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Hong SN, Lai FTT, Wang B, Choi EPH, Wong ICK, Lam CLK, Wan EYF. Age-specific Multimorbidity Patterns and Burden on All-Cause Mortality and Public Direct Medical Expenditure: A Retrospective Cohort Study. J Epidemiol Glob Health 2024:10.1007/s44197-024-00256-y. [PMID: 38869775 DOI: 10.1007/s44197-024-00256-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVE To evaluate age-specific multimorbidity patterns and morbidity burden on mortality and healthcare expenditure across age groups. PATIENTS AND METHODS Retrospective observational study between January 1, 2009 to December 31, 2017 using electronic health records in Hong Kong: Individuals were stratified by age (< 50, 50-64, 65-79, ≥ 80), and sub-classified by number of morbidities (0, 1, 2, 3, ≥ 4) out of 21 common chronic conditions. Clustering analyses were conducted to identify specific patterns of multimorbidity. Association between the number as well as combinations of morbidities and all-cause mortality and public expenditure was examined. RESULTS 4,562,832 individuals with a median follow-up of 7 years were included. Mental disorders were the top morbidities among young individuals, while cardiovascular diseases were prevalent in the elderly. An increased number of morbidities was associated with a greater relative risk for mortality and medical expenditure, and this relationship was stronger among younger patients. Compared to individuals in the same age group without morbidity, the hazard ratios (HR; 95% CI) of all-cause mortality in patients aged < 50 and ≥ 80 with two comorbidities 3.81 (3.60-4.03) and 1.38 (1.36-1.40), respectively, which increased to 14.22 (9.87-20.47) and 2.20 (2.13-2.26), respectively, as the number of morbidities increased to ≥ 4. The stroke-hypertension cluster was shown to be associated with the highest HR of mortality 2.48 (2.43-2.53) among all identified clusters arising from the clustering analysis. CONCLUSION Given the stronger association between multimorbidity and all-cause mortality and greater opportunity costs in younger populations, prevention and management of early-onset multimorbidity are warranted. (248 words).
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Affiliation(s)
- Sabrina Nan Hong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Francisco Tsz Tsun Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong Science Park, Hong Kong SAR, China
| | - Boyuan Wang
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong Science Park, Hong Kong SAR, China
- Aston Pharmacy School, Aston University, Birmingham B4 7ET, United Kingdom
- School of Pharmacy, Medical Sciences Division, Macau University of Science and Technology, Macau, Macau SAR
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Family Medicine, the University of Hong Kong Shenzhen Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
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Oliveira FEG, Griep RH, Chor D, Barreto SM, Molina MDCB, Machado LAC, Fonseca MDJMD, Bastos LS. Racial inequalities in the development of multimorbidity of chronic conditions: results from a Brazilian prospective cohort. Int J Equity Health 2024; 23:120. [PMID: 38867238 PMCID: PMC11170781 DOI: 10.1186/s12939-024-02201-8] [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: 03/31/2024] [Accepted: 05/21/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The occurrence of multimorbidity and its impacts have differentially affected population subgroups. Evidence on its incidence has mainly come from high-income regions, with limited exploration of racial disparities. This study investigated the association between racial groups and the development of multimorbidity and chronic conditions in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS Data from self-reported white, brown (pardos or mixed-race), and black participants at baseline of ELSA-Brasil (2008-2010) who were at risk for multimorbidity were analysed. The development of chronic conditions was assessed through in-person visits and self-reported diagnosis via telephone until the third follow-up visit (2017-2019). Multimorbidity was defined when, at the follow-up visit, the participant had two or more morbidities. Cumulative incidences, incidence rates, and adjusted incidence rate ratios (IRRs) were estimated using Poisson models. RESULTS Over an 8.3-year follow-up, compared to white participants: browns had a 27% greater incidence of hypertension and obesity; and blacks had a 62% and 45% greater incidence, respectively. Blacks also had 58% more diabetes. The cancer incidence was greater among whites. Multimorbidity affected 41% of the participants, with a crude incidence rate of 57.5 cases per 1000 person-years (ranging from 56.3 for whites to 63.9 for blacks). Adjusted estimates showed a 20% higher incidence of multimorbidity in black participants compared to white participants (IRR: 1.20; 95% CI: 1.05-1.38). CONCLUSIONS Significant racial disparities in the risk of chronic conditions and multimorbidity were observed. Many associations revealed a gradient increase in illness risk according to darker skin tones. Addressing fundamental causes such as racism and racial discrimination, alongside considering social determinants of health, is vital for comprehensive multimorbidity care. Intersectoral, equitable policies are essential for ensuring health rights for historically marginalized groups.
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Affiliation(s)
| | - Rosane Härter Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
| | - Dora Chor
- Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, 4365 Brazil Avenue, Manguinhos, Rio de Janeiro, 21040900, Brazil
| | - Sandhi Maria Barreto
- Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Luciana A C Machado
- Clinical Hospital/EBSERH, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Executive Office, Science Integrity Alliance, Sunrise, Florida, US
| | - Maria de Jesus Mendes da Fonseca
- Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, 4365 Brazil Avenue, Manguinhos, Rio de Janeiro, 21040900, Brazil
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Osibogun O, Li W, Jebai R, Kalan ME. Cigarettes and e-cigarettes use among US adults with multimorbidity. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100231. [PMID: 38665253 PMCID: PMC11043839 DOI: 10.1016/j.dadr.2024.100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Background Tobacco use leads to multiple illnesses. Yet, the effects of different categories of tobacco use on multimorbidity remain understudied. We investigated the associations between tobacco use categories and multimorbidity and the potential moderating effects of age, sex, or race/ethnicity among adults in the United States. Methods We conducted a cross-sectional analysis using pooled data from the Behavioral Risk Factor Surveillance System for the years 2020-2022. Multimorbidity was ascertained through self-reported ≥2 chronic health conditions. We categorized tobacco use into nine derived from nonuse (did not use e-cigarettes or cigarettes), former cigarette or e-cigarette use, current (used on some days/everyday) cigarette use or e-cigarette use, or both (dual use). We used multinomial logistic regression to investigate the associations while accounting for potential confounding factors. Results Within the sample (N=1,080,257), 28.2% reported multimorbidity. For the categories examined (former exclusive e-cigarette, exclusive e-cigarette, former exclusive cigarette, former dual, former cigarette/current e-cigarette, exclusive cigarette, current cigarette/former e-cigarette and dual use), all reported higher odds of having multimorbidity compared to those who reported nonuse of both e-cigarettes and cigarettes. We found significant interactions for age, sex and race/ethnicity with the tobacco use categories for multimorbidity (p<0.01), where stronger associations were observed among younger adults, females and non-Hispanic Multiracial for current dual use (p<0.05). Conclusions The use of cigarettes, e-cigarettes, or both was associated with multimorbidity among adults, which was more pronounced among younger adults, females and non-Hispanic Multiracial. These findings underscore the importance of implementing targeted public health interventions to mitigate the health risks associated with using both products, particularly among specific demographics, to reduce the prevalence of multimorbidity.
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Affiliation(s)
- Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Wei Li
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Rime Jebai
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA, USA
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Oehrlein EM, Schoch S, Majercak K, Gressler LE, Costantino RC, Love TR, Perfetto EM. Development and Testing of a Chronic-Disease Patient Experience Mapping Toolbox. THE PATIENT 2024; 17:263-274. [PMID: 38172406 DOI: 10.1007/s40271-023-00658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Stakeholders increasingly expect research and care delivery to be guided by and to optimize patient experiences. However, standardized tools to engage patients to gather high-quality data about their experiences, priorities, and desired outcomes are not publicly available. The objective of this study was to develop and test a Toolbox with a disease-agnostic interview guide template and accompanying resources to assist researchers in engaging patients living with chronic disease in a dialogue about their experiences. METHODS Guided by a multidisciplinary workgroup, a targeted literature review (PubMed) was conducted, followed by group discussions to identify/thematically organize patient experience concepts, development of a conceptual model, and drafting of an interview guide template and patient-facing visual. Materials were tested/refined via cognitive (n = 5) and pilot (n = 30) interviews conducted virtually with US patients diagnosed with chronic/potentially disabling conditions from December 2020 to April 2021. Patient-facing tools were reviewed by health literacy experts for applicability/accessibility. English-speaking adults who self-reported receiving a chronic condition diagnosis at least 6 months prior participated in a 60-90 min interview. RESULTS Patient experience concepts were organized thematically under three domains: (1) life before a diagnosis, (2) experiences getting a diagnosis, and (3) experiences living with a diagnosis. A plain language consent sheet template, interview guide template, and patient experience conceptual model were developed and revised based on input from interviewees, interviewers, and the workgroup. CONCLUSIONS A disease-agnostic patient-engagement Toolbox was developed and tested to capture patient experience data. These materials can be customized based on study objectives and leveraged by various stakeholders to identify opportunities to enhance the patient centricity of healthcare delivery and research.
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Affiliation(s)
- Elisabeth M Oehrlein
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA.
- Applied Patient Experience, LLC, 2201 Wisconsin Ave NW, Suite 200, Washington, DC, 20007, USA.
| | - Silke Schoch
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
| | - Kelsie Majercak
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
| | - Laura Elisabeth Gressler
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
| | - Ryan C Costantino
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
| | - T Rosie Love
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
- Enterprise Intelligence and Data Solutions Program Management Office, Program Executive Office, Defense Healthcare Management Systems, 1700 North Moore Street, Suite 2300, Arlington, VA, 22209, USA
| | - Eleanor M Perfetto
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
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Ren K, Tao Y, Wang M. The association between intensity-specific physical activity and the number of multiple chronic diseases among Chinese elderly: A study based on the China Health and Retirement Longitudinal study (CHARLS). Prev Med Rep 2024; 41:102714. [PMID: 38586467 PMCID: PMC10995969 DOI: 10.1016/j.pmedr.2024.102714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024] Open
Abstract
Background With ageing, the elderly are facing a complex situation where multiple chronic diseases coexist. This paper aims to investigate the effect of intensity-specific physical activity on the number of multiple chronic diseases in the elderly. Methods Our data came from wave 4 of the China Health and Retirement Longitudinal Survey (CHARLS), which involved 10,341 residents aged ≥ 60 years. The intensity-specific physical activity was divided into two categories: moderate-intensity physical activity (MPA) lasting ≥ 150 min/week and vigorous-intensity physical activity (VPA) lasting ≥ 75 min/week. Data on 14 types of chronic diseases were collected. Propensity score matching (PSM) with controlling nine confounding factors were used to analyse the effects of intensity-specific physical activity. Results Among 10,341 samples, 40.12% of the elderly often participated in MPA and 25.72% participated in VPA. The PSM results showed that performing 150 min/week of MPA leads to 0.0675(P<0.05) fewer multiple chronic diseases than not achieving this standard, and VPA up to 75 min/week leads to 0.0785(P<0.05) fewer multiple chronic disease than that does not meet this criterion. Additionally, VPA is more effective than MPA. Conclusion Both MPA of at least 150 min/week and VPA of at least 75 min/week can significantly reduce the number of multiple chronic diseases in elderly. Elderly people should increase their exercise intensity as much as possible while ensuring safety.
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Affiliation(s)
- Kexin Ren
- College of Physical Education, Jilin Normal University, Siping City, Jilin Province, China
| | - Yuan Tao
- College of Mathematics and Computer, Jilin Normal University, Siping City, Jilin Province, China
| | - Meihong Wang
- College of Physical Education, Jilin Normal University, Siping City, Jilin Province, China
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McGovern I, Cappell K, Bogdanov AN, Haag MDM. Number of Influenza Risk Factors Informs an Adult's Increased Potential of Severe Influenza Outcomes: A Multiseason Cohort Study From 2015 to 2020. Open Forum Infect Dis 2024; 11:ofae203. [PMID: 38737426 PMCID: PMC11083624 DOI: 10.1093/ofid/ofae203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Background While studies have evaluated factors influencing the risk of severe influenza outcomes, there is limited evidence on the additive impact of having multiple influenza risk factors and how this varies by age. Methods Patients ≥18 years of age in the United States were evaluated retrospectively in 5 seasonal cohorts during the 2015-2020 influenza seasons. Patient-level electronic medical records linked to pharmacy and medical claims were used to ascertain covariates and outcomes. Multivariable logistic regression models were fitted for the overall population and by age subgroups to evaluate the association of demographic and clinical characteristics with odds of influenza-related medical encounters (ICD-10 codes J09*-J11*). The logistic regression models included sex, race/ethnicity, geographic region, baseline health care resource use, vaccination status, specific high-risk comorbidities, number of influenza risk factors, body mass index, and smoking status. Odds ratios from each of the 5 seasons were summarized via fixed effect meta-analysis. Results Season cohort sizes ranged from 887 260 to 3 628 168 adults. Of all patient characteristics evaluated, an individual's cumulative number of high-risk influenza conditions, as defined per the Centers for Disease Control and Prevention, was the most predictive of an increased probability of having an influenza-related medical encounter overall and across age groups. For adults of any age, odds ratios for influenza hospitalization ranged from 1.8 (95% CI, 1.7-2.0) for 1 risk factor to 6.4 (95% CI, 5.8-7.0) for ≥4 risk factors. Conclusions These results show that a simple measure such as the number of influenza risk factors can be highly informative of an adult's potential for severe influenza outcomes.
