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Zhu R, Xu H, Cai H, Wang S, Mao J, Zhang J, Xiong X, Wang X, Zhou W, Guo L. Effects of cereal bran consumption on cardiometabolic risk factors: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2023; 33:1849-1865. [PMID: 37482485 DOI: 10.1016/j.numecd.2023.04.020] [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: 12/07/2022] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 07/25/2023]
Abstract
AIMS Cardiovascular disease is a prevalent worldwide disease, and cardiometabolic risk factors (CMRFs) include hyperlipidemia, hypertension, diabetes, and adiposity. Healthy diets are the critical factor in controlling these CMRFs risks, especially cereal bran which contains many beneficial substances. However, there are still contradictions in the indicators of improving CMRFs by bran from different grain sources or even the same grain source. Therefore, this study aimed to investigate the effects of cereal bran consumption on CMRFs. DATA SYNTHESIS Eligible randomized controlled studies were searched in PubMed, Embase, Scopus, the Cochrane Library and Web of Science until February 2023. The random-effects model was used to calculate overall effect sizes of weighted mean difference (WMD) and 95% confidence interval (CI). Finally, 22 studies were included in the present meta-analysis. Compared to the control, cereal bran consumption had no significant effect on high-density lipoprotein cholesterol, triglycerides, waist circumference, and body mass index, but could reduce systolic blood pressure (WMD: -1.59; 95% CI: -2.45 to -0.72), diastolic blood pressure (WMD: -1.96; 95% CI: -3.89 to -0.04), total cholesterol (WMD: -0.19; 95% CI: -0.34 to -0.04), low-density lipoprotein cholesterol (WMD: -0.21; 95% CI: -0.38 to -0.04), and fasting blood glucose (WMD: -0.13; 95% CI: -0.24 to -0.01). Additionally, oat bran can lower blood lipids in individuals with lipid diseases and blood pressure in obese or hypertensive patients. CONCLUSIONS Cereal bran could significantly reduce blood pressure, total cholesterol, low-density lipoprotein cholesterol, and fasting blood glucose in individuals with CMRFs, and oat bran had the most obvious effect.
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Affiliation(s)
- Ruiting Zhu
- School of Nursing, Jilin University, Changchun, Jilin, 130021, China
| | - Haiyan Xu
- School of Nursing, Jilin University, Changchun, Jilin, 130021, China
| | - Hongwei Cai
- Yantai Affiliated Hospital of Binzhou Medical University, 264100, China
| | - Saikun Wang
- School of Nursing, Jilin University, Changchun, Jilin, 130021, China
| | - Jing Mao
- School of Nursing, Jilin University, Changchun, Jilin, 130021, China
| | - Jingyi Zhang
- College of Animal Sciences, Jilin University, Changchun, Jilin, 130062, China
| | - Xuance Xiong
- Medical College, Beihua University, Jilin, Jilin, 132013, China
| | - Xingyu Wang
- School of Nursing, Jilin University, Changchun, Jilin, 130021, China
| | - Wei Zhou
- The First Hospital of Jilin University, Changchun, Jilin, 130021, China.
| | - Lirong Guo
- School of Nursing, Jilin University, Changchun, Jilin, 130021, China.
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Yeh EJ, Grigolon RB, Rodrigues SR, A Bueno AP. Systematic literature review and meta-analysis of cardiovascular risk factor management in selected Asian countries. J Comp Eff Res 2023; 12:e220085. [PMID: 36861459 PMCID: PMC10402804 DOI: 10.57264/cer-2022-0085] [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: 05/06/2022] [Accepted: 01/20/2023] [Indexed: 03/03/2023] Open
Abstract
Aim: There is a need to understand the management status of hypertension, dyslipidemia/hypercholesterolemia, and diabetes mellitus in the Asia-Pacific region (APAC). Methods: We conducted a systematic literature review and meta-analysis to summarize the awareness, treatment, and/or control rates of these risk factors in adults across 11 APAC countries/regions. Results: We included 138 studies. Individuals with dyslipidemia had the lowest pooled rates compared with those with other risk factors. Levels of awareness with diabetes mellitus, hypertension, and hypercholesterolemia were comparable. Individuals with hypercholesterolemia had a statistically lower pooled treatment rate but a higher pooled control rate than those with hypertension. Conclusion: The management of hypertension, dyslipidemia, and diabetes mellitus was suboptimal in these 11 countries/regions.
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Amatori S, Ferri Marini C, Gobbi E, Sisti D, Giombini G, Rombaldoni R, Rocchi MBL, Lucertini F, Federici A, Perroni F, Calcagnini G. Short High-Intensity Interval Exercise for Workplace-Based Physical Activity Interventions: A Systematic Review on Feasibility and Effectiveness. Sports Med 2023; 53:887-901. [PMID: 36840913 PMCID: PMC10036456 DOI: 10.1007/s40279-023-01821-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Workplace exercise interventions showed good results, but lack of time was often reported as a barrier to participation. To overcome this problem, several studies attempted to implement short high-intensity interval training (HIT) within the workplace. OBJECTIVES The aim of this systematic review is to explore the feasibility and effectiveness of HIT interventions within the workplace setting. DATA SOURCES A systematic literature search was conducted in PubMed and SPORTDiscus to identify articles related to HIT within the workplace. STUDY ELIGIBILITY CRITERIA Only interventions that consisted of HIT programmes within the workplace and tested at least one physiological, psychological, or work-related outcome were included. RESULTS Seven studies (317 participants) met the inclusion criteria. HIT interventions lasted 6-12 weeks, with a frequency of 2-4 sessions/week and a duration of 8-30 min per session. Feasibility was qualitatively investigated in four studies, with key positive aspects reported for HIT time-appeal, the sense of competence driven by individual intensity, and improved intention to exercise; five studies reported adherence rates > 80%. Small-to-large effect sizes were reported for improvements in cardiorespiratory and muscular fitness. Small-to-medium effect sizes were reported for blood parameters and health-related quality of life. CONCLUSIONS HIT interventions in the workplace showed limited effectiveness in improving health-related outcomes, while promising results regarding feasibility were reported, mainly due to the time-efficiency and the positive post-exercise psychosocial responses. However, further high-quality studies involving more participants are still needed to make firm conclusions on HIT effectiveness and feasibility compared to other types of exercise in this context.
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Affiliation(s)
- Stefano Amatori
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Via Dell'Annunziata 4, 61029, Urbino, Italy
| | - Carlo Ferri Marini
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Via Dell'Annunziata 4, 61029, Urbino, Italy
| | - Erica Gobbi
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Via Dell'Annunziata 4, 61029, Urbino, Italy.
