to review and synthesize the existing epidemiological evidence on whether work stress increases the risk of recurrent CHD events in patients with the first CHD. A systematic literature search in the PubMed database (January 1990 - December 2013) for prospective studies was performed. Inclusion criteria included: peer-reviewed English papers with original data, studies with substantial follow-up (> 3 years), end points defined as cardiac death or nonfatal myocardial infarction, as well as work stress assessed with reliable and valid instruments. Meta-analysis using random-effects modeling was conducted in order to synthesize the observed effects across the studies. Five papers derived from 4 prospective studies conducted in Sweden and Canada were included in this systematic review. The measurement of work stress was based on the Demand- Control model (4 papers) or the Effort-Reward Imbalance model (1 paper). According to the estimation by meta-analysis based on 4 papers, a significant effect of work stress on the risk of recurrent CHD events (hazard ratio: 1.65, 95% confidence interval: 1.23-2.22) was observed. Our findings suggest that, in patients with the first CHD, work stress is associated with an increased relative risk of recurrent CHD events by 65%. Due to the limited literature, more well-designed prospective research is needed to examine this association, in particular, from other than western regions of the world.
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Hyun KK, Essue BM, Woodward M, Jan S, Brieger D, Chew D, Nallaiah K, Howell T, Briffa T, Ranasinghe I, Astley C, Redfern J. The household economic burden for acute coronary syndrome survivors in Australia. BMC Health Serv Res 2016; 16:636. [PMID: 27825335 PMCID: PMC5101825 DOI: 10.1186/s12913-016-1887-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies of chronic diseases are associated with a financial burden on households. We aimed to determine if survivors of acute coronary syndrome (ACS) experience household economic burden and to quantify any potential burden by examining level of economic hardship and factors associated with hardship. METHODS Australian patients admitted to hospital with ACS during 2-week period in May 2012, enrolled in SNAPSHOT ACS audit and who were alive at 18 months after index admission were followed-up via telephone/paper survey. Regression models were used to explore factors related to out-of-pocket expenses and economic hardship. RESULTS Of 1833 eligible patients at baseline, 180 died within 18 months, and 702 patients completed the survey. Mean out-of-pocket expenditure (n = 614) in Australian dollars was A$258.06 (median: A$126.50) per month. The average spending for medical services was A$120.18 (SD: A$310.35) and medications was A$66.25 (SD: A$80.78). In total, 350 (51 %) of patients reported experiencing economic hardship, 78 (12 %) were unable to pay for medical services and 81 (12 %) could not pay for medication. Younger age (18-59 vs ≥80 years (OR): 1.89), no private health insurance (OR: 2.04), pensioner concession card (OR: 1.80), residing in more disadvantaged area (group 1 vs 5 (OR): 1.77), history of CVD (OR: 1.47) and higher out-of-pocket expenses (group 4 vs 1 (OR): 4.57) were more likely to experience hardship. CONCLUSION Subgroups of ACS patients are experiencing considerable economic burden in Australia. These findings provide important considerations for future policy development in terms of the cost of recommended management for patients.