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Affiliation(s)
- Ian McGovern
- CSL Seqirus, Center for Outcomes Research and Epidemiology, Waltham, Massachusetts, USA
| | | | | | - Mendel D M Haag
- CSL Seqirus, Center for Outcomes Research and Epidemiology, Amsterdam, the Netherlands
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Pradhan P, Wen W, Shrubsole M, Steinwandel M, Han X, Powers AC, Lipworth L, Zheng W. Association of cardiometabolic comorbidities with mortality among low-income Black and White Americans. J Natl Med Assoc 2024; 116:189-201. [PMID: 38296693 DOI: 10.1016/j.jnma.2024.01.009] [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: 10/25/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 02/02/2024]
Abstract
METHODS Investigated the association of multiple cardiometabolic comorbidities with total/major cause-specific mortality and evaluate if this association might be modified by race among predominantly low-income Black and White participants. METHODS The Southern Community Cohort Study, prospective cohort study. Participants (40-79 years) recruited predominantly from community health centers across 12 states in southeastern United States. Enrollment began in 2002 and concluded in 2009, follow-up until 2020. Cardiometabolic comorbidities (diabetes, hypertension, myocardial infarction, stroke) ascertained at the baseline survey. Cox proportional hazard models used. RESULTS Study included 76,721 participants; 16,197, 41,944, 5,247, and 4,919 participants with prior diagnosis of diabetes, hypertension, myocardial infarction, and stroke, respectively at baseline. Compared to individuals with no comorbidity, individuals with any single comorbidity experienced a significantly 30 to 90% increased rate of death due to any causes. The increase in mortality was elevated with an increasing number of comorbidities, with HR of 3.81 (95% CI: 3.26-4.46) and a cumulative risk of 62.5% at age 75 years for total mortality for those with four comorbidities. The risk was high for death due to cardiovascular diseases (HR: 6.18, 95% CI: 5.12-7.47). These associations were stronger among Blacks than Whites. Individuals with four comorbidities at age 40 years were estimated to have a 16-year loss in life expectancy compared with those without any comorbidity. CONCLUSION Cardiometabolic comorbidities were associated with increases in all-cause and major cause-specific mortality, particularly Black Americans. This study calls for effective measures to prevent cardiometabolic comorbidities to reduce premature deaths in underserved Americans.
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Affiliation(s)
- Pranoti Pradhan
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN, 37232 USA
| | - Wanqing Wen
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN, 37232 USA
| | - Martha Shrubsole
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN, 37232 USA
| | - Mark Steinwandel
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN, 37232 USA
| | - Xijing Han
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN, 37232 USA
| | - Alvin C Powers
- Division of Diabetes and Endocrinology, Department of Medicine, Vanderbilt University Medical Center, 1301 Medical Center Drive, Nashville, TN, 37232 USA
| | - Loren Lipworth
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN, 37232 USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN, 37232 USA.
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Jain S, Rosenbaum PR, Reiter JG, Ramadan OI, Hill AS, Silber JH, Fleisher LA. Assessing the Ambulatory Surgery Center Volume-Outcome Association. JAMA Surg 2024; 159:397-403. [PMID: 38265816 PMCID: PMC10809135 DOI: 10.1001/jamasurg.2023.7161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/01/2023] [Indexed: 01/25/2024]
Abstract
Importance In surgical patients, it is well known that higher hospital procedure volume is associated with better outcomes. To our knowledge, this volume-outcome association has not been studied in ambulatory surgery centers (ASCs) in the US. Objective To determine if low-volume ASCs have a higher rate of revisits after surgery, particularly among patients with multimorbidity. Design, Setting, and Participants This matched case-control study used Medicare claims data and analyzed surgeries performed during 2018 and 2019 at ASCs. The study examined 2328 ASCs performing common ambulatory procedures and analyzed 4751 patients with a revisit within 7 days of surgery (defined to be either 1 of 4735 revisits or 1 of 16 deaths without a revisit). These cases were each closely matched to 5 control patients without revisits (23 755 controls). Data were analyzed from January 1, 2018, through December 31, 2019. Main Outcomes and Measures Seven-day revisit in patients (cases) compared with the matched patients without the outcome (controls) in ASCs with low volume (less than 50 procedures over 2 years) vs higher volume (50 or more procedures). Results Patients at a low-volume ASC had a higher odds of a 7-day revisit vs patients who had their surgery at a higher-volume ASC (odds ratio [OR], 1.21; 95% CI, 1.09-1.36; P = .001). The odds of revisit for patients with multimorbidity were higher at low-volume ASCs when compared with higher-volume ASCs (OR, 1.57; 95% CI, 1.27-1.94; P < .001). Among patients with multimorbidity in low-volume ASCs, for those who underwent orthopedic procedures, the odds of revisit were 84% higher (OR, 1.84; 95% CI, 1.36-2.50; P < .001) vs higher-volume centers, and for those who underwent general surgery or other procedures, the odds of revisit were 36% higher (OR, 1.36; 95% CI, 1.01-1.83; P = .05) vs a higher-volume center. The findings were not statistically significant for patients without multimorbidity. Conclusions and Relevance In this observational study, the surgical volume of an ASC was an important indicator of patient outcomes. Older patients with multimorbidity should discuss with their surgeon the optimal location of their care.
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Affiliation(s)
- Siddharth Jain
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia
| | - Paul R. Rosenbaum
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia
- Department of Statistics and Data Science, The Wharton School, The University of Pennsylvania, Philadelphia
| | - Joseph G. Reiter
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia
| | - Omar I. Ramadan
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia
- Department of Surgery, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia
| | - Alexander S. Hill
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia
| | - Jeffrey H. Silber
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia
- The Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia
| | - Lee A. Fleisher
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia
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Song G, Li W, Ma Y, Xian Y, Liao X, Yang X, Zhang H, Cade JE. Nutrient intake and risk of multimorbidity: a prospective cohort study of 25,389 women. BMC Public Health 2024; 24:696. [PMID: 38439008 PMCID: PMC10913224 DOI: 10.1186/s12889-024-18191-9] [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: 10/09/2023] [Accepted: 02/23/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Multimorbidity is becoming an increasingly serious public health challenge in the aging population. The impact of nutrients on multimorbidity remains to be determined and was explored using data from a UK cohort study. METHOD Our research analysis is mainly based on the data collected by the United Kingdom Women's Cohort Study (UKWCS), which recruited 35,372 women aged 35-69 years at baseline (1995 to 1998), aiming to explore potential associations between diet and chronic diseases. Daily intakes of energy and nutrients were estimated using a validated 217-item food frequency questionnaire at recruitment. Multimorbidity was assessed using the Charlson comorbidity index (CCI) through electronic linkages to Hospital Episode Statistics up to March 2019. Cox's proportional hazards models were used to estimate associations between daily intakes of nutrients and risk of multimorbidity. Those associations were also analyzed in multinomial logistic regression as a sensitivity analysis. In addition, a stratified analysis was conducted with age 60 as the cutoff point. RESULTS Among the 25,389 participants, 7,799 subjects (30.7%) were confirmed with multimorbidity over a median follow-up of 22 years. Compared with the lowest quintile, the highest quintile of daily intakes of energy and protein were associated with 8% and 12% increased risk of multimorbidity respectively (HR 1.08 (95% CI 1.01, 1.16), p-linearity = 0.022 for energy; 1.12 (1.04, 1.21), p-linearity = 0.003 for protein). Higher quintiles of daily intakes of vitamin C and iron had a slightly lowered risk of multimorbidity, compared to the lowest quintile. A significantly higher risk of multimorbidity was found to be linearly associated with higher intake quintiles of vitamin B12 and vitamin D (p-linearity = 0.001 and 0.002, respectively) in Cox models, which became insignificant in multinomial logistic regression. There was some evidence of effect modification by age in intakes of iron and vitamin B1 associated with the risk of multimorbidity (p-interaction = 0.006 and 0.025, respectively). CONCLUSIONS Our findings highlight a link between nutrient intake and multimorbidity risk. However, there is uncertainty in our results, and more research is needed before definite conclusions can be reached.
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Affiliation(s)
- Ge Song
- Department of Clinical Nutrition, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, 710061, Xi'an, China
| | - Weimin Li
- Department of Clinical Nutrition, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, 710061, Xi'an, China
| | - Yanfen Ma
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, 710061, Xi'an, China
| | - Yao Xian
- Department of Clinical Nutrition, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, 710061, Xi'an, China
| | - Xia Liao
- Department of Clinical Nutrition, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, 710061, Xi'an, China
| | - Xueliang Yang
- Department of Clinical Nutrition, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, 710061, Xi'an, China
| | - Huifeng Zhang
- Department of Clinical Nutrition, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, 710061, Xi'an, China.
- School of Food Science and Nutrition, University of Leeds, LS2 9AT, Leeds, UK.
| | - Janet E Cade
- School of Food Science and Nutrition, University of Leeds, LS2 9AT, Leeds, UK
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Jäger M, Zangger G, Bricca A, Dideriksen M, Smith SM, Midtgaard J, Taylor RS, Skou ST. Mapping interventional components and behavior change techniques used to promote self-management in people with multimorbidity: a scoping review. Health Psychol Rev 2024; 18:165-188. [PMID: 36811829 PMCID: PMC7615688 DOI: 10.1080/17437199.2023.2182813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
Ageing populations and improved survival, have contributed to a rise in the number of people living with multimorbidity, raising issues related to polypharmacy, treatment burden, competing priorities and poor coordination of care. Self-management programs are increasingly included as an essential component of interventions to improve outcomes in this population. However, an overview of how interventions supporting self-management in patients with multimorbidity is missing. This scoping review focused on mapping the literature on patient-centered interventions for people living with multimorbidity. We searched several databases, clinical registries, and grey literature for RCTs published between 1990-2019 describing interventions that supported self-management in people with multimorbidity. We included 72 studies that were found to be very heterogeneous when it comes to the population, delivery modes and modalities, intervention elements and facilitators. The results pointed to an extensive use of cognitive behavioral therapy as a basis for interventions, as well as behavior change theories and disease management frameworks. The most coded behavior change techniques stemmed from the categories Social Support, Feedback and monitoring and Goals and Planning. To allow for implementation of effective interventions in clinical practice, improved reporting of intervention mechanisms in RCTs is warranted.
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Affiliation(s)
- Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Danish Centre for Motivation and Behaviour Science, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Graziella Zangger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Mette Dideriksen
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Susan M. Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Rod S. Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, Scotland
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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Gudenkauf LM, Li X, Hoogland AI, Oswald LB, Lmanirad I, Permuth JB, Small BJ, Jim HSL, Rodriguez Y, Bryant CA, Zambrano KN, Walters KO, Reblin M, Gonzalez BD. Feasibility and acceptability of C-PRIME: A health promotion intervention for family caregivers of patients with colorectal cancer. Support Care Cancer 2024; 32:198. [PMID: 38416143 DOI: 10.1007/s00520-024-08395-5] [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: 05/10/2023] [Accepted: 02/18/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE This study aimed to test the feasibility and acceptability of a digital health promotion intervention for family caregivers of patients with advanced colorectal cancer and explore the intervention's preliminary efficacy for mitigating the impact of caregiving on health and well-being. METHODS We conducted a single-arm pilot feasibility trial of C-PRIME (Caregiver Protocol for Remotely Improving, Monitoring, and Extending Quality of Life), an 8-week digital health-promotion behavioral intervention involving monitoring and visualizing health-promoting behaviors (e.g., objective sleep and physical activity data) and health coaching (NCT05379933). A priori benchmarks were established for feasibility (≥ 50% recruitment and objective data collection; ≥ 75% session engagement, measure completion, and retention) and patient satisfaction (> 3 on a 1-5 scale). Preliminary efficacy was explored with pre- to post-intervention changes in quality of life (QOL), sleep quality, social engagement, and self-efficacy. RESULTS Participants (N = 13) were M = 52 years old (SD = 14). Rates of recruitment (72%), session attendance (87%), assessment completion (87%), objective data collection (80%), and retention (100%) all indicated feasibility. All participants rated the intervention as acceptable (M = 4.7; SD = 0.8). Most participants showed improvement or maintenance of QOL (15% and 62%), sleep quality (23% and 62%), social engagement (23% and 69%), and general self-efficacy (23% and 62%). CONCLUSION The C-PRIME digital health promotion intervention demonstrated feasibility and acceptability among family caregivers of patients with advanced colorectal cancer. A fully powered randomized controlled trial is needed to test C-PRIME efficacy, mechanisms, and implementation outcomes, barriers, and facilitators in a divserse sample of family caregivers. TRIAL REGISTRATION The Caregiver Protocol for Remotely Improving, Monitoring, and Extending Quality of Life (C-PRIME) study was registered on clinicaltrials.gov, NCT05379933, in May 2022.