| | - Davide Sisti
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Via Dell'Annunziata 4, 61029, Urbino, Italy
| | - Germana Giombini
- Department of Economics, Social Science, and Politics, University of Urbino Carlo Bo, Urbino, Italy
| | - Rosalba Rombaldoni
- Department of Economics, Social Science, and Politics, University of Urbino Carlo Bo, Urbino, Italy
| | - Marco B L Rocchi
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Via Dell'Annunziata 4, 61029, Urbino, Italy
| | - Francesco Lucertini
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Via Dell'Annunziata 4, 61029, Urbino, Italy
| | - Ario Federici
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Via Dell'Annunziata 4, 61029, Urbino, Italy
| | - Fabrizio Perroni
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Via Dell'Annunziata 4, 61029, Urbino, Italy
| | - Giorgio Calcagnini
- Department of Economics, Social Science, and Politics, University of Urbino Carlo Bo, Urbino, Italy
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Assessing forgetfulness and polypharmacy and their impact on health-related quality of life among patients with hypertension and dyslipidemia in Greece during the COVID-19 pandemic. Qual Life Res 2021; 31:193-204. [PMID: 34156596 PMCID: PMC8218571 DOI: 10.1007/s11136-021-02917-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/03/2022]
Abstract
Purpose We estimate the association between forgetfulness to take medications as prescribed and polypharmacy and health-related quality of life (HRQoL) among a cohort of patients with hypertension, dyslipidemia or both in Greece during the COVID-19 pandemic. Methods A telephone survey of 1018 randomly selected adults was conducted in Greece in June 2020. Participants were included in the survey, if they (a) had a diagnosis of hypertension, dyslipidemia or both and (b) were on prescription treatment for these conditions. HRQoL was calculated using the short form (SF) -12 Patient Questionnaire. A multivariable generalized linear regression model (GLM) was used to estimate the association between forgetfulness and polypharmacy and HRQoL, controlling for sociodemographic and health-related covariates. Results Overall, 351 respondents met the inclusion criteria, of whom 28 did not fully complete the questionnaire (response rate: 92%, n = 323). Of those, 37% were diagnosed with hypertension only, 28% with dyslipidemia only, and 35% with both. Most reported good to average physical (64.1%) and mental health (48.6%). Overall, 25% indicated that they sometimes forget to take their prescribed medications, and 12% took two or more pills multiple times daily. Total HRQoL score was 68.9% (s.d. = 18.0%). About 10% of participants reported paying less attention to their healthcare condition during the pandemic. Estimates of multivariable analyses indicated a negative association between forgetfulness (− 9%, adjusted β: − 0.047, 95% confidence interval − 0.089 to − 0.005, p = 0.029), taking two or more pills multiple times daily compared to one pill once a day (− 16%, adjusted β: − 0.068, 95% confidence interval − 0.129 to − 0.008, p = 0.028) and total HRQoL. Conclusion Our results suggest that among adult patients with hypertension, dyslipidemia or both in Greece, those who forget to take their medications and those with more complex treatment regimens had lower HRQoL. Such patients merit special attention and require targeted approaches by healthcare providers to improve treatment compliance and health outcomes.
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Rissanen I, Ala-Mursula L, Nerg I, Korhonen M. Adjusted productivity costs of stroke by human capital and friction cost methods: a Northern Finland Birth Cohort 1966 study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:531-545. [PMID: 33625624 PMCID: PMC8166714 DOI: 10.1007/s10198-021-01271-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Productivity costs result from loss of paid and unpaid work and replacements due to morbidity and mortality. They are usually assessed in health economic evaluations with human capital method (HCM) or friction cost method (FCM). The methodology for estimating lost productivity is an area of considerable debate. OBJECTIVE To compare traditional and adjusted HCM and FCM productivity cost estimates among young stroke patients. METHODS The Northern Finland Birth Cohort 1966 was followed until the age of 50 to identify all 339 stroke patients whose productivity costs were estimated with traditional, occupation-specific and adjusted HCM and FCM models by using detailed, national register-based data on care, disability, mortality, education, taxation and labour market. RESULTS Compared to traditional HCM, taking into account occupational class, national unemployment rate, disability-free life expectancy and decline in work ability, the productivity cost estimate decreased by a third, from €255,960 to €166,050. When traditional FCM was adjusted for occupational class and national unemployment rate, the estimate more than doubled from €3,040 to €7,020. HCM was more sensitive to adjustments for discount rate and wage growth rate than FCM. CONCLUSIONS This study highlights the importance of adjustments of HCM and FCM. Routine register-based data can be used for accurate productivity cost estimates of health shocks.
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Affiliation(s)
- Ina Rissanen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Huispost nr. STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Leena Ala-Mursula
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Iiro Nerg
- Oulu Business School, Department of Economics, University of Oulu, Oulu, Finland
| | - Marko Korhonen
- Oulu Business School, Department of Economics, University of Oulu, Oulu, Finland
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Impact of Obesity on Work Productivity in Different US Occupations: Analysis of the National Health and Wellness Survey 2014 to 2015. J Occup Environ Med 2019; 60:6-11. [PMID: 29065062 PMCID: PMC5770108 DOI: 10.1097/jom.0000000000001144] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: The aim of this study was to quantify the relationship between workers’ body mass index and work productivity within various occupations. Methods: Data from two administrations (2014 and 2015) of the United States (US) National Health and Wellness Survey, an Internet-based survey administered to an adult sample of the US population, were used for this study (n = 59,772). Occupation was based on the US Department of Labor's 2010 Standardized Occupation Codes. Outcomes included work productivity impairment and indirect costs of missed work time. Results: Obesity had the greatest impact on work productivity in Construction, followed by Arts and Hospitality occupations. Outcomes varied across occupations; multivariable analyses found significant differences in work productivity impairment and indirect costs between normal weight and at least one obesity class. Conclusion: Obesity differentially impacted productivity and costs, depending upon occupation.
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Food insecurity and dietary intake by Supplemental Nutrition Assistance Program participation status among mainland US Puerto Rican adults after the 2009 American Recovery and Reinvestment Act. Public Health Nutr 2019; 22:2989-2998. [PMID: 31397252 DOI: 10.1017/s1368980019002209] [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: 11/07/2022]
Abstract
OBJECTIVE The 2009 American Recovery and Reinvestment Act (ARRA) increased monthly Supplemental Nutrition Assistance Program (SNAP) benefits and expanded SNAP eligibility, yet limited evidence exists on the potential impact of ARRA on dietary intake among at-risk individuals. We aimed to examine pre-/post-ARRA differences in food insecurity (FI) and dietary intake by SNAP participation status. DESIGN Pre/post analysis. SETTING Boston, MA, USA. PARTICIPANTS Data were from the longitudinal Boston Puerto Rican Health Study (2007-2015). The US Department of Agriculture ten-item adult module assessed FI. A validated FFQ assessed dietary intake. Diet quality was assessed using the Alternate Healthy Eating Index-2010 (AHEI-2010). Self-reported pre-/post-ARRA household SNAP participation responses were categorized as: sustained (n 249), new (n 95) or discontinued (n 58). We estimated differences in odds of FI and in mean nutrient intakes and AHEI-2010 scores post-ARRA. RESULTS Compared with pre-ARRA, OR (95 % CI) of FI post-ARRA were lower for all participants (0·69 (0·51, 0·94)), and within sustained (0·63 (0·43, 0·92)) but not within new (0·94 (0·49, 1·80)) or discontinued (0·63 (0·25, 1·56)) participants. Post-ARRA, total carbohydrate intake was higher, and alcohol intake was lower, for sustained and new participants, and dietary fibre was higher for sustained participants, compared with discontinued participants. Scores for AHEI-2010 and its components did not differ post-ARRA, except for lower alcohol intake for sustained v. discontinued participants. CONCLUSIONS Post-ARRA, FI decreased for sustained participants and some nutrient intakes were healthier for sustained and new participants. Continuing and expanding SNAP benefits and eligibility likely protects against FI and may improve dietary intake.