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Affiliation(s)
- Karice K. Hyun
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
- Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, NSW 2050 Australia
| | - Beverley M. Essue
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Mark Woodward
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
- Nuffield Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Stephen Jan
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - David Brieger
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia
| | - Derek Chew
- Department of Cardiology, Flinders University, Adelaide, Australia
| | - Kellie Nallaiah
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Tom Briffa
- School of Population Health, University of Western Australia, Perth, Australia
| | | | - Carolyn Astley
- South Australia Division, The Heart foundation, Adelaide, Australia
| | - Julie Redfern
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
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21
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Vujcic I, Vlajinac H, Dubljanin E, Vasiljevic Z, Matanovic D, Maksimovic J, Sipetic S. Psychosocial Stress and Risk of Myocardial Infarction: A Case-Control Study in Belgrade (Serbia). ACTA CARDIOLOGICA SINICA 2016; 32:281-289. [PMID: 27274168 PMCID: PMC4884755 DOI: 10.6515/acs20150424k] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 04/24/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The purpose of this study was to investigate which psychosocial risk factors show the strongest association with occurrence of myocardial infarction (MI) in the population of Belgrade in peacetime, after the big political changes in Serbia. METHODS A case-control study was conducted involving 154 consecutive newly diagnosed patients with MI, and 308 controls matched by gender, age, and place of residence. RESULTS According to conditional logistic regression analysis, after adjustment for conventional coronary risk factors, the odds ratios (95% confidence intervals) for work-related stressful events, financial stress, deaths and diseases, and general stress were 3.78 (1.83-7.81), 3.80 (1.96-7.38), 1.69 (1.03-2.78), and 3.54 (2.01-6.22), respectively. Among individual stressful life events, the following were independently related to MI: death of a close family member, 2.21 (1.01-4.84); death of a close friend, 42.20 (3.70-481.29); major financial problems, 8.94 (1.83-43.63); minor financial problems, 4.74 (2.02-11.14); changes in working hours, 4.99 (1.64-15.22); and changes in working conditions, 30.94 (5.43-176.31). CONCLUSIONS During this political transition period , stress at work, financial stress, and stress in general as they impacted the population of Belgrade, Serbia were strongly associated with occurence of MI.
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Affiliation(s)
| | | | - Eleonora Dubljanin
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade
| | | | - Dragana Matanovic
- Clinic of Physical Medicine and Rehabilitation, Clinical Centre of Serbia, Belgrade, Serbia
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Graham G, Xiao YYK, Rappoport D, Siddiqi S. Population-level differences in revascularization treatment and outcomes among various United States subpopulations. World J Cardiol 2016; 8:24-40. [PMID: 26839655 PMCID: PMC4728105 DOI: 10.4330/wjc.v8.i1.24] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/29/2015] [Accepted: 11/04/2015] [Indexed: 02/06/2023] Open
Abstract
Despite recent general improvements in health care, significant disparities persist in the cardiovascular care of women and racial/ethnic minorities. This is true even when income, education level, and site of care are taken into consideration. Possible explanations for these disparities include socioeconomic considerations, elements of discrimination and racism that affect socioeconomic status, and access to adequate medical care. Coronary revascularization has become the accepted and recommended treatment for myocardial infarction (MI) today and is one of the most common major medical interventions in the United States, with more than 1 million procedures each year. This review discusses recent data on disparities in co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in revascularization as treatment for acute coronary syndrome, looking especially at women and minority populations in the United States. The data show that revascularization is used less in both female and minority patients. We summarize recent data on disparities in co-morbidities and presentation symptoms related to MI; access to care, medical resources, and treatments; and outcomes in women, blacks, and Hispanics. The picture is complicated among the last group by the many Hispanic/Latino subgroups in the United States. Some differences in outcomes are partially explained by presentation symptoms and co-morbidities and external conditions such as local hospital capacity. Of particular note is the striking differential in both presentation co-morbidities and mortality rates seen in women, compared to men, especially in women ≤ 55 years of age. Surveillance data on other groups in the United States such as American Indians/Alaska Natives and the many Asian subpopulations show disparities in risk factors and co-morbidities, but revascularization as treatment for MI in these populations has not been adequately studied. Significant research is required to understand the extent of disparities in treatment in these subpopulations.