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Affiliation(s)
- Lisa M Gudenkauf
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
| | - Xiaoyin Li
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Iman Lmanirad
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jennifer B Permuth
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Brent J Small
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Yvelise Rodriguez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Crystal A Bryant
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Kellie N Zambrano
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Kerie O Walters
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Maija Reblin
- Department of Family Medicine, University of Vermont, Burlington, VT, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
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12
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Cruz-Ávila HA, Ramírez-Alatriste F, Martínez-García M, Hernández-Lemus E. Comorbidity patterns in cardiovascular diseases: the role of life-stage and socioeconomic status. Front Cardiovasc Med 2024; 11:1215458. [PMID: 38414921 PMCID: PMC10897012 DOI: 10.3389/fcvm.2024.1215458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Abstract
Cardiovascular diseases stand as a prominent global cause of mortality, their intricate origins often entwined with comorbidities and multimorbid conditions. Acknowledging the pivotal roles of age, sex, and social determinants of health in shaping the onset and progression of these diseases, our study delves into the nuanced interplay between life-stage, socioeconomic status, and comorbidity patterns within cardiovascular diseases. Leveraging data from a cross-sectional survey encompassing Mexican adults, we unearth a robust association between these variables and the prevalence of comorbidities linked to cardiovascular conditions. To foster a comprehensive understanding of multimorbidity patterns across diverse life-stages, we scrutinize an extensive dataset comprising 47,377 cases diagnosed with cardiovascular ailments at Mexico's national reference hospital. Extracting sociodemographic details, primary diagnoses prompting hospitalization, and additional conditions identified through ICD-10 codes, we unveil subtle yet significant associations and discuss pertinent specific cases. Our results underscore a noteworthy trend: younger patients of lower socioeconomic status exhibit a heightened likelihood of cardiovascular comorbidities compared to their older counterparts with a higher socioeconomic status. By empowering clinicians to discern non-evident comorbidities, our study aims to refine therapeutic designs. These findings offer profound insights into the intricate interplay among life-stage, socioeconomic status, and comorbidity patterns within cardiovascular diseases. Armed with data-supported approaches that account for these factors, clinical practices stand to be enhanced, and public health policies informed, ultimately advancing the prevention and management of cardiovascular disease in Mexico.
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Affiliation(s)
- Héctor A Cruz-Ávila
- Graduate Program in Complexity Sciences, Autonomous University of México City, México City, Mexico
- Immunology Department, National Institute of Cardiology 'Ignacio Chávez', México City, Mexico
| | | | - Mireya Martínez-García
- Immunology Department, National Institute of Cardiology 'Ignacio Chávez', México City, Mexico
| | - Enrique Hernández-Lemus
- Computational Genomics Division, National Institute of Genomic Medicine, México City, Mexico
- Center for Complexity Sciences, Universidad Nacional Autónoma de México, México City, Mexico
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Li Y, Wu X, Pan J, Gong L, Min D. Hepatocyte steatosis activates macrophage inflammatory response accelerating atherosclerosis development. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023; 52:751-765. [PMID: 38105677 PMCID: PMC10764189 DOI: 10.3724/zdxbyxb-2023-0315] [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: 07/08/2023] [Accepted: 09/15/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES To investigate the mechanism of comorbidity between non-alcoholic fatty liver disease (NAFLD) and atherosclerosis (AS) based on metabolomics and network pharmacology. METHODS Six ApoE-/- mice were fed with a high-fat diet for 16 weeks as a comorbid model of NAFLD and AS (model group). Normal diet was given to 6 wildtype C57BL/6J mice (control group). Serum samples were taken from both groups for a non-targeted metabolomics assay to identify differential metabolites. Network pharmacology was applied to explore the possible mechanistic effects of differential metabolites on AS and NAFLD. An in vitro comorbid cell model was constructed using NCTC1469 cells and RAW264.7 macrophage. Cellular lipid accumulation, cell viability, morphology and function of mitochondria were detected with oil red O staining, CCK-8 assay, transmission electron microscopy and JC-1 staining, respectively. RESULTS A total of 85 differential metabolites associated with comorbidity of NAFLD and AS were identified. The top 20 differential metabolites were subjected to network pharmacology analysis, which showed that the core targets of differential metabolites related to AS and NAFLD were STAT3, EGFR, MAPK14, PPARG, NFKB1, PTGS2, ESR1, PPARA, PTPN1 and SCD. The Kyoto Encyclopedia of Genes and Genomes showed the top 10 signaling pathways were PPAR signaling pathway, AGE-RAGE signaling pathway in diabetic complications, alcoholic liver disease, prolactin signaling pathway, insulin resistance, TNF signaling pathway, hepatitis B, the relax in signaling pathway, IL-17 signaling pathway and NAFLD. Experimental validation showed that lipid metabolism-related genes PPARG, PPARA, PTPN1, and SCD were significantly changed in hepatocyte models, and steatotic hepatocytes affected the expression of macrophage inflammation-related genes STAT3, NFKB1 and PTGS2; steatotic hepatocytes promoted the formation of foam cells and exacerbated the accumulation of lipids in foam cells; the disrupted morphology, impaired function, and increased reactive oxygen species production were observed in steatotic hepatocyte mitochondria, while the formation of foam cells aggravated mitochondrial damage. CONCLUSIONS Abnormal lipid metabolism and inflammatory response are distinctive features of comorbid AS and NAFLD. Hepatocyte steatosis causes mitochondrial damage, which leads to mitochondrial dysfunction, increased reactive oxygen species and activation of macrophage inflammatory response, resulting in the acceleration of AS development.
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Affiliation(s)
- Yue Li
- Department of Cardiology, the First Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110032, China.
| | - Xize Wu
- Department of Critical Care Medicine, Nantong Hospital of Traditional Chinese Medicine, Nantong 226000, Jiangsu Province, China
- Graduate School of Liaoning University of Traditional Chinese Medicine, Shenyang 110847, China
| | - Jiaxiang Pan
- Department of Cardiology, the First Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110032, China
| | - Lihong Gong
- Department of Cardiology, the First Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110032, China.
| | - Dongyu Min
- Experimental Center of Traditional Chinese Medicine, the First Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110032, China.
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14
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Dooley EE, Chen L, Ghazi L, Hornikel B, Martinez-Amezcua P, Palta P, Bowling CB, Muntner P, Lewis CE, Pettee Gabriel K. Multimorbidity is associated with lower total 24-hour movement activity among US adults. Prev Med Rep 2023; 36:102483. [PMID: 37954962 PMCID: PMC10632122 DOI: 10.1016/j.pmedr.2023.102483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/28/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
Objective Having chronic conditions may result in reduced physical and cognitive function but less is known about multimorbidity with daily movement. We examined the association of multimorbidity and device-measured total daily movement in a nationally representative sample of US adults aged ≥ 30 years from the 2011-2014 National Health and Nutrition Examination Surveys. Methods Any multimorbidity (≥2 conditions) and complex multimorbidity (≥3 conditions across ≥ 3 body systems) were quantified using 16 chronic conditions via self-report and/or clinical thresholds. Total movement over 24-hours (Monitor-Independent Movement Summary units [MIMS-units]) was measured using a wrist-worn device (ActiGraph GT3X). Multivariable linear regression examined the association of 1) each chronic condition, 2) number of conditions, 3) any multimorbidity, and 4) complex multimorbidity with total movement. Covariates included age, gender, race/ethnicity, educational attainment, and smoking status. Results Among US adults (N = 7304, mean age: 53.2 ± 0.34 years, 53.2% female, 69.4% Non-Hispanic White), 62.2% had any multimorbidity with 34.2% having complex multimorbidity. After adjustment, a higher number of chronic conditions was associated with incrementally lower total movement (β MIMS-units [95% CI] compared to those with no chronic conditions; one: -419 [-772, -66], two: -605 [-933, -278], three: -1201 [-1506, -895], four: -1908 [-2351, -1465], 5+: -2972 [-3384, -2560]). Complex multimorbidity presence was associated with -1709 (95% CI: -2062, -1357) and -1269 (-1620, -918) lower total movement compared to those without multimorbidity and multimorbidity but not complex, respectively. Conclusions Multimorbidity was associated with lower 24-h movement among US adults and may be helpful for identifying adults at risk for low movement.
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Affiliation(s)
- Erin E. Dooley
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ligong Chen
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lama Ghazi
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bjoern Hornikel
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pablo Martinez-Amezcua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Priya Palta
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C. Barrett Bowling
- U.S. Department of Veterans Affairs, Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Bennett MD, McDaniel JT, Albright DL. Chronic disease multimorbidity and substance use among African American men: veteran-non-veteran differences. ETHNICITY & HEALTH 2023; 28:1145-1160. [PMID: 37331990 DOI: 10.1080/13557858.2023.2224949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES The purpose of the study was to explore the extent to which prior military service may moderate the relationship between chronic disease multimorbidity and substance use among African American men in the United States. DESIGN Data for this cross-sectional study was downloaded from the 2016 -2019 United States (US) National Survey on Drug Use and Health. We estimated three survey-weighted multivariable logistic regression models, where use of each of the following substances served as the dependent variables: illicit drugs, opioids, and tobacco. Differences in these outcomes were examined along two primary independent variables: veteran status and multimorbidity (and an interaction term for these variables). We also controlled for the following covariates: age, education, income, rurality, criminal behavior, and religiosity. RESULTS From the 37,203,237 (weighted N) African American men in the sample, approximately 17% reported prior military service. Veterans with ≥ 2 chronic diseases had higher rates of illicit drug use (aOR = 1.37, 95% CI = 1.01, 1.87; 32% vs. 28%) than non-veterans with ≥ 2 chronic diseases. Non-veterans with one chronic disease had higher rates of tobacco use (aOR = 0.80, 95% CI = 0.69, 0.93; 29% vs. 26%) and opioid misuse (aOR = 0.49, 95% CI = 0.36, 0.67; 29% vs. 18%) than veterans with one chronic disease. DISCUSSION Chronic disease multi-morbidity appears to be a context in which African American veterans may be at greater risk for certain undesirable health behaviors than African American non-veterans and at lower risk for others. This may be due to exposure to trauma, difficulty accessing care, socio-environmental factors, and co-occurring mental health conditions. These complex interactions may contribute to higher rates of SUDs among African American veterans compared to African American non-veterans.
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Affiliation(s)
- M Daniel Bennett
- School of Social Work, University of Arkansas, Fayetteville, AR, USA
| | - Justin T McDaniel
- School of Human Sciences, Southern Illinois University Carbondale, Carbondale, IL, USA
| | - David L Albright
- Department of Political Science, The University of Alabama, Tuscaloosa, AL, USA
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16
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Bobinet K, Greer SM. The Iterative Mindset Method: a neuroscientific theoretical approach for sustainable behavior change and weight-loss in digital medicine. NPJ Digit Med 2023; 6:179. [PMID: 37752181 PMCID: PMC10522664 DOI: 10.1038/s41746-023-00910-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
With the growing prevalence of chronic conditions driving 85% of all healthcare costs, digital health offers a promising opportunity to reverse disease and improve health at-scale. The healthcare industry's predominant approach to behavior change is performance-based with a focus on goals and tracking. This has not reversed the epidemic of chronic diseases and also can harm chronically ill and vulnerable patients via perceived failure-induced loss of motivation. Still nascent, the digital health industry is uniquely positioned to adopt and scale new and better behavior change approaches. In this paper, we present the theoretical foundation and initial findings of a neuroscience-based behavior change approach-what we call the Iterative Mindset MethodTM. We discuss its promise, as a potentially more effective, neuroscience-based approach to changing health behaviors long-term, particularly in vulnerable populations. We conclude with avenues for future research.
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Affiliation(s)
- Kyra Bobinet
- Fresh Tri, Inc., 13001 East Zayante Road, Felton, CA, 95018, USA.