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Prevalence of Metabolic Syndrome in an Employed Population as Determined by Analysis of Three Data Sources. J Occup Environ Med 2017; 59:161-168. [DOI: 10.1097/jom.0000000000000931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chang C, Lee SM, Choi BW, Song JH, Song H, Jung S, Bai YK, Park H, Jeung S, Suh DC. Costs Attributable to Overweight and Obesity in Working Asthma Patients in the United States. Yonsei Med J 2017; 58:187-194. [PMID: 27873513 PMCID: PMC5122636 DOI: 10.3349/ymj.2017.58.1.187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/22/2016] [Accepted: 06/29/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To estimate annual health care and productivity loss costs attributable to overweight or obesity in working asthmatic patients. MATERIALS AND METHODS This study was conducted using the 2003-2013 Medical Expenditure Panel Survey (MEPS) in the United States. Patients aged 18 to 64 years with asthma were identified via self-reported diagnosis, a Clinical Classification Code of 128, or a ICD-9-CM code of 493.xx. All-cause health care costs were estimated using a generalized linear model with a log function and a gamma distribution. Productivity loss costs were estimated in relation to hourly wages and missed work days, and a two-part model was used to adjust for patients with zero costs. To estimate the costs attributable to overweight or obesity in asthma patients, costs were estimated by the recycled prediction method. RESULTS Among 11670 working patients with a diagnosis of asthma, 4428 (35.2%) were obese and 3761 (33.0%) were overweight. The health care costs attributable to obesity and overweight in working asthma patients were estimated to be $878 [95% confidence interval (CI): $861-$895] and $257 (95% CI: $251-$262) per person per year, respectively, from 2003 to 2013. The productivity loss costs attributable to obesity and overweight among working asthma patients were $256 (95% CI: $253-$260) and $26 (95% CI: $26-$27) per person per year, respectively. CONCLUSION Health care and productivity loss costs attributable to overweight and obesity in asthma patients are substantial. This study's results highlight the importance of effective public health and educational initiatives targeted at reducing overweight and obesity among patients with asthma, which may help lower the economic burden of asthma.
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Affiliation(s)
| | - Seung Mi Lee
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | - Byoung Whui Choi
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jong Hwa Song
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | - Hee Song
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | - Sujin Jung
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | | | - Haedong Park
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | | | - Dong Churl Suh
- College of Pharmacy, Chung-Ang University, Seoul, Korea.
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McQueen RB, Ghushchyan V, Olufade T, Sheehan JJ, Nair KV, Saseen JJ. Incremental increases in economic burden parallels cardiometabolic risk factors in the US. Diabetes Metab Syndr Obes 2016; 9:233-41. [PMID: 27536152 PMCID: PMC4976812 DOI: 10.2147/dmso.s106809] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Estimate the economic burden associated with incremental increases in the number of cardiometabolic risk factors (CMRFs) in the US. METHODS We used the nationally representative Medical Expenditure Panel Survey from 2010 to 2012 to create a retrospective cohort of people based on the number of CMRFs (one, two, and three or four), and a comparison cohort of people with zero CMRFs. CMRFs included abdominal obesity, elevated blood pressure, elevated triglycerides, and elevated glucose and were defined using diagnostic codes, prescribed medications, and survey responses. Adjusted regression analysis was developed to compare health expenditures, utilization, and lost-productivity differences between the cohorts. Generalized linear regression was used for health care expenditures, and negative binomial regression was used for utilization and productivity, controlling for individual characteristics. RESULTS The number of CMRFs was associated with significantly more annual utilization, health care expenditures, and reduced productivity. As compared with people with zero CMRFs, people with one, two, and three or four CMRFs had 1.15 (95% confidence interval [CI]: 1.06, 1.24), 1.37 (95% CI: 1.25, 1.51), and 1.39 (95% CI: 1.22, 1.57) times higher expected rate of emergency room visits, respectively. Compared with people with zero CMRFs, people with one, two, and three or four CMRFs had increased incremental health care expenditures of US$417 (95% CI: $70, $763), US$2,326 (95% CI: $1,864, $2,788), and US$4,117 (95% CI: $3,428, $4,807), respectively. Those with three or four CMRFs reported employment of 60%, compared with 80% in patients with zero CMRFs. People with three or four CMFRs had 1.75 (95% CI: 1.42, 2.17) times higher expected rate of days missed at work due to illness, compared with people with zero CMRFs. CONCLUSION Our findings demonstrate a direct association between economic burden and number of CMRFs. Although this was expected, the increase in burden that was independent from the cost of cardiovascular disease was surprising.
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Affiliation(s)
- R Brett McQueen
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA
| | - Vahram Ghushchyan
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA
- College of Business and Economics, American University of Armenia, Yerevan, Armenia
| | | | | | - Kavita V Nair
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA
| | - Joseph J Saseen
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Mamudu HM, Paul TK, Wang L, Veeranki SP, Panchal HB, Alamian A, Sarnosky K, Budoff M. The effects of multiple coronary artery disease risk factors on subclinical atherosclerosis in a rural population in the United States. Prev Med 2016; 88:140-6. [PMID: 27090918 DOI: 10.1016/j.ypmed.2016.04.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The risk factors for cardiovascular disease (CVD) are associated with coronary atherosclerosis and having multiple risk factors potentiates atherosclerosis. This study examined the prevalence of multiple biological and lifestyle/behavioral risk factors and their association with coronary artery calcium (CAC), a marker for subclinical coronary atherosclerosis. METHODS This is a cross-sectional study of 1607 community-dwelling asymptomatic individuals from central Appalachia who participated in CAC screening between January 2011 and December 2012. Data on demographics (sex and age) and 7 traditional risk factors for coronary artery disease (CAD) were collected and categorized into 5 groups (0-1, 2, 3, 4, and ≥5). Prevalence of these risk factors and CAC scores (0, 1-99, 100-399, ≥400) were assessed, and the impact of the number of risk factors on CAC scores were delineated using multiple logistic regression. RESULTS Over 98% of participants had ≥1 risk factor. While obesity, diabetes, hypertension, and family history of CAD significantly increased the odds of having CAC, CAC scores significantly increased with number of risk factors. After adjusting for demographic factors, having 3, 4, and ≥5 risk factors was significantly associated with increased odds of having higher CAC scores when compared to zero CAC score by more than one and half times [OR=1.65, CI (1.20-2.25)], two times [OR=2.32, CI (1.67-3.23)] and three times [OR=3.45, CI (2.42-4.92)], respectively. CONCLUSION The high prevalence of multiple risk factors in the study population suggests the need for aggressive multiple risk factors interventions for primary prevention of CAD, which could address CVD health disparities.
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Affiliation(s)
- Hadii M Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN, United States.
| | - Timir K Paul
- Division of Cardiology, James. H. Quillen College of Medicine, East Tennessee State University, 329 N State of Franklin Rd, Johnson City, TN 37604, United States.
| | - Liang Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, United States.
| | - Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, United States.
| | - Hemang B Panchal
- Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37604, United States.
| | - Arsham Alamian
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, United States.
| | - Kamrie Sarnosky
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, United States.
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance, CA 90502, United States.
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Valero-Elizondo J, Salami JA, Ogunmoroti O, Osondu CU, Aneni EC, Malik R, Spatz ES, Rana JS, Virani SS, Blankstein R, Blaha MJ, Veledar E, Nasir K. Favorable Cardiovascular Risk Profile Is Associated With Lower Healthcare Costs and Resource Utilization. Circ Cardiovasc Qual Outcomes 2016; 9:143-53. [DOI: 10.1161/circoutcomes.115.002616] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/21/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Javier Valero-Elizondo
- From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.)
| | - Joseph A. Salami
- From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.)
| | - Oluseye Ogunmoroti
- From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.)
| | - Chukwuemeka U. Osondu
- From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.)
| | - Ehimen C. Aneni
- From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.)
| | - Rehan Malik
- From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.)
| | - Erica S. Spatz
- From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.)
| | - Jamal S. Rana
- From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.)
| | - Salim S. Virani
- From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.)
| | - Ron Blankstein
- From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.)
| | - Michael J. Blaha
- From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.)
| | - Emir Veledar
- From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.)
| | - Khurram Nasir
- From the Center for Healthcare Advancement and Outcomes (J.V.-E., J.A.S., O.O., C.U.O., E.C.A., R.M., E.V., K.N.) and Miami Cardiac and Vascular Institute (K.N.), Baptist Health South Florida, Miami; Department of Epidemiology, Robert Stempel College of Public Health (O.O., C.U.O., E.C.A., E.V., K.N.) and Department of Medicine, Herbert Wertheim College of Medicine (K.N.), Florida International University, Miami; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL (E.C.A.)