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Chen SI, Wang Y, Dreyer R, Strait KM, Spatz ES, Xu X, Smolderen KG, Desai NR, Lorenze NP, Lichtman JH, Spertus JA, D'Onofrio G, Bueno H, Masoudi FA, Krumholz HM. Insurance and Prehospital Delay in Patients ≤55 Years With Acute Myocardial Infarction. Am J Cardiol 2015; 116:1827-32. [PMID: 26541907 PMCID: PMC5323057 DOI: 10.1016/j.amjcard.2015.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/06/2015] [Accepted: 09/06/2015] [Indexed: 10/22/2022]
Abstract
This prospective study assessed whether gender differences in health insurance help explain gender differences in delay in seeking care for patients in the US, with acute myocardial infarction (AMI). We also assessed gender differences in such prehospital delay for AMI in Spain, a country with universal insurance. We used data from 2,951 US and 496 Spanish patients aged 18 to 55 years with AMI. US patients were grouped by insurance status: adequately insured, underinsured, or uninsured. For each country, we assessed the association between gender and prehospital delay (symptom onset to hospital arrival). For the US cohort, we modeled the relation between insurance groups and delay of >12 hours. US women were less likely than men to be uninsured but more likely to be underinsured, and a larger proportion of women than men experienced delays of >12 hours (38% vs 29%). We found no association between insurance status and delays of >12 hours in men or women. Only 17.3% of Spanish patients had delays of >12 hours, and there were no significant gender differences. In conclusion, women were more likely than men to delay, although it was not explained by differences in insurance status. The lack of gender differences in prehospital delays in Spain suggests that these differences may vary by health care system and culture.
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Affiliation(s)
- Serene I Chen
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yongfei Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rachel Dreyer
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Kelly M Strait
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Kim G Smolderen
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nancy P Lorenze
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - John A Spertus
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Instituto de investigación i + 12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Universidad Complutense de Madrid, Spain
| | - Frederick A Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
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Kirchberger I, Braitmayer K, Coenen M, Oberhauser C, Meisinger C. Feasibility and psychometric properties of the German 12-item WHO Disability Assessment Schedule (WHODAS 2.0) in a population-based sample of patients with myocardial infarction from the MONICA/KORA myocardial infarction registry. Popul Health Metr 2014. [DOI: 10.1186/s12963-014-0027-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Karimi-Moonaghi H, Mojalli M, Khosravan S. Psychosocial complications of coronary artery disease. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e18162. [PMID: 25068057 PMCID: PMC4102990 DOI: 10.5812/ircmj.18162] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/15/2014] [Accepted: 04/05/2014] [Indexed: 11/18/2022]
Abstract
Background: Cardiovascular diseases are the leading causes of death around the world. The coronary artery disease (CAD) is one of the most common diseases in this category, which can be the trigger to various psychosocial complications. We believe that inadequate attention has been paid to this issue. Objectives: The purpose of the present study was to explore the psychosocial complications of CAD from the Iranian patients’ perspective. Patients and Methods: A qualitative design based on the content analysis approach was used to collect the data and analyze the perspective of 18 Iranian patients suffered from CAD, chosen by a purposeful sampling strategy. Semi-structured interviews were held in order to collect the data. Sampling was continued until the data saturation. The data were analyzed using qualitative content analysis approach by MAXQUDA 2010 software. Results: This study revealed the theme of the patients’ challenges with CAD. This theme consisted of: "primary challenges," including doubting early diagnosis and treatment, and feeling being different from others; "psychological issues," including preoccupation, fear of death and surgical intervention, recurrence stress , anxiety and depression; "problems of life," including financial problems, work-related problems, and family-related problems; and "sociocultural issues," including change in perspective of people towards the patient, and cultural issues. Conclusions: Although the management of physical problems in patients with CAD is important, psychosocial effects of this disease is more important. Thus, health care personnel should pay ample attention to identify and resolve psychosocial problems of these patients. Results of this study can be used to empower these patients.