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17
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Collins LF, Palella FJ, Mehta CC, Holloway J, Stosor V, Lake JE, Brown TT, Topper EF, Naggie S, Anastos K, Taylor TN, Kassaye S, French AL, Adimora AA, Fischl MA, Kempf MC, Koletar SL, Tien PC, Ofotokun I, Sheth AN. Aging-Related Comorbidity Burden Among Women and Men With or At-Risk for HIV in the US, 2008-2019. JAMA Netw Open 2023; 6:e2327584. [PMID: 37548977 PMCID: PMC10407688 DOI: 10.1001/jamanetworkopen.2023.27584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Importance Despite aging-related comorbidities representing a growing threat to quality-of-life and mortality among persons with HIV (PWH), clinical guidance for comorbidity screening and prevention is lacking. Understanding comorbidity distribution and severity by sex and gender is essential to informing guidelines for promoting healthy aging in adults with HIV. Objective To assess the association of human immunodeficiency virus on the burden of aging-related comorbidities among US adults in the modern treatment era. Design, Setting, and Participants This cross-sectional analysis included data from US multisite observational cohort studies of women (Women's Interagency HIV Study) and men (Multicenter AIDS Cohort Study) with HIV and sociodemographically comparable HIV-seronegative individuals. Participants were prospectively followed from 2008 for men and 2009 for women (when more than 80% of participants with HIV reported antiretroviral therapy use) through last observation up until March 2019, at which point outcomes were assessed. Data were analyzed from July 2020 to April 2021. Exposures HIV, age, sex. Main Outcomes and Measures Comorbidity burden (the number of total comorbidities out of 10 assessed) per participant; secondary outcomes included individual comorbidity prevalence. Linear regression assessed the association of HIV status, age, and sex with comorbidity burden. Results A total of 5929 individuals were included (median [IQR] age, 54 [46-61] years; 3238 women [55%]; 2787 Black [47%], 1153 Hispanic or other [19%], 1989 White [34%]). Overall, unadjusted mean comorbidity burden was higher among women vs men (3.4 [2.1] vs 3.2 [1.8]; P = .02). Comorbidity prevalence differed by sex for hypertension (2188 of 3238 women [68%] vs 2026 of 2691 men [75%]), psychiatric illness (1771 women [55%] vs 1565 men [58%]), dyslipidemia (1312 women [41%] vs 1728 men [64%]), liver (1093 women [34%] vs 1032 men [38%]), bone disease (1364 women [42%] vs 512 men [19%]), lung disease (1245 women [38%] vs 259 men [10%]), diabetes (763 women [24%] vs 470 men [17%]), cardiovascular (493 women [15%] vs 407 men [15%]), kidney (444 women [14%] vs 404 men [15%]) disease, and cancer (219 women [7%] vs 321 men [12%]). In an unadjusted model, the estimated mean difference in comorbidity burden among women vs men was significantly greater in every age strata among PWH: age under 40 years, 0.33 (95% CI, 0.03-0.63); ages 40 to 49 years, 0.37 (95% CI, 0.12-0.61); ages 50 to 59 years, 0.38 (95% CI, 0.20-0.56); ages 60 to 69 years, 0.66 (95% CI, 0.42-0.90); ages 70 years and older, 0.62 (95% CI, 0.07-1.17). However, the difference between sexes varied by age strata among persons without HIV: age under 40 years, 0.52 (95% CI, 0.13 to 0.92); ages 40 to 49 years, -0.07 (95% CI, -0.45 to 0.31); ages 50 to 59 years, 0.88 (95% CI, 0.62 to 1.14); ages 60 to 69 years, 1.39 (95% CI, 1.06 to 1.72); ages 70 years and older, 0.33 (95% CI, -0.53 to 1.19) (P for interaction = .001). In the covariate-adjusted model, findings were slightly attenuated but retained statistical significance. Conclusions and Relevance In this cross-sectional study, the overall burden of aging-related comorbidities was higher in women vs men, particularly among PWH, and the distribution of comorbidity prevalence differed by sex. Comorbidity screening and prevention strategies tailored by HIV serostatus and sex or gender may be needed.
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Affiliation(s)
- Lauren F. Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Healthcare System, Ponce de Leon Center, Atlanta, Georgia
| | - Frank J. Palella
- Division of Infectious Diseases, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - C. Christina Mehta
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - JaNae Holloway
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Valentina Stosor
- Division of Infectious Diseases, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Jordan E. Lake
- Department of Medicine, University of Texas Health Sciences Center, Houston
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth F. Topper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susanna Naggie
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Tonya N. Taylor
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Seble Kassaye
- Georgetown University Medical Center, Washington, DC
| | - Audrey L. French
- Division of Infectious Diseases, CORE Center, Stroger Hospital of Cook County, Chicago, Illinois
| | - Adaora A. Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Margaret A. Fischl
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham
| | - Susan L. Koletar
- Division of Infectious Diseases, The Ohio State University Medical Center, Columbus
| | - Phyllis C. Tien
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco
- Medical Service, Department of Veterans Affairs, San Francisco, California
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Healthcare System, Ponce de Leon Center, Atlanta, Georgia
| | - Anandi N. Sheth
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Healthcare System, Ponce de Leon Center, Atlanta, Georgia
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Mohamud MA, Campbell DJT, Wick J, Leung AA, Fabreau GE, Tonelli M, Ronksley PE. 20-year trends in multimorbidity by race/ethnicity among hospitalized patient populations in the United States. Int J Equity Health 2023; 22:137. [PMID: 37488549 PMCID: PMC10367428 DOI: 10.1186/s12939-023-01950-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/03/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The challenges presented by multimorbidity continue to rise in the United States. Little is known about how the relative contribution of individual chronic conditions to multimorbidity has changed over time, and how this varies by race/ethnicity. The objective of this study was to describe trends in multimorbidity by race/ethnicity, as well as to determine the differential contribution of individual chronic conditions to multimorbidity in hospitalized populations over a 20-year period within the United States. METHODS This is a serial cross-sectional study using the Nationwide Inpatient Sample (NIS) from 1993 to 2012. We identified all hospitalized patients aged ≥ 18 years old with available data on race/ethnicity. Multimorbidity was defined as the presence of 3 or more conditions based on the Elixhauser comorbidity index. The relative change in the proportion of hospitalized patients with multimorbidity, overall and by race/ethnicity (Black, White, Hispanic, Asian/Pacific Islander, Native American) were tabulated and presented graphically. Population attributable fractions were estimated from modified Poisson regression models adjusted for sex, age, and insurance type. These fractions were used to describe the relative contribution of individual chronic conditions to multimorbidity over time and across racial/ethnic groups. RESULTS There were 123,613,970 hospitalizations captured within the NIS between 1993 and 2012. The prevalence of multimorbidity increased in all race/ethnic groups over the 20-year period, most notably among White, Black, and Native American populations (+ 29.4%, + 29.7%, and + 32.0%, respectively). In both 1993 and 2012, Black hospitalized patients had a higher prevalence of multimorbidity (25.1% and 54.8%, respectively) compared to all other race/ethnic groups. Native American populations exhibited the largest overall increase in multimorbidity (+ 32.0%). Furthermore, the contribution of metabolic diseases to multimorbidity increased, particularly among Hispanic patients who had the highest population attributable fraction values for diabetes without complications (15.0%), diabetes with complications (5.1%), and obesity (5.8%). CONCLUSIONS From 1993 to 2012, the secular increases in the prevalence of multimorbidity as well as changes in the differential contribution of individual chronic conditions has varied substantially by race/ethnicity. These findings further elucidate the racial/ethnic gaps prevalent in multimorbidity within the United States. PRIOR PRESENTATIONS Preliminary finding of this study were presented at the Society of General Internal Medicine (SGIM) Annual Conference, Washington, DC, April 21, 2017.
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Affiliation(s)
- Mursal A Mohamud
- Cumming School of Medicine, Undergraduate Medical Education, University of Calgary, Calgary, AB, Canada
| | - David J T Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James Wick
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alexander A Leung
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gabriel E Fabreau
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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19
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Rosen CB, Roberts SE, Syvyk S, Finn C, Tong J, Wirtalla C, Spinks H, Kelz RR. A Novel Mobile App to Identify Patients With Multimorbidity in the Emergency Setting: Development of an App and Feasibility Trial. JMIR Form Res 2023; 7:e42970. [PMID: 37440310 PMCID: PMC10375392 DOI: 10.2196/42970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/14/2023] [Accepted: 03/28/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Multimorbidity is associated with an increased risk of poor surgical outcomes among older adults; however, identifying multimorbidity in the clinical setting can be a challenge. OBJECTIVE We created the Multimorbid Patient Identifier App (MMApp) to easily identify patients with multimorbidity identified by the presence of a Qualifying Comorbidity Set and tested its feasibility for use in future clinical research, validation, and eventually to guide clinical decision-making. METHODS We adapted the Qualifying Comorbidity Sets' claims-based definition of multimorbidity for clinical use through a modified Delphi approach and developed MMApp. A total of 10 residents input 5 hypothetical emergency general surgery patient scenarios, common among older adults, into the MMApp and examined MMApp test characteristics for a total of 50 trials. For MMApp, comorbidities selected for each scenario were recorded, along with the number of comorbidities correctly chosen, incorrectly chosen, and missed for each scenario. The sensitivity and specificity of identifying a patient as multimorbid using MMApp were calculated using composite data from all scenarios. To assess model feasibility, we compared the mean task completion by scenario to that of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (ACS-NSQIP-SRC) using paired t tests. Usability and satisfaction with MMApp were assessed using an 18-item questionnaire administered immediately after completing all 5 scenarios. RESULTS There was no significant difference in the task completion time between the MMApp and the ACS-NSQIP-SRC for scenarios A (86.3 seconds vs 74.3 seconds, P=.85) or C (58.4 seconds vs 68.9 seconds,P=.064), MMapp took less time for scenarios B (76.1 seconds vs 87.4 seconds, P=.03) and E (20.7 seconds vs 73 seconds, P<.001), and more time for scenario D (78.8 seconds vs 58.5 seconds, P=.02). The MMApp identified multimorbidity with 96.7% (29/30) sensitivity and 95% (19/20) specificity. User feedback was positive regarding MMApp's usability, efficiency, and usefulness. CONCLUSIONS The MMApp identified multimorbidity with high sensitivity and specificity and did not require significantly more time to complete than a commonly used web-based risk-stratification tool for most scenarios. Mean user times were well under 2 minutes. Feedback was overall positive from residents regarding the usability and usefulness of this app, even in the emergency general surgery setting. It would be feasible to use MMApp to identify patients with multimorbidity in the emergency general surgery setting for validation, research, and eventual clinical use. This type of mobile app could serve as a template for other research teams to create a tool to easily screen participants for potential enrollment.
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Affiliation(s)
| | | | - Solomiya Syvyk
- Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Caitlin Finn
- Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Jason Tong
- Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | | | - Hunter Spinks
- Hospital of the University of Pennsylvania, Philadelphia, PA, United States
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20
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Hassan AM, Chu CK, Liu J, Angove R, Rocque G, Gallagher KD, Momoh AO, Caston NE, Williams CP, Wheeler S, Offodile Ii AC. A nationwide cross-sectional study on the association of patient-level factors with financial anxiety in the context of chronic medical conditions. Sci Rep 2023; 13:10363. [PMID: 37365187 DOI: 10.1038/s41598-023-36282-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
Patient-level characteristics associated with the prevalence and severity of financial anxiety have yet to be described. We conducted a cross-sectional analysis of survey data assessing financial anxiety in patients with chronic medical conditions in December 2020. 1771 patients (42.6% response rate) participated in the survey. Younger age (19-35 age compared to ≥ 75 age) (β, 5.86; 95% CI 2.10-9.63), male sex (β, - 1.9; 95% CI - 3.1 to - 0.73), Hispanic/Latino race/ethnicity (compared with White patients) (β, 2.55; 95% CI 0.39-4.71), household size ≥ 4 (compare with single household) (β, 4.54; 95% CI 2.44-6.64), household income of ≥ $96,000-$119,999 (compared with ≤ $23,999) (β, - 3.2; 95% CI - 6.3 to 0.04), single marital status (compared with married) (β, 2.18; 95% CI 0.65-3.71), unemployment (β, 2.07; 95% CI 0.39-3.74), high-school education (compared with advanced degrees) (β, 3.10; 95% CI 1.32-4.89), lack of insurance coverage (compared with private insurance) (β, 6.05; 95% CI 2.66-9.45), more comorbidities (≥ 3 comorbidities compared to none) (β, 2.95; 95% CI 1.00-4.90) were all independently associated with financial anxiety. Patients who are young, female, unmarried, and representing vulnerable sub-populations are at elevated risk for financial anxiety.
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Affiliation(s)
- Abbas M Hassan
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA
| | - Carrie K Chu
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA
| | - Jun Liu
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA
| | | | - Gabrielle Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Adeyiza O Momoh
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nicole E Caston
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Courtney P Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephanie Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anaeze C Offodile Ii
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA.
- Department of Health Policy Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Baker Institute for Public Policy, Rice University, Houston, TX, USA.