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Guy GP, Yabroff KR, Ekwueme DU, Smith AW, Dowling EC, Rechis R, Nutt S, Richardson LC. Estimating the health and economic burden of cancer among those diagnosed as adolescents and young adults. Health Aff (Millwood) 2015; 33:1024-31. [PMID: 24889952 DOI: 10.1377/hlthaff.2013.1425] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Adolescent and young adult cancer survivors-those who were ages 15-39 at their first cancer diagnosis-have important health limitations. These survivors are at risk for higher health care expenditures and lost productivity, compared to adults without a history of cancer. Using Medical Expenditure Panel Survey data, we present nationally representative estimates of the economic burden among people who were diagnosed with cancer in adolescence or young adulthood. Our findings demonstrate that surviving cancer at this age is associated with a substantial economic burden. Compared to adults without a history of cancer, adolescent and young adult cancer survivors had excess annual medical expenditures of $3,170 per person and excess annual productivity losses of $2,250 per person. Multifaceted prevention strategies, including education and sustained intervention programs to ensure access to lifelong risk-based follow-up care, may be effective ways to improve the economic outcomes associated with cancer survivorship in this population.
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Affiliation(s)
- Gery P Guy
- Gery P. Guy Jr. is a health economist in the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia
| | - K Robin Yabroff
- K. Robin Yabroff is an epidemiologist in the Division of Cancer Control and Population Sciences, National Cancer Institute (NCI), in Bethesda, Maryland
| | - Donatus U Ekwueme
- Donatus U. Ekwueme is a senior health economist in the Division of Cancer Prevention and Control, CDC
| | - Ashley Wilder Smith
- Ashley Wilder Smith is a behavioral scientist in the Division of Cancer Control and Population Sciences, NCI
| | - Emily C Dowling
- Emily C. Dowling is program manager for the Institute for Technology Assessment, Massachusetts General Hospital, in Boston, Massachusetts
| | - Ruth Rechis
- Ruth Rechis is vice president of Programs and Strategy at the LIVESTRONG Foundation, in Austin, Texas
| | - Stephanie Nutt
- Stephanie Nutt is a program manager on the Research and Evaluation Team, LIVESTRONG Foundation
| | - Lisa C Richardson
- Lisa C. Richardson is director of the Division of Blood Disorders, CDC
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Promoción de la salud desde el lugar de trabajo. HIPERTENSION Y RIESGO VASCULAR 2015; 32:97-9. [DOI: 10.1016/j.hipert.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 06/11/2015] [Indexed: 11/18/2022]
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Finkelstein EA, Chay J, Bajpai S. The economic burden of self-reported and undiagnosed cardiovascular diseases and diabetes on Indonesian households. PLoS One 2014; 9:e99572. [PMID: 24915510 PMCID: PMC4051736 DOI: 10.1371/journal.pone.0099572] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 05/15/2014] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The goal of this study is: (1) to estimate the current direct out-of-pocket (OOP) and indirect non-communicable diseases (NCD) burden on Indonesian households and (2) to project NCD prevalence and burden in 2020 focusing specifically on hypertension, diabetes, heart problems and stroke. METHODS This study relies on econometric analyses based on four waves of the Indonesian Family Life Survey (IFLS). RESULTS In aggregate, of the NCDs studied, heart problems exert the greatest economic burden on households, costing Int$1.56 billion in OOP and indirect burden in 2010. This was followed by hypertension (Int$1.36 billion), diabetes (Int$0.81 billion) and stroke (Int$0.29 billion). The OOP and indirect burden of these conditions is estimated to be Int$4.02 billion. Diabetes and stroke are expected to have the largest proportional increases in burden by 2020; 56.0% for diabetes and 56.9% for stroke to total Int$1.27 billion and Int$0.45 billion respectively. The burden of heart problems in 2020 is expected to increase by 34.4% to total Int$2.09 billion and hypertension burden will increase by 46.1% to Int$1.99 billion. In 2020, these conditions are expected to impose an economic burden of Int$5.80 billion. CONCLUSION In conclusion, this study demonstrates the significant burden of 4 primary NCDs on Indonesian households. In addition to the indirect burden, hypertension, diabetes, heart problems and stroke account for 8% of the nation's OOP healthcare expenditure, and due to rising disease prevalence and an aging population, this figure is expected to increase to 12% by 2020 without a significant health intervention.
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Affiliation(s)
- Eric A. Finkelstein
- Health Services and Systems Research Program, Duke-NUS Graduate Medical School, Singapore, Singapore
- Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Junxing Chay
- Health Services and Systems Research Program, Duke-NUS Graduate Medical School, Singapore, Singapore
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Guy GP, Ekwueme DU, Yabroff KR, Dowling EC, Li C, Rodriguez JL, de Moor JS, Virgo KS. Economic burden of cancer survivorship among adults in the United States. J Clin Oncol 2013; 31:3749-57. [PMID: 24043731 PMCID: PMC3795887 DOI: 10.1200/jco.2013.49.1241] [Citation(s) in RCA: 264] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To present nationally representative estimates of the impact of cancer survivorship on medical expenditures and lost productivity among adults in the United States. METHODS Using the 2008 to 2010 Medical Expenditure Panel Survey, we identified 4,960 cancer survivors and 64,431 individuals without a history of cancer age ≥ 18 years. Direct medical costs were measured using annual health care expenditures and examined by source of payment and service type. Indirect morbidity costs were estimated from lost productivity as a result of employment disability, missed work days, and lost household productivity. We evaluated the economic burden of cancer survivorship by estimating excess costs among cancer survivors, stratified by time since diagnosis (recently diagnosed [≤ 1 year] and previously diagnosed [> 1 year]), compared with individuals without a history of cancer using multivariable regression models stratified by age (18 to 64 and ≥ 65 years), controlling for age, sex, race/ethnicity, education, and comorbidities. RESULTS In 2008 to 2010, the annual excess economic burden of cancer survivorship among recently diagnosed cancer survivors was $16,213 per survivor age 18 to 64 years and $16,441 per survivor age ≥ 65 years. Among previously diagnosed cancer survivors, the annual excess burden was $4,427 per survivor age 18 to 64 years and $4,519 per survivor age ≥ 65 years. Excess medical expenditures composed the largest share of the economic burden among cancer survivors, particularly among those recently diagnosed. CONCLUSION The economic impact of cancer survivorship is considerable and is also high years after a cancer diagnosis. Efforts to reduce the economic burden caused by cancer will be increasingly important given the growing population of cancer survivors.