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Affiliation(s)
- Hossein Karimi-Moonaghi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Department of Medical education, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohammad Mojalli
- PhD Candidate in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding Author: Mohammad Mojalli, PhD Candidate in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5118591511, E-mail:
| | - Shahla Khosravan
- Social Determents Health Research Center, Gonabad University of Medical Sciences, Gonabad, IR Iran
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Edmondson D, Green P, Ye S, Halazun HJ, Davidson KW. Psychological stress and 30-day all-cause hospital readmission in acute coronary syndrome patients: an observational cohort study. PLoS One 2014; 9:e91477. [PMID: 24621575 PMCID: PMC3951368 DOI: 10.1371/journal.pone.0091477] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 02/11/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Many acute coronary syndrome (ACS; myocardial infarction and unstable angina) patients are rehospitalized within 30 days of discharge, and recent US health policy initiatives have tied hospital Medicare reimbursement to 30-day readmission rates. Patient-perceived psychological stress is thought to impact prognosis after ACS. A recently offered "posthospital syndrome" model of 30-day readmissions posits that the stress level at the time of the index hospitalization itself may increase 30-day risk for readmission in ACS patients. We tested whether self-reported stress in the days surrounding the ACS hospitalization was associated with increased risk for readmission within 30 days. METHODS A mean of 8.5 days after discharge, 342 consecutively hospitalized ACS patients reported on how often they felt stress during the past two weeks. Readmission within 30 days of hospital discharge for any cause was determined by follow-up telephone calls to patients and confirmed by hospital records. RESULTS Overall, 40 (11.7%) participants were readmitted within 30 days, and 22 (6.4%) reported high stress. Readmission within 30 days was more common in patients with high stress (5 admissions, 23%) than in patients with low stress (35 admissions, 11%). After adjustment for demographic and clinical factors, as well as depression, high stress was associated with a 3-fold increased risk of 30-day readmission (HR = 3.21, 95% CI = 1.13, 9.10). CONCLUSIONS Previous research has shown that stress in the days surrounding a hospitalization can mark long-term cardiovascular risk, but this is the first study to test a hypothesis of the posthospital syndrome model of early readmission. Further research is needed to confirm the association between stress and readmission risk, and to identify the processes of hospitalization that could be modified to both reduce the stress experienced and that would also be effective for reducing readmissions.
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Affiliation(s)
- Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
- * E-mail:
| | - Philip Green
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Hadi J. Halazun
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Karina W. Davidson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
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Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, Barreto-Filho JA, Kim N, Suter LG, Bernheim SM, Drye EE, Krumholz HM. Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions. BMJ 2013; 347:f6571. [PMID: 24259033 PMCID: PMC3898430 DOI: 10.1136/bmj.f6571] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether high performing hospitals with low 30 day risk standardized readmission rates have a lower proportion of readmissions from specific diagnoses and time periods after admission or instead have a similar distribution of readmission diagnoses and timing to lower performing institutions. DESIGN Retrospective cohort study. SETTING Medicare beneficiaries in the United States. PARTICIPANTS Patients aged 65 and older who were readmitted within 30 days after hospital admission for heart failure, acute myocardial infarction, or pneumonia in 2007-09. MAIN OUTCOME MEASURES Readmission diagnoses were classified with a modified version of the Centers for Medicare and Medicaid Services' condition categories, and readmission timing was classified by day (0-30) after hospital discharge. Hospital 30 day risk standardized readmission rates over the three years of study were calculated with public reporting methods of the US federal government, and hospitals were categorized with bootstrap analysis as having high, average, or low readmission performance for each index condition. High and low performing hospitals had ≥ 95% probability of having an interval estimate respectively less than or greater than the national 30 day readmission rate over the three year period of study. All remaining hospitals were considered average performers. RESULTS For readmissions in the 30 days after the index admission, there were 320,003 after 1,291,211 admissions for heart failure (4041 hospitals), 102,536 after 517,827 admissions for acute myocardial infarction (2378 hospitals), and 208,438 after 1,135,932 admissions for pneumonia (4283 hospitals). The distribution of readmissions by diagnosis was similar across categories of hospital performance for all three conditions. High performing hospitals had fewer readmissions for all common diagnoses. Median time to readmission was similar by hospital performance for heart failure and acute myocardial infarction, though was 1.4 days longer among high versus low performing hospitals for pneumonia (P<0.001). Findings were unchanged after adjustment for other hospital characteristics potentially associated with readmission patterns. CONCLUSIONS High performing hospitals have proportionately fewer 30 day readmissions without differences in readmission diagnoses and timing, suggesting the possible benefit of strategies that lower risk of readmission globally rather than for specific diagnoses or time periods after hospital stay.
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Affiliation(s)
- Kumar Dharmarajan
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, 630 West 168th Street, Box 93, PH 10-203, New York, NY 10032, USA
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