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21
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Mossadeghi B, Caixeta R, Ondarsuhu D, Luciani S, Hambleton IR, Hennis AJM. Multimorbidity and social determinants of health in the US prior to the COVID-19 pandemic and implications for health outcomes: a cross-sectional analysis based on NHANES 2017-2018. BMC Public Health 2023; 23:887. [PMID: 37189096 DOI: 10.1186/s12889-023-15768-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/26/2023] [Indexed: 05/17/2023] Open
Abstract
Multimorbidity increases the risk of all-cause mortality, and along with age, is an independent risk factor for severe disease and mortality from COVID-19. Inequities in the social determinants of health contributed to increased mortality from COVID-19 among disadvantaged populations. This study aimed to evaluate the prevalence of multimorbid conditions and associations with the social determinants of health in the US prior to the pandemic.Methods Data from the 2017-18 cycle of NHANES were used to determine the prevalence of 13 chronic conditions, and the prevalence of having 0, 1, or 2 or more of those conditions, among the US adult population aged ≥ 20 years. Multimorbidity was defined as having 2 or more of these conditions. Data were stratified according to demographic, socioeconomic and indicators of health access, and analyses including logistic regression, performed to determine the factors associated with multimorbidity.Results The prevalence of multimorbidity was 58.4% (95% CI 55.2 to 61.7). Multimorbidity was strongly associated with age and was highly prevalent among those aged 20-29 years at 22.2% (95% CI 16.9 to 27.6) and continued to increase with older age. The prevalence of multimorbidity was highest in those defined as Other or multiple races (66.9%), followed in decreasing frequency by rates among non-Hispanic Whites (61.2%), non-Hispanic Blacks (57.4%), Hispanic (52.0%) and Asian (41.3%) groups.Logistic regression showed a statistically significant relationship between multimorbidity and age, as expected. Asian race was associated with a reduced likelihood of 2 or more chronic conditions (OR 0.4; 95% CI 0.35 to 0.57; P < 0.0001). Socioeconomic factors were related to multimorbidity. Being above the poverty level (OR 0.64; 95% CI 0.46 to 0.91, p = 0.013); and a lack of regular access to health care (OR 0.61 (95% CI 0.42 to 0.88, p = 0.008) were both associated with a reduced likelihood of multimorbidity. Furthermore, there was a borderline association between not having health insurance and reduced likelihood of multimorbidity (OR 0.63; 95% CI 0.40 to 1.0; p = 0.053).Conclusions There are high levels of multimorbidity in the US adult population, evident from young adulthood and increasing with age. Cardiometabolic causes of multimorbidity were highly prevalent, especially obesity, hyperlipidemia, hypertension, and diabetes; conditions subsequently found to be associated with severe disease and death from COVID-19. A lack of access to care was paradoxically associated with reduced likelihood of comorbidity, likely linked to underdiagnosis of chronic conditions. Obesity, poverty, and lack of access to healthcare are factors related to multimorbidity and were also relevant to the health impact of the COVID-19 pandemic, that must be addressed through comprehensive social and public policy measures. More research is needed on the etiology and determinants of multimorbidity, on those affected, patterns of co-morbidity, and implications for individual health and impact on health systems and society to promote optimal outcomes. Comprehensive public health policies are needed to tackle multimorbidity and reduce disparities in the social determinants of health, as well as to provide universal access to healthcare.
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Affiliation(s)
- Bijan Mossadeghi
- Stony Brook University Medical Center, 101 Nicolls Road Health Sciences Center, Stony Brook, NY, 11794-843, USA
- , New York, United States
| | - Roberta Caixeta
- Pan American Health Organization, Washington, DC, USA
- , Washington D.C., United States
| | - Dolores Ondarsuhu
- Pan American Health Organization, Washington, DC, USA
- , Washington D.C., United States
| | - Silvana Luciani
- Pan American Health Organization, Washington, DC, USA
- , Washington D.C., United States
| | - Ian R Hambleton
- George Alleyne Chronic Disease Research Centre, The University of the West Indies, Bridgetown, Barbados
- , Bridgetown, Barbados
| | - Anselm J M Hennis
- Pan American Health Organization, Washington, DC, USA.
- , Washington D.C., United States.
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22
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Pignatiello GA, Cuccia A, Boston-Leary K. The relationships between the healthy nurse, Healthy Nation program, RN perceptions of their work system, and health-related quality of life. Nurs Outlook 2023; 71:101983. [PMID: 37207516 PMCID: PMC10523875 DOI: 10.1016/j.outlook.2023.101983] [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: 11/29/2022] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND There is limited research on the effects of nationally oriented health care workforce interventions on RNs' perceptions of their work systems and health-related quality of life (HRQOL). PURPOSE Guided by a systems framework, we examined the association of being affiliated with an organization partnered with the American Nurses Association's Healthy Nurse, Healthy Nation (HNHN) program on RNs' perceptions of their work systems and HRQOL. METHODS We performed a correlational, cross-sectional secondary analysis of a national RN sample (N = 2,166) with case-control matching. We used multiple linear and logistic regressions to evaluate our research questions. DISCUSSION Affiliation with an HNHN partner organization was directly associated with more desirable work system perceptions, and indirectly associated with greater HRQOL. Organization-level workplace interventions hold promise to improve RN working conditions and well-being. CONCLUSION There is an ongoing need to continue developing and evaluating scalable workplace well-being interventions for health care organizations.
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Affiliation(s)
| | - Alison Cuccia
- American Nurses Association, Silver Spring, MD; The Milken Institute of Public Health, George Washington University, Washington, DC
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23
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Silber JH, Rosenbaum PR, Reiter JG, Jain S, Ramadan OI, Hill AS, Hashemi S, Kelz RR, Fleisher LA. The Safety of Performing Surgery at Ambulatory Surgery Centers Versus Hospital Outpatient Departments in Older Patients With or Without Multimorbidity. Med Care 2023; 61:328-337. [PMID: 36929758 PMCID: PMC10079624 DOI: 10.1097/mlr.0000000000001836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Surgery for older Americans is increasingly being performed at ambulatory surgery centers (ASCs) rather than hospital outpatient departments (HOPDs), while rates of multimorbidity have increased. OBJECTIVE To determine whether there are differential outcomes in older patients undergoing surgical procedures at ASCs versus HOPDs. RESEARCH DESIGN Matched cohort study. SUBJECTS Of Medicare patients, 30,958 were treated in 2018 and 2019 at an ASC undergoing herniorrhaphy, cholecystectomy, or open breast procedures, matched to similar HOPD patients, and another 32,702 matched pairs undergoing higher-risk procedures. MEASURES Seven and 30-day revisit and complication rates. RESULTS For the same procedures, HOPD patients displayed a higher baseline predicted risk of 30-day revisits than ASC patients (13.09% vs 8.47%, P < 0.0001), suggesting the presence of considerable selection on the part of surgeons. In matched Medicare patients with or without multimorbidity, we observed worse outcomes in HOPD patients: 30-day revisit rates were 8.1% in HOPD patients versus 6.2% in ASC patients ( P < 0.0001), and complication rates were 41.3% versus 28.8%, P < 0.0001. Similar patterns were also found for 7-day outcomes and in higher-risk procedures examined in a secondary analysis. Similar patterns were also observed when analyzing patients with and without multimorbidity separately. CONCLUSIONS The rates of revisits and complications for ASC patients were far lower than for closely matched HOPD patients. The observed initial baseline risk in HOPD patients was much higher than the baseline risk for the same procedures performed at the ASC, suggesting that surgeons are appropriately selecting their riskier patients to be treated at the HOPD rather than the ASC.
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Affiliation(s)
- Jeffrey H. Silber
- Center for Outcomes Research, Children’s Hospital of
Philadelphia, Philadelphia, PA
- The Leonard Davis Institute of Health Economics, The
University of Pennsylvania, Philadelphia, PA
- The Department of Pediatrics, The University of
Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Health Care Management, The Wharton School,
The University of Pennsylvania, Philadelphia, PA
| | - Paul R. Rosenbaum
- The Leonard Davis Institute of Health Economics, The
University of Pennsylvania, Philadelphia, PA
- Department of Statistics and Data Science, The Wharton
School, The University of Pennsylvania, Philadelphia, PA
| | - Joseph G. Reiter
- Center for Outcomes Research, Children’s Hospital of
Philadelphia, Philadelphia, PA
| | - Siddharth Jain
- Center for Outcomes Research, Children’s Hospital of
Philadelphia, Philadelphia, PA
- The Leonard Davis Institute of Health Economics, The
University of Pennsylvania, Philadelphia, PA
| | - Omar I. Ramadan
- The Leonard Davis Institute of Health Economics, The
University of Pennsylvania, Philadelphia, PA
- Department of Surgery, The Perelman School of Medicine, The
University of Pennsylvania
| | - Alexander S. Hill
- Center for Outcomes Research, Children’s Hospital of
Philadelphia, Philadelphia, PA
| | - Sean Hashemi
- Center for Outcomes Research, Children’s Hospital of
Philadelphia, Philadelphia, PA
| | - Rachel R. Kelz
- The Leonard Davis Institute of Health Economics, The
University of Pennsylvania, Philadelphia, PA
- Department of Surgery, The Perelman School of Medicine, The
University of Pennsylvania
| | - Lee A. Fleisher
- The Leonard Davis Institute of Health Economics, The
University of Pennsylvania, Philadelphia, PA
- Department of Anesthesiology and Critical Care, The
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Perioperative Outcomes Research and
Transformation, The University of Pennsylvania, Philadelphia, PA
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24
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Temkin SM, Barr E, Moore H, Caviston JP, Regensteiner JG, Clayton JA. Chronic conditions in women: the development of a National Institutes of health framework. BMC Womens Health 2023; 23:162. [PMID: 37024841 PMCID: PMC10077654 DOI: 10.1186/s12905-023-02319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
Rising rates of chronic conditions were cited as one of the key public health concerns in the Fiscal Year (FY) 2021 U.S. Senate and House of Representatives appropriations bills, where a review of current National Institutes of Health (NIH) portfolios relevant to research on women's health was requested. Chronic conditions were last defined by the US Department of Health and Human Services (HHS) in 2010. However, existing definitions of chronic conditions do not incorporate sex or gender considerations. Sex and gender influence health, yet significant knowledge gaps exist in the evidence-base for prevention, diagnosis, and treatment of chronic diseases amongst women. The presentation, prevalence, and long-term effects of chronic conditions and multimorbidity differs in women from men. A clinical framework was developed to adequately assess the NIH investment in research related to chronic conditions in women. The public health needs and NIH investment related to conditions included in the framework were measured. By available measures, research within the NIH has not mapped to the burden of chronic conditions among women. Clinical research questions and endpoints centered around women can be developed and implemented; clinical trials networks with expanded or extended eligibility criteria can be created; and data science could be used to extrapolate the effects of overlapping or multiple morbidities on the health of women. Aligning NIH research priorities to address the specific needs of women with chronic diseases is critical to addressing women's health needs from a life course perspective.
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Affiliation(s)
- Sarah M Temkin
- Office of Research On Women's Health, National Institutes of Health, Bethesda, MD, USA.
| | - Elizabeth Barr
- Office of Research On Women's Health, National Institutes of Health, Bethesda, MD, USA
| | - Holly Moore
- National Institute On Drug Abuse National Institutes of Health, Bethesda, MD, USA
| | - Juliane P Caviston
- Office of Research On Women's Health, National Institutes of Health, Bethesda, MD, USA
| | - Judith G Regensteiner
- Department of Medicine, Ludeman Family Center for Women's Health Research, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Janine A Clayton
- Office of Research On Women's Health, National Institutes of Health, Bethesda, MD, USA
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Karamercan MA, Dündar DZ, Slagman A, Ergin M, Janssens KAC, Fabbri A, Bjornsen LP, Somodi S, Adam VN, Polyzogopoulou E, Demir HA, Laribi S. Epidemiology of geriatric patients presenting to emergency departments in Europe: EGERS study. Eur J Emerg Med 2023; 30:117-124. [PMID: 36719188 DOI: 10.1097/mej.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND IMPORTANCE Patients aged 65 and above constitute a large and growing part of emergency department (ED) visits in western countries. OBJECTIVE The primary aim of this European prospective study was to determine the epidemiologic characteristics of elderly patients presenting to EDs across Europe. Our secondary objective was to determine the hospitalization rate, characteristics, and in-hospital mortality rates of geriatric patients presenting to EDs. DESIGN SETTING AND PARTICIPANTS An observational prospective cohort study over seven consecutive days between 19 October and 30 November 2020, in 36 EDs from nine European countries. Patients aged 65 years and older presenting to EDs with any complaint during a period of seven consecutive days were included. OUTCOME MEASURES Data were collected on demographics, the major presenting complaint, the presenting vital signs, comorbidities, usual medication, and outcomes after the ED, including disposition, in-hospital outcome, and the final hospital diagnosis. The patients were stratified into three groups: old (65-74 years), older (75-84 years), and oldest age (>85 years). MAIN RESULTS A total of 5767 patients were included in the study. The median age of the patients was 77 (interquartile range: 71-84) years. The majority presented with a non-traumatic complaint (81%) and about 90% of the patients had at least one comorbid disease and were on chronic medication. An ED visit resulted in subsequent hospital admission in 51% of cases, with 9% of patients admitted to an intensive care unit. Overall in-hospital mortality was 8%, and ED mortality was 1%. Older age was associated with a higher female proportion, comorbidities, need for home care service, history of previous falls, admission rates, length of ED, and hospital stay. CONCLUSION The characteristics of ED elderly patients and their subsequent hospital stay are reported in this prospective study.