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Affiliation(s)
- Gery P. Guy
- Gery P. Guy Jr, Donatus U. Ekwueme, Chunyu Li, and Juan L. Rodriguez, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; Katherine S. Virgo, Rollins School of Public Health, Emory University, Atlanta, GA; K. Robin Yabroff and Janet S. de Moor, National Cancer Institute, Bethesda, MD; and Emily C. Dowling, Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Donatus U. Ekwueme
- Gery P. Guy Jr, Donatus U. Ekwueme, Chunyu Li, and Juan L. Rodriguez, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; Katherine S. Virgo, Rollins School of Public Health, Emory University, Atlanta, GA; K. Robin Yabroff and Janet S. de Moor, National Cancer Institute, Bethesda, MD; and Emily C. Dowling, Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - K. Robin Yabroff
- Gery P. Guy Jr, Donatus U. Ekwueme, Chunyu Li, and Juan L. Rodriguez, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; Katherine S. Virgo, Rollins School of Public Health, Emory University, Atlanta, GA; K. Robin Yabroff and Janet S. de Moor, National Cancer Institute, Bethesda, MD; and Emily C. Dowling, Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Emily C. Dowling
- Gery P. Guy Jr, Donatus U. Ekwueme, Chunyu Li, and Juan L. Rodriguez, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; Katherine S. Virgo, Rollins School of Public Health, Emory University, Atlanta, GA; K. Robin Yabroff and Janet S. de Moor, National Cancer Institute, Bethesda, MD; and Emily C. Dowling, Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Chunyu Li
- Gery P. Guy Jr, Donatus U. Ekwueme, Chunyu Li, and Juan L. Rodriguez, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; Katherine S. Virgo, Rollins School of Public Health, Emory University, Atlanta, GA; K. Robin Yabroff and Janet S. de Moor, National Cancer Institute, Bethesda, MD; and Emily C. Dowling, Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Juan L. Rodriguez
- Gery P. Guy Jr, Donatus U. Ekwueme, Chunyu Li, and Juan L. Rodriguez, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; Katherine S. Virgo, Rollins School of Public Health, Emory University, Atlanta, GA; K. Robin Yabroff and Janet S. de Moor, National Cancer Institute, Bethesda, MD; and Emily C. Dowling, Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Janet S. de Moor
- Gery P. Guy Jr, Donatus U. Ekwueme, Chunyu Li, and Juan L. Rodriguez, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; Katherine S. Virgo, Rollins School of Public Health, Emory University, Atlanta, GA; K. Robin Yabroff and Janet S. de Moor, National Cancer Institute, Bethesda, MD; and Emily C. Dowling, Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Katherine S. Virgo
- Gery P. Guy Jr, Donatus U. Ekwueme, Chunyu Li, and Juan L. Rodriguez, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; Katherine S. Virgo, Rollins School of Public Health, Emory University, Atlanta, GA; K. Robin Yabroff and Janet S. de Moor, National Cancer Institute, Bethesda, MD; and Emily C. Dowling, Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
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Calvo-Bonacho E, Ruilope LM, Sanchez-Chaparro MA, Cerezo C, Catalina-Romero C, Martinez-Munoz P, Banegas JR, Waeber B, Gonzalez-Quintela A, Zanchetti A. Influence of high cardiovascular risk in asymptomatic people on the duration and cost of sick leave: results of the ICARIA study. Eur Heart J 2013; 35:299-306. [DOI: 10.1093/eurheartj/eht156] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Wang L, Wei W, Miao R, Xie L, Baser O. Real-world outcomes of US employees with type 2 diabetes mellitus treated with insulin glargine or neutral protamine Hagedorn insulin: a comparative retrospective database study. BMJ Open 2013; 3:bmjopen-2012-002348. [PMID: 23633415 PMCID: PMC3641450 DOI: 10.1136/bmjopen-2012-002348] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To compare real-world outcomes of initiating insulin glargine (GLA) versus neutral protamine Hagedorn (NPH) insulin among employees with type 2 diabetes mellitus (T2DM) who had both employer-sponsored health insurance and short-tem-disability coverages. DESIGN Retrospective cohort study. SETTING MarketScan Commercial Claims and Encounters/Health and Productivity Management Databases 2003-2009. PARTICIPANTS Adult employees with T2DM who were previously treated with oral antidiabetic drugs and/or glucagon-like-peptide 1 receptor agonists and initiated GLA or NPH were included if they were continuously enrolled in healthcare and short-term-disability coverages for 3 months before (baseline) and 1 year after (follow-up) initiation. Treatment selection bias was addressed by 2:1 propensity score matching. Sensitivity analyses were conducted using different matching ratios. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes during 1-year follow-up were measured and compared: insulin treatment persistence and adherence; hypoglycaemia rates and daily average consumption of insulin; total and diabetes-specific healthcare resource utilisation and costs and loss in productivity, as measured by short-term disability, and the associated costs. RESULTS A total of 534 patients were matched and analysed (GLA: 356; NPH 178) with no significant differences in baseline characteristics. GLA patients were more persistent and adherent (both p<0.05), had lower rates of hospitalisation (23% vs 31.4%; p=0.036) and endocrinologist visits (19.1% vs 26.9%; p=0.038), similar hypoglycaemia rates (both 4.4%; p=1.0), higher diabetes drug costs ($2031 vs $1522; p<0.001), but similar total healthcare costs ($14 550 vs $16 093; p=0.448) and total diabetes-related healthcare costs ($4686 vs $5604; p=0.416). Short-term disability days and costs were numerically lower in the GLA cohort (16.0 vs 24.5 days; p=0.086 and $2824 vs $4363; p=0.081, respectively). Sensitivity analyses yielded similar findings. CONCLUSIONS Insulin GLA results in better persistence and adherence, compared with NPH insulin, with no overall cost disadvantages. Better persistence and adherence may lead to long-term health benefits for employees with T2DM.
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Affiliation(s)
- Li Wang
- STATinMED Research, Ann Arbor, Michigan, USA
| | - Wenhui Wei
- Sanofi-aventis US, Bridgewater, New Jersey, USA
| | | | - Lin Xie
- STATinMED Research, Ann Arbor, Michigan, USA
| | - Onur Baser
- STATinMED Research, Ann Arbor, Michigan, USA
- The University of Michigan, Ann Arbor, Michigan, USA
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Kraja AT, Lawson HA, Arnett DK, Borecki IB, Broeckel U, de las Fuentes L, Hunt SC, Province MA, Cheverud J, Rao D. Obesity-insulin targeted genes in the 3p26-25 region in human studies and LG/J and SM/J mice. Metabolism 2012; 61:1129-41. [PMID: 22386932 PMCID: PMC3586585 DOI: 10.1016/j.metabol.2012.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 01/05/2012] [Accepted: 01/06/2012] [Indexed: 01/05/2023]
Abstract
Identifying metabolic syndrome (MetS) genes is important for novel drug development and health care. This study extends the findings on human chromosome 3p26-25 for an identified obesity-insulin factor QTL, with an LOD score above 3. A focused association analysis comprising up to 9578 African American and Caucasian subjects from the HyperGEN Network (908 African Americans and 1025 whites), the Family Heart Study (3035 whites in time 1 and 1943 in time 2), and the Framingham Heart Study (1317 in Offspring and 1320 in Generation 3) was performed. The homologous mouse region was explored in an F(16) generation of an advanced intercross between the LG/J and SM/J inbred strains, in an experiment where 1002 animals were fed low-fat (247 males; 254 females) or high-fat (253 males; 248 females) diets. Association results in humans indicate pleiotropic effects for SNPs within or surrounding CNTN4 on obesity, lipids and blood pressure traits and for SNPs near IL5RA, TRNT1, CRBN, and LRRN1 on central obesity and blood pressure. Linkage analyses of this region in LG/J×SM/J mice identify a highly significant pleiotropic QTL peak for insulin and glucose levels, as well as response to glucose challenge. The mouse results show that insulin and glucose levels interact with high and low fat diets and differential gene expression was identified for Crbn and Arl8b. In humans, ARL8B resides ~137kbps away from BHLHE40, expression of which shows up-regulation in response to insulin treatment. This focused human genetic analysis, incorporating mouse research evidenced that 3p26-25 has important genetic contributions to MetS components. Several of the candidate genes have functions in the brain. Their interaction with MetS and the brain warrants further investigation.
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Affiliation(s)
- Aldi T. Kraja
- Division of Statistical Genomics, Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Corresponding authors. Aldi Kraja, is to be contacted at Division of Statistical Genomics, Washington University School of Medicine, St. Louis, MO 63110 USA. Heather Lawson, Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Heather A. Lawson
- Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Corresponding authors. Aldi Kraja, is to be contacted at Division of Statistical Genomics, Washington University School of Medicine, St. Louis, MO 63110 USA. Heather Lawson, Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Donna K. Arnett
- Department of Epidemiology, University of Alabama, Birmingham, AL 35294, USA
| | - Ingrid B. Borecki
- Division of Statistical Genomics, Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ulrich Broeckel
- Individualized Medicine Institute, Medical College of Wisconsin, WI 53226, USA
| | - Lisa de las Fuentes
- Cardiovascular Division Department of Medicine, Cardiovascular Imaging and Clinical Research Core Laboratory, Washington University School of Medicine 63110, St. Louis, MO, USA
| | - Steven C. Hunt
- Cardiovascular Genetics Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Michael A. Province
- Division of Statistical Genomics, Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - James Cheverud
- Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - D.C. Rao
- Division of Biostatistics, Washington University School of Medicine 63110, St. Louis, MO, USA
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VanWormer JJ, Johnson PJ, Pereira RF, Boucher JL, Britt HR, Stephens CW, Thygeson NM, Graham KJ. The Heart of New Ulm Project: Using Community-Based Cardiometabolic Risk Factor Screenings in a Rural Population Health Improvement Initiative. Popul Health Manag 2012; 15:135-43. [DOI: 10.1089/pop.2011.0027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jeffrey J. VanWormer
- Epidemiology Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
- Department of Education, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Pamela Jo Johnson
- Center for Healthcare Innovation, Allina Hospitals and Clinics, Minneapolis, Minnesota
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Raquel F. Pereira
- Department of Education, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Jackie L. Boucher
- Department of Education, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Heather R. Britt
- Center for Healthcare Innovation, Allina Hospitals and Clinics, Minneapolis, Minnesota
| | - Charles W. Stephens
- New Ulm Medical Center, Allina Hospitals and Clinics, Minneapolis, Minnesota
| | - N. Marcus Thygeson
- Center for Healthcare Innovation, Allina Hospitals and Clinics, Minneapolis, Minnesota
| | - Kevin J. Graham
- Minneapolis Heart Institute, Allina Hospitals and Clinics, Minneapolis, Minnesota
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Piñol C, Alegría E, Langham S. Carga epidemiológica y económica de la hipertensión arterial en pacientes con síndrome metabólico en España: un modelo basado en la prevalencia. HIPERTENSION Y RIESGO VASCULAR 2011. [DOI: 10.1016/j.hipert.2011.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Grossniklaus DA, Dunbar SB, Tohill BC, Gary R, Higgins MK, Frediani J. Psychological factors are important correlates of dietary pattern in overweight adults. J Cardiovasc Nurs 2010; 25:450-60. [PMID: 20938248 PMCID: PMC3086895 DOI: 10.1097/jcn.0b013e3181d25433] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND PURPOSE Abdominal obesity, the central distribution of adipose tissue, is a well-established cardiometabolic disease risk factor. The prevalence has steadily increased since 1988, and now more than 50% of adults have abdominal obesity. Psychological distress coupled with increased dietary energy density (ED) may contribute to abdominal obesity. Guided by the stress and coping model, this study examined the relationship between psychological factors (perceived stress and depressive symptoms) and dietary ED in overweight, working adults. The first hypothesis tested if psychological factors explained a significant amount of food and beverage ED variance above that accounted for by demographic factors. The second hypothesis tested if psychological factors explained a significant amount of food and nonalcoholic beverage ED variance above that accounted for by demographic factors. Post hoc analyses compared macronutrient composition and food group pattern between overweight, working adults with and without depressive symptoms. METHODS This descriptive, cross-sectional, correlation study was composed of 87 overweight, working adults (mean age, 41.3 [SD, 10.2] years; mean body mass index, 32.1 [SD, 6.1] kg/m²; 73.6% women; 50.6% African American). Participants completed the Beck Depression Inventory II and Perceived Stress Scale and weighed-3-day-food record analyzed for caloric intake (kilocalories) and weight (in grams) of consumed foods and beverages that were used to calculate ED (in kilocalories/gram). Height and weight were measured to calculate body mass index. Descriptive statistics, Mann-Whitney U test, and sequential regression modeling were used for data analysis. RESULTS Depressive symptoms were reported by 21.9% of participants and explained variance in food and beverage ED above that accounted for by African American race and reporting adequate caloric intake. Depressive symptoms explained variance in food and nonalcoholic beverage ED above that accounted for male sex, African American race, and reporting adequate caloric intake. Perceived stress and depressive symptoms were positively correlated; however, perceived stress was not a significant predictor of food and beverage ED. CONCLUSIONS Depressive symptoms, potentially modifiable, were 4 times that found in the general population and independently predicted increased food and beverage ED. Further research is needed to determine if improvements in depressive symptoms alter dietary ED, potentially reducing cardiometabolic disease risk.
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Davila EP, Florez H, Fleming LE, Lee DJ, Goodman E, LeBlanc WG, Caban-Martinez AJ, Arheart KL, McCollister KE, Christ SL, Clark JC, Clarke T. Prevalence of the metabolic syndrome among U.S. workers. Diabetes Care 2010; 33:2390-5. [PMID: 20585004 PMCID: PMC2963500 DOI: 10.2337/dc10-0681] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Differences in the prevalence of cardiovascular disease (CVD) and its risk factors among occupational groups have been found in several studies. Certain types of workers (such as shift workers) may have a greater risk for metabolic syndrome, a precursor of CVD. The objective of this study was to assess the differences in prevalence and risk of metabolic syndrome among occupational groups using nationally representative data of U.S. workers. RESEARCH DESIGN AND METHODS Data from 8,457 employed participants (representing 131 million U.S. adults) of the 1999-2004 National Health and Nutrition Examination Survey were used. Unadjusted and age-adjusted prevalence and simple and multiple logistic regression analyses were conducted, adjusting for several potential confounders (BMI, alcohol drinking, smoking, physical activity, and sociodemographic characteristics) and survey design. RESULTS Of the workers, 20% met the criteria for the metabolic syndrome, with "miscellaneous food preparation and food service workers" and "farm operators, managers, and supervisors" having the greatest age-adjusted prevalence (29.6-31.1%) and "writers, artists, entertainers, and athletes," and "engineers, architects, scientists" the lowest (8.5-9.2%). In logistic regression analyses "transportation/material moving" workers had significantly greater odds of meeting the criteria for metabolic syndrome relative to "executive, administrative, managerial" professionals (odds ratio 1.70 [95% CI 1.49-2.52]). CONCLUSIONS There is variability in the prevalence of metabolic syndrome by occupational status, with "transportation/material moving" workers at greatest risk for metabolic syndrome. Workplace health promotion programs addressing risk factors for metabolic syndrome that target workers in occupations with the greatest odds may be an efficient way to reach at-risk populations.
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Affiliation(s)
- Evelyn P Davila
- Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, Florida, USA.