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Affiliation(s)
- Mehmet A Karamercan
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara
| | - Defne Z Dündar
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara
| | - Ana Slagman
- Division of Emergency and Acute Medicine, Campus Virchow Klinikum and Charité Campus Mitte, Charite Universitatmedizin, Berlin, Germany
| | - Mehmet Ergin
- Department of Emergency Medicine, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | | | - Andrea Fabbri
- Dipartimento Emergenza, Azienda USL della Romagna, Forli, Italy
| | - Lars P Bjornsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sándor Somodi
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Visnja N Adam
- Department of Anesthesiology, Resuscitation and Intensive Care, Clinical Hospital Sveti Duh, Zagreb, Croatia
| | - Effie Polyzogopoulou
- Emergency Medicine Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Hüseyin A Demir
- Department of Emergency Medicine, Sanliurfa Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
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Ong JC, Kalmbach DA. Mindfulness as an Adjunct or Alternative to CBT-I. Sleep Med Clin 2023; 18:59-71. [PMID: 36764787 DOI: 10.1016/j.jsmc.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Mindfulness-based interventions (MBIs) are programs that teach mindfulness concepts through guided meditation and self-regulation practices. MBIs have been found to improve sleep and reduce cognitive arousal, which are central to the development and perpetuation of insomnia. In this article, we review theoretic frameworks and clinical trial effectiveness data supporting MBIs for insomnia. Based on this review, we provide suggestions for using MBIs as an adjunct or alternative treatment option to CBT-I with regard to how, when, and for whom. We conclude with an agenda for future directions that can clarify the use of mindfulness as a treatment option for insomnia.
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Affiliation(s)
- Jason C Ong
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Dr, Chicago, IL 60625, USA; Behavioral Sleep Medicine, Nox Health, 5000 Research Court, Suite 500, Suwanee, GA 30024, USA.
| | - David A Kalmbach
- Thomas Roth Sleep Disorders Center, Henry Ford Health System, 39450 W 12 Mile Road, Novi, Detroit, MI 48377, USA; Department of Pulmonary & Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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27
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Chowdhury SR, Chandra Das D, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine 2023; 57:101860. [PMID: 36864977 PMCID: PMC9971315 DOI: 10.1016/j.eclinm.2023.101860] [Citation(s) in RCA: 84] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Knowing the prevalence of multimorbidity among adults across continents is a crucial piece of information for achieving Sustainable Development Goal 3.4, which calls for reducing premature death due to non-communicable diseases. A high prevalence of multimorbidity indicates high mortality and increased healthcare utilization. We aimed to understand the prevalence of multimorbidity across WHO geographic regions among adults. METHODS We performed a systematic review and meta-analysis of surveys designed to estimate the prevalence of multimorbidity among adults in community settings. We searched PubMed, ScienceDirect, Embase and Google Scholar databases for studies published between January 1, 2000, and December 31, 2021. The random-effects model estimated the pooled proportion of multimorbidity in adults. Heterogeneity was quantified using I2 statistics. We performed subgroup analyses and sensitivity analyses based on continents, age, gender, multimorbidity definition, study periods and sample size. The study protocol was registered with PROSPERO (CRD42020150945). FINDINGS We analyzed data from 126 peer-reviewed studies that included nearly 15.4 million people (32.1% were male) with a weighted mean age of 56.94 years (standard deviation of 10.84 years) from 54 countries around the world. The overall global prevalence of multimorbidity was 37.2% (95% CI = 34.9-39.4%). South America (45.7%, 95% CI = 39.0-52.5) had the highest prevalence of multimorbidity, followed by North America (43.1%, 95% CI = 32.3-53.8%), Europe (39.2%, 95% CI = 33.2-45.2%), and Asia (35%, 95% CI = 31.4-38.5%). The subgroup study highlights that multimorbidity is more prevalent in females (39.4%, 95% CI = 36.4-42.4%) than males (32.8%, 95% CI = 30.0-35.6%). More than half of the adult population worldwide above 60 years of age had multimorbid conditions (51.0%, 95% CI = 44.1-58.0%). Multimorbidity has become increasingly prevalent in the last two decades, while the prevalence appears to have stayed stable in the recent decade among adults globally. INTERPRETATION The multimorbidity patterns by geographic regions, time, age, and gender suggest noticeable demographic and regional differences in the burden of multimorbidity. According to insights about prevalence among adults, priority is required for effective and integrative interventions for older adults from South America, Europe, and North America. A high prevalence of multimorbidity among adults from South America suggests immediate interventions are needed to reduce the burden of morbidity. Furthermore, the high prevalence trend in the last two decades indicates that the global burden of multimorbidity continues at the same pace. The low prevalence in Africa suggests that there may be many undiagnosed chronic illness patients in Africa. FUNDING None.
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Affiliation(s)
- Saifur Rahman Chowdhury
- Department of Public Health, North South University, Dhaka, Bangladesh
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Dipak Chandra Das
- Department of Public Health, North South University, Dhaka, Bangladesh
| | | | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Ahmed Hossain
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Global Health Institute, North South University, Dhaka, Bangladesh
- Corresponding author.
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Botoseneanu A, Markwardt S, Quiñones AR. Multimorbidity and Functional Disability among Older Adults: The Role of Inflammation and Glycemic Status - An Observational Longitudinal Study. Gerontology 2023; 69:826-838. [PMID: 36858034 PMCID: PMC10442862 DOI: 10.1159/000528648] [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: 01/07/2022] [Accepted: 12/07/2022] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Specific multimorbidity combinations, in particular those including arthritis, stroke, and cognitive impairment, have been associated with high burden of activities of daily living (ADL)-instrumental activities of daily living (IADL) disability in older adults. The biologic underpinnings of these associations are still unclear. METHODS Observational longitudinal study using data from the Health and Retirement Study (N = 8,618, mean age = 74 years, 58% female, 25% non-white) and negative binomial regression models stratified by sex to evaluate the role of inflammatory and glycemic biomarkers (high-sensitivity C-reactive protein (hs-CRP) and HbA1c) in the association between specific multimorbidity combinations (grouped around one of eight index diseases: arthritis, cancer, cognitive impairment, diabetes, heart disease, hypertension, lung disease, and stroke; assessed between 2006 and 2014) and prospective ADL-IADL disability (2 years later, 2008-2016). Results were adjusted for sociodemographic characteristics, body mass index, number of coexisting diseases, and baseline ADL-IADL score. RESULTS Multimorbidity combinations indexed by arthritis (IRR = 1.1, 95% CI = 1.01-1.20), diabetes (IRR = 1.19, 95% CI = 1.09-1.30), and cognitive impairment (IRR = 1.11, 95% CI = 1.01-1.23) among men and diabetes-indexed multimorbidity combinations (IRR = 1.07, 95% CI = 1.01-1.14) among women were associated with higher ADL-IADL scores at increasing levels of HbA1c. Across higher levels of hs-CRP, multimorbidity combinations indexed by arthritis (IRR = 1.06, 95% CI = 1.02-1.11), hypertension (IRR = 1.06, 95% CI = 1.02-1.11), heart disease (IRR = 1.06, 95% CI = 1.01-1.12), and lung disease (IRR = 1.14, 95% CI = 1.07-1.23) were associated with higher ADL-IADL scores among women, while there were no significant associations among men. CONCLUSION The findings suggest potential for anti-inflammatory management among older women and optimal glycemic control among older men with these particular multimorbidity combinations as focus for therapeutic/preventive options for maintaining functional health.
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Affiliation(s)
- Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, MI, USA
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA
| | - Sheila Markwardt
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Ana R. Quiñones
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Giovannelli I, Pagliaro S, Spaccatini F, Pacilli MG. Self-reported psychological symptoms and severe stress events, but not patients' gender, affect illness representation and medical advice by lay-referral network advisors. Soc Sci Med 2023; 320:115666. [PMID: 36645945 DOI: 10.1016/j.socscimed.2023.115666] [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: 05/26/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/08/2023]
Abstract
People who experience symptoms tend to discuss their ailments with other individuals who create their own illness representations, acting as intuitive physicians. We conducted two experimental studies to examine lay-referral network advisors' (i.e., acquaintances) representation of illness etiology and their recommendation to undergo health screenings for a man or woman with physical (vs. both physical and psychological) symptoms and a severe stressful (vs. no stressful) period in life. The presence of psychological and physical symptoms (Studies 1 and 2) and severe stressful life events (Study 2) affects lay-referral network advisors' disease representation. These factors cause participants to attribute symptoms etiology to psychological rather than organic factors and recommend more psychological screenings rather than physical ones. The simultaneous presence of psychological and physical symptoms and severe stressful events increases the likelihood of attributing the illness etiology to psychological factors, which increases participants' willingness to recommend psychological screenings. Study variables were unaffected by patient gender. The main findings, limitations, and future directions are discussed.
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Affiliation(s)
- Ilaria Giovannelli
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, Italy.
| | - Stefano Pagliaro
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, Italy
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Kringle EA, Tucker D, Wu Y, Lv N, Kannampallil T, Barve A, Dosala S, Wittels N, Dai R, Ma J. Associations between daily step count trajectories and clinical outcomes among adults with comorbid obesity and depression. Ment Health Phys Act 2023; 24:100512. [PMID: 37206660 PMCID: PMC10191421 DOI: 10.1016/j.mhpa.2023.100512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Purpose To examine the relationship between features of daily measured step count trajectories and clinical outcomes among people with comorbid obesity and depression in the ENGAGE-2 Trial. Methods This post hoc analysis used data from the ENGAGE-2 trial where adults (n=106) with comorbid obesity (BMI ≥30.0 or 27.0 if Asian) and depressive symptoms (Patient Health Questionnaire-9 score ≥10) were randomized (2:1) to receive the experimental intervention or usual care. Daily step count trajectories over the first 60 days (Fitbit Alta HR) were characterized using functional principal component analyses. 7-day and 30-day trajectories were also explored. Functional principal component scores that described features of step count trajectories were entered into linear mixed models to predict weight (kg), depression (Symptom Checklist-20), and anxiety (Generalized Anxiety Disorder Questionnaire-7) at 2-months (2M) and 6-months (6M). Results Features of 60-day step count trajectories were interpreted as overall sustained high, continuous decline, and disrupted decline. Overall sustained high step count was associated with low anxiety (2M, β=-0.78, p<.05; 6M, β=-0.80, p<.05) and low depressive symptoms (6M, β=-0.15, p<.05). Continuous decline in step count was associated with high weight (2M, β=0.58, p<.05). Disrupted decline was not associated with clinical outcomes at 2M or 6M. Features of 30-day step count trajectories were also associated with weight (2M, 6M), depression (6M), and anxiety (2M, 6M); Features of 7-day step count trajectories were not associated with weight, depression, or anxiety at 2M or 6M. Conclusions Features of step count trajectories identified using functional principal component analysis were associated with depression, anxiety, and weight outcomes among adults with comorbid obesity and depression. Functional principal component analysis may be a useful analytic method that leverages daily measured physical activity levels to allow for precise tailoring of future behavioral interventions.
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Affiliation(s)
| | - Danielle Tucker
- Department of Mathematics, Statistics, and Computer Science, University of Illinois at Chicago
| | - Yichao Wu
- Department of Mathematics, Statistics, and Computer Science, University of Illinois at Chicago
| | - Nan Lv
- Department of Medicine, University of Illinois at Chicago
| | - Thomas Kannampallil
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis
| | - Amruta Barve
- Department of Medicine, University of Illinois at Chicago
| | | | - Nancy Wittels
- Department of Medicine, University of Illinois at Chicago
| | - Ruixuan Dai
- Department of Computer Science and Engineering, McKelvey School of Engineering, Washington University in St. Louis
| | - Jun Ma
- Department of Medicine, University of Illinois at Chicago
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Delpino FM, Caputo EL, Arcêncio RA, Cassuriaga J, Huckembeck CM, Nunes BP, Rombaldi AJ, Reichert FF, da Silva MC, Feter N. Association of Sleep Duration and Use of Sleeping Medication with Multimorbidity in Adults: Results from the PAMPA (Brazil) Cohort Study. Sleep Sci 2023; 16:68-74. [PMID: 37151761 PMCID: PMC10157832 DOI: 10.1055/s-0043-1767757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/14/2022] [Indexed: 05/09/2023] Open
Abstract
Objective To analyze the association of sleep duration and use of sleeping medication with multimorbidity. Materials and Methods We conducted a cross-sectional study using data from the Prospective Study about Mental and Physical Health (PAMPA) cohort. Multimorbidity was defined as the presence of two or more conditions from a list of twelve health problems. Descriptive analyses were performed considering proportion and its 95% confidence interval (95%CI). We performed logistic regression (to obtain odds ratios, ORs) to estimate the associations, including models adjusted for confounding factors. Results In total, 2,936 participants were included, 79,1% of them women, 54.2% aged between 18 and 39 years, and 88.9% with white skin color. Compared with regular sleep (seven to eight hours a day), five hours or less of sleep increased the odds of multimorbidity by 145% (95%CI: 1.90-3.14), and 9 hours or more of sleep increased the odds by 49% (95%CI: 1.14-1.95) for the crude model; the results remained significant even in the adjusted models. Discussion Consumption of sleeping medication was associated with multimorbidity. Short and prolonged sleep duration increased the odds of multimorbidity, regardless of the sociodemographic and behavior characteristics. The regular use of sleeping medication was also associated with multimorbidity. The results of the present study are important but require caution due to reverse causality, and longitudinal studies are needed to confirm the findings.