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Bo Hu, Fu AZ. Predicting Utility for Joint Health States: A General Framework and a New Nonparametric Estimator. Med Decis Making 2010; 30:E29-39. [DOI: 10.1177/0272989x10374508] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Measuring utility is important in clinical decision making and cost-effectiveness analysis because utilities are often used to compute quality-adjusted life expectancy, a metric used in measuring the effectiveness of health care programs and medical interventions. Predicting utility for joint health states has become an increasingly valuable research topic because of the aging of the population and the increasing prevalence of comorbidities. Although multiplicative, minimum, and additive estimators are commonly used in practice, research has shown that they are all biased. In this study, the authors propose a general framework for predicting utility for joint health states. This framework includes these 3 nonparametric estimators as special cases. A new simple nonparametric estimator, the adjusted decrement estimator, [Uij = Umin - Umin (1 - Ui )(1 - Uj )], is introduced under the proposed framework. When applied to 2 independent data sources, the new nonparametric estimator not only generated unbiased prediction of utilities for joint health states but also had the least root mean squared error and highest concordance when compared with other nonparametric and parametric estimators. Further research and validation of this new estimator are needed.
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Affiliation(s)
- Bo Hu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Alex Z. Fu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH,
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Hospitalization costs associated with hypertension as a secondary diagnosis among insured patients aged 18-64 years. Am J Hypertens 2010; 23:275-81. [PMID: 20010701 DOI: 10.1038/ajh.2009.241] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND We estimated the hospitalization costs associated with hypertension as a secondary diagnosis among insured adults aged 18-64 years by using data from 2005 MarketScan Commercial Claims and Encounters (CCAE) inpatient admissions. METHODS We analyzed costs for four patient groups (N = 455,944): (i) all selected patients; (ii) patients with the primary diagnosis of ischemic heart disease (IHD); (iii) patients with the primary diagnosis of cerebrovascular disease; and (iv) patients with neither IHD nor cerebrovascular disease as the primary diagnosis. We conducted propensity score matching to control possible bias in cost estimates due to sample selections and estimated the costs of hypertension by using a regression model on the matched populations that controlled for subjects' age, sex, length of hospital stay, Charlson comorbidity index (CCI), region of residence, and urbanization of residence. RESULTS For all patients with hypertension as a secondary diagnosis, the estimated average annual hospitalization cost per patient was $21,094, of which $2,734 (13%; P < 0.01) was associated with hypertension. The estimated average costs were $31,106 for patients with a primary diagnosis of IHD, $17,298 for those with a primary diagnosis of cerebrovascular disease, and $18,693 for those without a primary diagnosis of IHD or cerebrovascular disease; hypertension-associated costs for these patients were $3,540 (11.4%; P < 0.01), $1,133 (6.5%; P < 0.01), and $2,254 (12.1%; P < 0.01), respectively. CONCLUSIONS Hypertension-associated hospitalization costs are substantial among insured US patients aged 18-64 years with hypertension as a secondary diagnosis and suggest a need for cost-effective programs to prevent, manage, and control hypertension.
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Belletti DA, Zacker C, Wogen J. Effect of cardiometabolic risk factors on hypertension management: a cross-sectional study among 28 physician practices in the United States. Cardiovasc Diabetol 2010; 9:7. [PMID: 20122170 PMCID: PMC2824690 DOI: 10.1186/1475-2840-9-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 02/01/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This cross-sectional study sought to determine the prevalence of cardiometabolic risk factor clusters (CMRFCs) and their effect on BP control among hypertensive patients from 28 US physician practices. METHODS Each participating practice identified a random sample of 150-300 adults aged >or= 18 years diagnosed with hypertension. The primary outcome variable was BP control (BP < 140/90 mmHg for non-diabetic and <130/80 mmHg for diabetic patients). CMRFCs included hypertension in addition to obesity, dyslipidemia, and diabetes. RESULTS Overall, 6,527 hypertensive patients were identified for study inclusion. More than half (54.3%) were female, and mean age was 64.7 years. Almost half (48.7%) were obese (BMI >or= 30 kg/m2). About 1 in every 4 patients (25.3%) had diabetes, and 60.7% had dyslipidemia. Mean blood pressure was 132.5/77.9 mmHg, and 55.0% of all patients had controlled BP; 62.4% of non-diabetic patients, and 33.3% of diabetic hypertensive patients, had BP controlled to recommended levels. Most (81.7%) hypertensive patients had >or= 1 cardiometabolic risk factor, and 12.2% had all 3 risk factors. As compared to hypertensive patients without additional risk factors, adjusted odds ratios for BP control were significantly lower for all combinations of CMRFCs (ORs 0.15-0.83, all p < 0.04), with the exception of patients who had only dyslipidemia in addition to hypertension (OR = 1.09, p = NS). Prescriber adherence to recommended hypertension treatment guidelines for patients with diabetes, heart failure, or prior myocardial infarction was high. Although patients with risk factors were prescribed more antihypertensive medications than those without, hypertensive patients with all 3 risk factors were prescribed a mean of 2.4 antihypertensive medications compared to 1.7 for those with no risk factors; odds of BP control in these patients, however, was 0.23 [95% CI 0.19-0.29] that of patients with no other CMRFCs. CONCLUSIONS Across 28 US practices, only 18% of hypertensive patients did not have any additional cardiometabolic risk factors. The high prevalence of CMRFCs presents a challenge to effective hypertension management.
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Affiliation(s)
- Daniel A Belletti
- Evidence-Based Medicine, Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936, USA
| | - Christopher Zacker
- Evidence-Based Medicine, Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936, USA
| | - Jenifer Wogen
- MedMentis Consulting LLC, 145 Waughaw Rd, Towaco, NJ 07082, USA
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Rodbard HW, Fox KM, Grandy S. Impact of obesity on work productivity and role disability in individuals with and at risk for diabetes mellitus. Am J Health Promot 2009; 23:353-60. [PMID: 19445439 DOI: 10.4278/ajhp.081010-quan-243] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Evaluate work absence, work productivity, and disruption of work, social, and family life among individuals of varying body mass index (BMI) with or at risk for diabetes mellitus. DESIGN Cross-sectional analysis of survey data. SETTING Community-based U.S. population. SUBJECTS Respondents (n = 15,132; n = 7338 working adults) participating in the U.S. Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD) study were stratified by combinations of BMI (i.e., > or = 30 kg/m2 [obese], 25 to 29.9 kg/ m2 [overweight], and < 25 kg/m2 [normal weight]) and diabetes (i.e., type 2 diabetes mellitus [T2DM], type 1 diabetes mellitus [T1DM], and high risk [HR] or low risk [LR] of T2DM). MEASURES Work impairment was measured using the Work Productivity and Activity Impairment Questionnaire: General Health. Disruption in life was measured using the Sheehan Disability Scale. HR was defined as 3 to 5 of the following factors: abdominal obesity, BMI > or = 28 kg/m2, reported diagnosis of "cholesterol problems,"reported diagnosis of "hypertension, "or history of coronary heart disease or stroke. LR was defined as < or = 2 of these factors. RESULTS Percentage of work impairment and proportion with severe disruption of work, family, and social life increased systematically from normal weight to obese (p < .001). Obese individuals had the greatest impairment at work (11%-15% of work time), greatest impairment of daily activities (20 %-34% of time), and greatest overall impairment (11%-15% of time) in the LR, HR, and T2DM groups. Obesity and T2DM were independent predictors of overall work impairment and life disruption (p < .001). Between 5% and 7% of total variance was explained in the regression models with BMI category, diabetes/risk group, age, gender, race, income, and household size as variables. CONCLUSION; Greatest impairment of work and daily activities was evident among obese individuals for all groups.
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Affiliation(s)
- Helena W Rodbard
- Endocrine and Metabolic Consultants, LLC, Rockville, Maryland, USA
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The prevalence of metabolic syndrome in an employed population and the impact on health and productivity. J Occup Environ Med 2009; 50:1139-48. [PMID: 18849759 DOI: 10.1097/jom.0b013e318188b8eb] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the prevalence of metabolic syndrome in an employed population and its association with health risks, health perception, illness days, work limitation (presenteeism), and short-term disability (STD). METHODS Five thousand five hundred twelve employees of a financial services company responded to an on-site health risk appraisal which included measured waist circumference and biometric results. The metabolic syndrome criteria were based on the 2005 AHA/NHLBI scientific statement on the diagnosis and management of metabolic syndrome. Perceived health, illness days, and presenteeism were self-reported; STD days were obtained from claims data. RESULTS In this employee population (61% women, average age 41 years), 22.6% met the criteria for metabolic syndrome and were more likely to report more health risks, poorer health perception, and more absent days due to illness. There was no clear association with presenteeism or STD incidence. However, as the number of metabolic risk factors increased, there was an increase in STD incidence, decrease in health perception, and increase in illness days. No association was found with number of metabolic risk factors and presenteeism. CONCLUSIONS Metabolic syndrome was associated with poor perceived health, increased illness days, and an increased trend of STD incidence. Worksite health promotion programs could be useful in helping employees and employers to identify metabolic syndrome risks and take steps to reduce risk and potential productivity losses.
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Rappange DR, Brouwer WBF, Hoogenveen RT, Van Baal PHM. Healthcare costs and obesity prevention: drug costs and other sector-specific consequences. PHARMACOECONOMICS 2009; 27:1031-1044. [PMID: 19908927 DOI: 10.2165/11319900-000000000-00000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Obesity is a major contributor to the overall burden of disease (also reducing life expectancy) and associated with high medical costs due to obesity-related diseases. However, obesity prevention, while reducing obesity-related morbidity and mortality, may not result in overall healthcare cost savings because of additional costs in life-years gained. Sector-specific financial consequences of preventing obesity are less well documented, for pharmaceutical spending as well as for other healthcare segments. OBJECTIVE To estimate the effect of obesity prevention on annual and lifetime drug spending as well as other sector-specific expenditures, i.e. the hospital segment, long-term care segment and primary healthcare. METHODS The RIVM (Dutch National Institute for Public Health and the Environment) Chronic Disease Model and Dutch cost of illness data were used to simulate, using a Markov-type model approach, the lifetime expenditures in the pharmaceutical segment and three other healthcare segments for a hypothetical cohort of obese (body mass index [BMI] >or=30 kg/m2), non-smoking people with a starting age of 20 years. In order to assess the sector-specific consequences of obesity prevention, these costs were compared with the costs of two other similar cohorts, i.e. a 'healthy-living' cohort (non-smoking and a BMI >or=18.5 and <25 kg/m2) and a smoking cohort. To assert whether preventing obesity results in cost savings in any of the segments, net present values were estimated using different discount rates. Sensitivity analyses were conducted across key input values and using a broader definition of healthcare. RESULTS Lifetime drug expenditures are higher for obese people than for 'healthy-living' people, despite shorter life expectancy for the obese. Obesity prevention results in savings on drugs for obesity-related diseases until the age of 74 years, which outweigh additional drug costs for diseases unrelated to obesity in life-years gained. Furthermore, obesity prevention will increase long-term care expenditures substantially, while savings in the other healthcare segments are small or non-existent. Discounting costs more heavily or using lower relative mortality risks for obesity would make obesity prevention a relatively more attractive strategy in terms of healthcare costs, especially for the long-term care segment. Application of a broader definition of healthcare costs has the opposite effect. CONCLUSIONS Obesity prevention will likely result in savings in the pharmaceutical segment, but substantial additional costs for long-term care. These are important considerations for policy makers concerned with the future sustainability of the healthcare system.
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Affiliation(s)
- David R Rappange
- Erasmus University Medical Centre, Department of Health Policy & Management and Institute for Medical Technology Assessment, Rotterdam, the Netherlands.
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Sullivan PW, Ghushchyan V, Ben-Joseph RH. The effect of obesity and cardiometabolic risk factors on expenditures and productivity in the United States. Obesity (Silver Spring) 2008; 16:2155-62. [PMID: 19186336 DOI: 10.1038/oby.2008.325] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the effect of obesity and cardiometabolic risk factors on medical expenditures and missed work days. METHODS AND PROCEDURES The 2000 and 2002 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the US population, was used to estimate the marginal effect of obesity (BMI > or = 30) on annual per-person medical expenditures and missed work days for patients with diabetes, dyslipidemia, or hypertension using multivariate regression methods controlling for age, sex, race, ethnicity, education, income, insurance, and smoking status. Maximum Likelihood Heckman Selection with Smearing retransformation was used to assess medical expenditures, and Negative Binomial regression was used for missed work days. RESULTS Normal weight individuals with diabetes, dyslipidemia, or hypertension had significantly greater medical expenditures than those without the respective condition ($6,006 (5,124-6,887), $4,760 (4,102-5,417), $3,911 (3,345-4,476)) and obesity significantly exacerbated this effect ($7,986 (7,397-8,574), $7,636 (7,072-8,200), $6,197 (5,745-6,649); $2007; all P < 0.05). In addition, diabetes, dyslipidemia, and hypertension resulted in greater missed work days (3.1 (0.94-6.21), 3.2 (0.42-7.91), 1.4 (0.0-3.52)) (all P < 0.05 except hypertension), which resulted in greater lost productivity ($433, $451, $199) and obesity significantly exacerbated the deleterious effect on work days (8.7 (4.44-15.2), 5.5 (2.18-10.5), 4.5 (2.92-6.34)) and lost productivity ($1,217, $763, $622) (all P < 0.05). In addition, medical expenditures increased for increasing weight category and increasing number of risk factors. DISCUSSION Obesity significantly exacerbates the deleterious effect of diabetes, dyslipidemia, and hypertension on medical expenditures and productivity loss in the United States. Obesity is preventable and public health efforts need to be undertaken to prevent its alarming increase in order to reduce the incidence and effect of cardiometabolic risk factors.
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Affiliation(s)
- Patrick W Sullivan
- Department of Clinical Pharmacy, University of Colorado at Denver, Colorado, USA.
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van Baal PHM, Polder JJ, de Wit GA, Hoogenveen RT, Feenstra TL, Boshuizen HC, Engelfriet PM, Brouwer WBF. Lifetime medical costs of obesity: prevention no cure for increasing health expenditure. PLoS Med 2008; 5:e29. [PMID: 18254654 PMCID: PMC2225430 DOI: 10.1371/journal.pmed.0050029] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 11/30/2007] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Obesity is a major cause of morbidity and mortality and is associated with high medical expenditures. It has been suggested that obesity prevention could result in cost savings. The objective of this study was to estimate the annual and lifetime medical costs attributable to obesity, to compare those to similar costs attributable to smoking, and to discuss the implications for prevention. METHODS AND FINDINGS With a simulation model, lifetime health-care costs were estimated for a cohort of obese people aged 20 y at baseline. To assess the impact of obesity, comparisons were made with similar cohorts of smokers and "healthy-living" persons (defined as nonsmokers with a body mass index between 18.5 and 25). Except for relative risk values, all input parameters of the simulation model were based on data from The Netherlands. In sensitivity analyses the effects of epidemiologic parameters and cost definitions were assessed. Until age 56 y, annual health expenditure was highest for obese people. At older ages, smokers incurred higher costs. Because of differences in life expectancy, however, lifetime health expenditure was highest among healthy-living people and lowest for smokers. Obese individuals held an intermediate position. Alternative values of epidemiologic parameters and cost definitions did not alter these conclusions. CONCLUSIONS Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.
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Affiliation(s)
- Pieter H M van Baal
- National Institute for Public Health and the Environment (RIVM), Centre for Prevention and Health Services Research, Bilthoven, The Netherlands.
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