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Affiliation(s)
- Felipe Mendes Delpino
- Federal University of Pelotas, Postgraduate Program in Nursing, Pelotas, Rio Grande do Sul, Brazil
- University of São Paulo, Postgraduate Program in Nursing in Public Health, São Paulo, São Paulo, Brazil
- Address for correspondence Felipe Mendes Delpino
| | - Eduardo L. Caputo
- Federal University of Pelotas, Postgraduate Program in Physical Education, Pelotas, Rio Grande do Sul, Brazil
| | | | - Júlia Cassuriaga
- Federal University of Pelotas, Postgraduate Program in Physical Education, Pelotas, Rio Grande do Sul, Brazil
| | - Caroline Malue Huckembeck
- Federal University of Pelotas, Postgraduate Program in Physical Education, Pelotas, Rio Grande do Sul, Brazil
| | - Bruno Pereira Nunes
- Federal University of Pelotas, Postgraduate Program in Nursing, Pelotas, Rio Grande do Sul, Brazil
| | - Airton José Rombaldi
- Federal University of Pelotas, Postgraduate Program in Physical Education, Pelotas, Rio Grande do Sul, Brazil
| | - Felipe Fossati Reichert
- Federal University of Pelotas, Postgraduate Program in Physical Education, Pelotas, Rio Grande do Sul, Brazil
| | - Marcelo Cozzensa da Silva
- Federal University of Pelotas, Postgraduate Program in Physical Education, Pelotas, Rio Grande do Sul, Brazil
| | - Natan Feter
- Federal University of Pelotas, Postgraduate Program in Physical Education, Pelotas, Rio Grande do Sul, Brazil
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Wang YM, Shen HW, Chen TJ. Potentially inappropriate medication in long-term care wards of a veteran hospital in Taiwan: Investigation using a spreadsheet-based rapid assessment tool. J Chin Med Assoc 2023; 86:313-319. [PMID: 36661273 DOI: 10.1097/jcma.0000000000000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Multimorbidity and polypharmacy increase in the aging population and are accompanied by the use of potentially inappropriate medications (PIMs) and adverse drug events (ADEs). This study developed a rapid assessment tool to investigate PIM use among patients in long-term care wards. METHODS We retrospectively collected the data of patients in long-term care wards of a veteran hospital in Taiwan between July 2019 and June 2020. The patients with chronic diseases and medications were selected. The data, including gender, age, diagnosis, and medications, were deidentified. Nonchronic disease diagnosis and short-term and topical use medications were excluded. We used Microsoft Excel (Microsoft Corporation, Redmond, Washington, USA) and the 2019 version of the Beers Criteria to establish a rapid assessment tool. The correlations between the prevalence of PIM use and age, the number of diagnoses, and the number of medications were analyzed using SPSS version 23. RESULTS A total of 176 patients were included in this study, of which 76.7% (n = 135) were male and 23.3% (n = 41) were female. The average age of men was 82.1 years and that of women was 83.4 years. The average number of diagnoses for men was 5.5, and that for women was 7.3. The average number of medications for men was 5.8, and that for women was 6.5. The prevalence of PIM use was 59.1% (n = 104). Logistic regression revealed that the prevalence of PIM use may be associated with the number of medications ( p < 0.001; odds ratio = 1.378). Decision tree analysis revealed that patients who simultaneously used more than four medications exhibited a higher risk of PIM. CONCLUSION PIM use is a key factor causing ADEs among older adults. Therefore, comprehensive assessment of PIM use is necessary. This study designed a rapid assessment tool to simultaneously integrate and evaluate medications. Future studies may investigate the effectiveness of the proposed assessment tool.
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Affiliation(s)
- Ying-Mei Wang
- Department of Medical Education and Research, Taipei Veterans General Hospital Hsinchu Branch, Hsinchu, Taiwan, ROC
- Department of Pharmacy, Taipei Veterans General Hospital Hsinchu Branch, Hsinchu, Taiwan, ROC
| | - Hung-Wei Shen
- Department of Medical Education and Research, Taipei Veterans General Hospital Hsinchu Branch, Hsinchu, Taiwan, ROC
| | - Tzeng-Ji Chen
- Department of Pharmacy, Taipei Veterans General Hospital Hsinchu Branch, Hsinchu, Taiwan, ROC
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Morris JL, Belcher SM, Jeon B, Godzik CM, Imes CC, Luyster F, Sereika SM, Scott PW, Chasens ER. Financial Hardship and its Associations with Perceived Sleep Quality in Participants with Type 2 Diabetes and Obstructive Sleep Apnea. Chronic Illn 2023; 19:197-207. [PMID: 34866430 PMCID: PMC10043926 DOI: 10.1177/17423953211065002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The purpose of this study was to explore social determinants of health (SDoH), and disease severity as predictors of sleep quality in persons with both Obstructive Sleep Apnea (OSA) and type 2 diabetes (T2D). METHODS Disease severity was measured by Apnea-Hypopnea Index [(AHI) ≥ 5] and HbA1c for glycemic control. SDoH included subjective and objective financial hardship, race, sex, marital status, education, and age. Sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI). RESULTS The sample (N = 209) was middle-aged (57.6 ± 10.0); 66% White and 34% African American; and 54% men and 46% women. Participants carried a high burden of disease (mean AHI = 20.7 ± 18.1, mean HbA1c = 7.9% ± 1.7%). Disease severity was not significantly associated with sleep quality (all p >.05). Worse sleep quality was associated with both worse subjective (b = -1.54, p = .015) and objective (b = 2.58, p <.001) financial hardship. Characteristics significantly associated with both subjective and objective financial hardship included being African American, female, ≤ 2 years post high school, and of younger ages (all p < .01).Discussion: Financial hardship is a more important predictor of sleep quality than disease severity, age, sex, race, marital status, and educational attainment, in patients with OSA and T2D.
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Affiliation(s)
- Jonna L Morris
- 6614University of Pittsburgh, School of Nursing, 3500 Victoria Street, Pittsburgh PA, 1526
| | - Sarah M Belcher
- 6614University of Pittsburgh, School of Nursing, 3500 Victoria Street, Pittsburgh PA, 1526
| | - Bomin Jeon
- 6614University of Pittsburgh, School of Nursing, 3500 Victoria Street, Pittsburgh PA, 1526
| | - Cassandra M Godzik
- 583584Dartmouth-Hitchcock Medical Center
- Geisel School of Medicine at Dartmouth, Department of Psychiatry,46 Centerra Parkway, Lebanon, NH 03766
| | - Christopher C Imes
- 6614University of Pittsburgh, School of Nursing, 3500 Victoria Street, Pittsburgh PA, 1526
| | - Faith Luyster
- 6614University of Pittsburgh, School of Nursing, 3500 Victoria Street, Pittsburgh PA, 1526
| | - Susan M Sereika
- 6614University of Pittsburgh, School of Nursing, 3500 Victoria Street, Pittsburgh PA, 1526
| | - Paul W Scott
- 6614University of Pittsburgh, School of Nursing, 3500 Victoria Street, Pittsburgh PA, 1526
| | - Eileen R Chasens
- 6614University of Pittsburgh, School of Nursing, 3500 Victoria Street, Pittsburgh PA, 1526
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Trias-Llimós S, Permanyer I. Cause-of-Death Diversity From a Multiple-Cause Perspective in the United States. Demography 2023; 60:73-98. [PMID: 36688513 DOI: 10.1215/00703370-10410415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Cause-of-death diversity captures the variability of deaths across causes and is an important marker of heterogeneity in a population's health. We contribute to the debate of cause-of-death diversity dynamics by following a novel multiple causes of death (MCOD) approach and applying it to the U.S. context between 2003 and 2018 and across education groups. Results show that cause-of-death diversity increased over this period, especially up to 2012. These trends were mainly driven by increases in the groups aged 65 years or more. The inclusion of MCOD resulted in higher increases in cause-of-death diversity over time compared with merely using underlying causes of death, except for the 85 or more age group, where no difference was observed for males and a reverted gradient was observed for females. Results by educational attainment reveal lower diversity among the highest educated groups and widening differences across groups from around 2012 onward. The clear educational gradient observed at ages 30-64 diminished at older ages. The observed increases in cause-of-death diversity should be monitored to better understand mortality dynamics in aging populations. Our new MCOD diversity measures suggest that traditional approaches relying on single causes of death might be underestimating cause-of-death diversity dynamics, particularly for males.
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Affiliation(s)
- Sergi Trias-Llimós
- Centre d'Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Iñaki Permanyer
- Centre d'Estudis Demogràfics, Centres de Recerca de Catalunya (CERCA), Universitat Autònoma de Barcelona, Bellaterra, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
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Khachadourian V, Kodesh A, Levine SZ, Lin E, Buxbaum JD, Bergink V, Sandin S, Reichenberg A, Janecka M. Somatic comorbidities of mental disorders in pregnancy. Eur Psychiatry 2023; 66:e15. [PMID: 36645097 PMCID: PMC9970155 DOI: 10.1192/j.eurpsy.2023.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Mental and physical health conditions are frequently comorbid. Despite the widespread physiological and behavioral changes during pregnancy, the pattern of comorbidities among women in pregnancy is not well studied. This study aimed to systematically examine the associations between mental and somatic disorders before and during pregnancy. METHOD The study used data from mothers of a nationally representative birth cohort of children born in Israel (1997-2008). We compared the risk of all major somatic disorders (International Classification of Diseases, Ninth Revision) in pregnant women with and without a mental disorder. All analyses were adjusted for maternal age, child's birth year, family socioeconomic status, and the total number of maternal encounters with health services around pregnancy period. RESULTS The analytical sample included 77,030 mother-child dyads, with 30,083 unique mothers. The mean age at child's birth was 29.8 years. Prevalence of diagnosis of mental disorder around pregnancy in our sample was 4.4%. Comorbidity between mental and somatic disorders was two times higher than the comorbidity between pairs of different somatic disorders. Of the 17 somatic disorder categories, seven were positively associated with mental health disorders. The highly prevalent comorbidities associated with mental disorders in pregnancy included e.g. musculoskeletal (OR = 1.30; 95% CI = 1.20-1.42) and digestive system diseases (OR = 1.23; 95% CI = 1.13-1.34). CONCLUSIONS We observed that associations between maternal diagnoses and mental health stand out from the general pattern of comorbidity between nonmental health diseases. The study results confirm the need for screening for mental disorders during pregnancy and for potential comorbid conditions associated with mental disorders.
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Affiliation(s)
- Vahe Khachadourian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
| | - Arad Kodesh
- The School of Public Health, University of Haifa, Haifa, Israel
- Meuhedet Health Services, Tel Aviv, Israel
| | | | - Emma Lin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
| | - Joseph D. Buxbaum
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Sven Sandin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
| | - Magdalena Janecka
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
- Department of Genetic and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York10029, USA
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Polypharmacy and Multimorbidity in the Urogynecology Population and Their Effect on Pelvic Floor Symptoms. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:80-87. [PMID: 36548108 DOI: 10.1097/spv.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Polypharmacy and multimorbidity are common in older adults but has not been well studied in the urogynecologic patient population. OBJECTIVES The objective of this study was to determine the prevalence of polypharmacy and multimorbidity in a diverse outpatient urogynecologic population and to examine whether polypharmacy and/or multimorbidity were associated with lower urinary tract symptoms, pelvic organ prolapse, defecatory distress, and/or female sexual dysfunction. STUDY DESIGN This is a secondary analysis of a dual-center cross-sectional study of new patients presenting for evaluation of pelvic floor disorders at 2 urban academic outpatient urogynecology clinics. Baseline demographics and clinical characteristics were obtained from the electronic medical record. Validated surveys were administered to determine severity of lower urinary tract symptoms (Overactive Bladder Validated 8-Question Screener, Urogenital Distress Inventory-6), pelvic floor dysfunction (Pelvic Organ Prolapse Distress Inventory-6, Colorectal-Anal Distress Inventory-8), and sexual dysfunction (6-item Female Sexual Function Index). Standard statistical techniques were used. RESULTS One hundred ninety-seven women with mean age 58.8 years (SD, 13.4 years) were included, and most were of minority race/ethnicity (Black, 34.0%; Hispanic, 21.8%). The majority of participants met criteria for polypharmacy (58.4%) and multimorbidity (85.8%), with a mean prescription number of 6.5 (SD, ± 4.9) and mean number of medical comorbidities of 4.9 (SD, ± 3.3). Polypharmacy and multimorbidity were significantly associated with higher CRADI-8 scores. Specifically, polypharmacy was associated with straining with bowel movements and painful stools, whereas multimorbidity was associated with incomplete emptying and fecal urgency. There was no significant association between polypharmacy and multimorbidity with urinary symptoms, prolapse, or sexual dysfunction. CONCLUSIONS Polypharmacy and multimorbidity are common in the urogynecologic population. There is a relationship between greater defecatory distress and polypharmacy and multimorbidity.
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Yuan C, Wang J, Zhang W, Yi H, Shu B, Li C, Liang Q, Liang D, Chen B, Xie X, Lin X, Wei X, Wang H, Chen P, Huang C, Xu H, Sun Y, Zhao Y, Shi Q, Tang D, Wang Y. Effects of obesity with reduced 25(OH)D levels on bone health in elderly Chinese people: a nationwide cross-sectional study. Front Immunol 2023; 14:1162175. [PMID: 37180138 PMCID: PMC10172581 DOI: 10.3389/fimmu.2023.1162175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023] Open
Abstract
Background Obesity is often accompanied by lower 25(OH)D levels, whereas these two parameters exhibit opposite effects on bone health. It is uncertain what are the effects of lower 25(OH)D levels in obesity on bone health in elderly Chinese people. Methods A nationally representative cross-sectional analysis of China Community-based Cohort of Osteoporosis (CCCO) was performed from 2016 to 2021, which consisted of 22,081 participants. Demographic data, disease history, Body mass index (BMI), bone mineral density (BMD), the levels of the biomarkers of vitamin D status and those of bone metabolism markers were measured for all participants (N = 22,081). The genes (rs12785878, rs10741657, rs4588, rs7041, rs2282679 and rs6013897) related to 25(OH)D transportation and metabolism were performed in a selected subgroup (N = 6008). Results Obese subjects exhibited lower 25(OH)D levels (p < 0.05) and higher BMD (p < 0.001) compared with those of normal subjects following adjustment. The genotypes and allele frequency of rs12785878, rs10741657, rs6013897, rs2282679, rs4588 and rs7041 indicated no significant differences among three BMI groups following correction by the Bonferroni's method (p > 0.05). The levels of total 25(OH)D (ToVD) were significantly different among the GC1F, GC1S and GC2 haplotype groups (p < 0.05). Correlation analysis indicated that ToVD levels were significantly correlated with parathyroid hormone levels, BMD, risk of osteoporosis (OP) and the concentration levels of other bone metabolism markers (p < 0.05). Generalized varying coefficient models demonstrated that the increasing BMI, ToVD levels and their interactions were positively associated with BMD outcomes (p < 0.001), whereas the reduced levels of ToVD and BMI increased the risk of OP, which was noted notably for the subjects with reduced ToVD levels (less than 20.69 ng/ml) combined with decreased BMI (less than 24.05 kg/m2). Conclusion There was a non-linear interaction of BMI and 25(OH)D. And higher BMI accompanied by decreased 25(OH)D levels is associated with increased BMD and decreased incidence of OP, optimal ranges exist for BMI and 25(OH)D levels. The cutoff value of BMI at approximately 24.05 kg/m2 combined with an approximate value of 25(OH)D at 20.69 ng/ml are beneficial for Chinese elderly subjects.
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Affiliation(s)
- Chunchun Yuan
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
| | - Jing Wang
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai, China
- Academic Research Center of Shixiaoshan’ Traumatology, Shanghai, China
| | - Weiqiang Zhang
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences and Human Phenome Institute, Fudan University, Shanghai, China
| | - Honggang Yi
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Bing Shu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- Academic Research Center of Shixiaoshan’ Traumatology, Shanghai, China
| | - Chenguang Li
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- Academic Research Center of Shixiaoshan’ Traumatology, Shanghai, China
| | - Qianqian Liang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- Academic Research Center of Shixiaoshan’ Traumatology, Shanghai, China
| | - De Liang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bolai Chen
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xingwen Xie
- The Second People’s Hospital of Gansu Province, Gansu, Lanzhou, China
- Affiliated Hospital of Northwest University for Nationalities, Gansu, Lanzhou, China
| | - Xinchao Lin
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xu Wei
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hui Wang
- State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peizhan Chen
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Huang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
| | - Hao Xu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
| | - Yueli Sun
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
| | - Yongjian Zhao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
| | - Qi Shi
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- Academic Research Center of Shixiaoshan’ Traumatology, Shanghai, China
| | - Dezhi Tang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- Academic Research Center of Shixiaoshan’ Traumatology, Shanghai, China
- *Correspondence: Yongjun Wang, ; Dezhi Tang,
| | - Yongjun Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- Academic Research Center of Shixiaoshan’ Traumatology, Shanghai, China
- *Correspondence: Yongjun Wang, ; Dezhi Tang,
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Marques LP, de Aguiar OB, Paula DP, Oliveira FEG, Chor D, Benseñor I, Ribeiro AL, Brunoni AR, A C Machado L, da Fonseca MDJM, Griep RH. Multimorbidity prevalence and patterns at the baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231173845. [PMID: 37223823 PMCID: PMC10201182 DOI: 10.1177/26335565231173845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/17/2023] [Indexed: 05/25/2023]
Abstract
Background To identify multimorbidity patterns, by sex, according to sociodemographic and lifestyle in ELSA-Brasil. Methods Cross-sectional study with 14,516 participants from ELSA-Brasil (2008-2010). Fuzzy c-means was used to identify multimorbidity patterns of 2+ chronic morbidities, where the consequent morbidity had to occur in at least 5% of all cases. Association rule (O/E≥1.5) was used to identify co-occurrence of morbidities, in each cluster, by sociodemographic and lifestyle factors. Results The prevalence of multimorbidity was higher in women (73.7%) compared to men (65.3%). Among women, cluster 1 was characterized by hypertension/diabetes (13.2%); cluster 2 had no overrepresented morbidity; and cluster 3 all participants had kidney disease. Among men, cluster 1 was characterized by cirrhosis/hepatitis/obesity; cluster 2, most combinations included kidney disease/migraine (6.6%); cluster 3, no pattern reached association ratio; cluster 4 predominated co-occurrence of hypertension/rheumatic fever, and hypertension/dyslipidemia; cluster 5 predominated diabetes and obesity, and combinations with hypertension (8.8%); and cluster 6 presented combinations of diabetes/hypertension/heart attack/angina/heart failure. Clusters were characterized by higher prevalence of adults, married and participants with university degrees. Conclusion Hypertension/diabetes/obesity were highly co-occurred, in both sexes. Yet, for men, morbidities like cirrhosis/hepatitis were commonly clustered with obesity and diabetes; and kidney disease was commonly clustered with migraine and common mental disorders. The study advances in understanding multimorbidity patterns, benefiting simultaneously or gradually prevention of diseases and multidisciplinary care responses.
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Affiliation(s)
- Larissa Pruner Marques
- Post-Graduate Program in
Epidemiology, Sergio Arouca National School of Public
Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Odaleia Barbosa de Aguiar
- Department of Applied Nutrition,
Institute of Nutrition, Rio de Janeiro State
University, Rio de Janeiro, Brazil
| | - Daniela Polessa Paula
- National School of Statistical
Sciences, Brazilian Institute of Geography and Statistics, Rio de
Janeiro, Brazil
| | | | - Dóra Chor
- Department of Epidemiology and
Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Isabela Benseñor
- Clinical and Epidemiologic Research
Center, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Antonio Luiz Ribeiro
- Department of Internal Medicine, Federal University of Minas
Gerais, Belo Horizonte, Brazil
| | - Andre R Brunoni
- Interdisciplinary Neuromodulation
Service, Psychiatry Institute, University of São Paulo School of
Medicine Hospital das Clínicas, HC-FMUSP, São Paulo, Brazil
| | - Luciana A C Machado
- Clinical Hospital/Ebserh, Universidade Federal de Minas
Gerais, HC-UFMG, Belo Horizonte, Brazil
| | - Maria de Jesus Mendes da Fonseca
- Department of Epidemiology and
Quantitative Methods in Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rosane Härter Griep
- Laboratory of Health and
Environment Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Doose M, Verhoeven D, Sanchez JI, McGee-Avila JK, Chollette V, Weaver SJ. Clinical Multiteam System Composition and Complexity Among Newly Diagnosed Early-Stage Breast, Colorectal, and Lung Cancer Patients With Multiple Chronic Conditions: A SEER-Medicare Analysis. JCO Oncol Pract 2023; 19:e33-e42. [PMID: 36473151 PMCID: PMC10166428 DOI: 10.1200/op.22.00304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Sixty percent of adults have multiple chronic conditions at cancer diagnosis. These patients may require a multidisciplinary clinical team-of-teams, or a multiteam system (MTS), of high-complexity involving multiple specialists and primary care, who, ideally, coordinate clinical responsibilities, share information, and align clinical decisions to ensure comprehensive care needs are managed. However, insights examining MTS composition and complexity among individuals with cancer and comorbidities at diagnosis using US population-level data are limited. METHODS Using SEER-Medicare data (2006-2016), we identified newly diagnosed patients with breast, colorectal, or lung cancer who had a codiagnosis of cardiopulmonary disease and/or diabetes (n = 75,201). Zaccaro's theory-based classification of MTSs was used to categorize clinical MTS complexity in the 4 months following cancer diagnosis: high-complexity (≥ 4 clinicians from ≥ 2 specialties) and low-complexity (1-3 clinicians from 1-2 specialties). We describe the proportions of patients with different MTS compositions and quantify the incidence of high-complexity MTS care by patient groups. RESULTS The most common MTS composition was oncology with primary care (37%). Half (50.3%) received high-complexity MTS care. The incidence of high-complexity MTS care for non-Hispanic Black and Hispanic patients with cancer was 6.7% (95% CI, -8.0 to -5.3) and 4.7% (95% CI, -6.3 to -3.0) lower than non-Hispanic White patients with cancer; 13.1% (95% CI, -14.1 to -12.2) lower for rural residents compared with urban; 10.4% (95% CI, -11.2 to -9.5) lower for dual Medicaid-Medicare beneficiaries compared with Medicare-only; and 16.6% (95% CI, -17.5 to -15.8) lower for colorectal compared with breast cancer. CONCLUSION Incidence differences of high-complexity MTS care were observed among cancer patients with multiple chronic conditions from underserved populations. The results highlight the need to further understand the effects of and mechanisms through which care team composition, complexity, and functioning affect care quality and outcomes.
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Affiliation(s)
- Michelle Doose
- Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, Bethesda, MD
| | - Dana Verhoeven
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Janeth I Sanchez
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Jennifer K McGee-Avila
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Veronica Chollette
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Sallie J Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Li XY, Liu H, Zhang LY, Yang XT. Association between dietary theobromine with depression: a population-based study. BMC Psychiatry 2022; 22:769. [PMID: 36474233 PMCID: PMC9727944 DOI: 10.1186/s12888-022-04415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The purpose of this study is to investigate the possible link between dietary theobromine intake and symptoms of depression. MATERIALS AND METHODS These results are based on the responses of 3637 people who took part in the National Health and Nutrition Examination Survey in 2017-2018. Participants' daily theobromine intake was determined using a 24-h food questionnaire from the 2017-2018 cycle. Presence of depression was defined as a score of 5 or above on the Patient Health Questionnaire. Association between theobromine intake and depression was examined using a multivariate logistic regression adjusting for several relevant sociodemographic, lifestyle and health-related factors. RESULTS A total of 6903 participants were included in the study. The results of multivariate logistic regression showed a correlation between depressive symptoms and theobromine intake (OR:1.17, 95%CI:1.02-1.34). CONCLUSIONS Our cross-sectional population based study suggests that increased theobromine intake is associated with increased risk for depression. Nevertheless, more investigations are needed to confirm our findings.
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Affiliation(s)
- Xin-yu Li
- grid.16821.3c0000 0004 0368 8293Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, No.639 Zhizaoju Road, Huangpu District, Shanghai, 200011 People’s Republic of China ,grid.412523.30000 0004 0386 9086Department of Neurosurgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Hui Liu
- grid.412528.80000 0004 1798 5117Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Lu-yu Zhang
- grid.412633.10000 0004 1799 0733The Department of Kidney Transplantation, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xi-tao Yang
- grid.16821.3c0000 0004 0368 8293Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, No.639 Zhizaoju Road, Huangpu District, Shanghai, 200011 People’s Republic of China
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Liu ZX, Whitehead B, Botoseneanu A. Association of Psychological distress and Physical Health with Subjective and Objective Memory in Older Adults. J Aging Health 2022:8982643221143828. [PMID: 36459693 DOI: 10.1177/08982643221143828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
ObjectivesTo investigate how indicators of psychological stress and physical health differentially influence subjective and objective memory in older adults. Methods: 404 adults aged ≥55 without cognitive impairment participated in remote assessment of physical health (PHY; multimorbidity, body-mass-index), psychological distress (PDS; perceived stress, anxiety, depression), subjective memory complaints (SM), and task-based objective memory performance (OM). Results: Separately, both PHY and PDS significantly predicted SM (p < 0.01), but only PHY was associated with OM (p = 0.05). Combined models showed that PHY and PDS maintained significant association with SM (p < 0.01, R2 = 0.30), while only PHY was associated with OM (p = .07, R2 = 0.03; for associative OM, p = 0.04). Discussion: SM is associated with participants' psychological profile, highlighting the importance of addressing these factors when assessing SM. The results also reveal that remotely-administered OM tasks are more immune to participants' psychological profile, and support previously-established links between physical health and objective and subjective memory function.
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Affiliation(s)
- Zhong-Xu Liu
- Department of Behavioral Sciences, 177870University of Michigan-Dearborn, Dearborn, MI, USA
| | - Brenda Whitehead
- Department of Behavioral Sciences, 177870University of Michigan-Dearborn, Dearborn, MI, USA.,School of Behavioral Science, 492177Grace College, Winona Lake, IN, USA
| | - Anda Botoseneanu
- Department of Health and Human Services, 14711University of Michigan-Dearborn, Dearborn, MI, USA.,Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA
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Defining and measuring multimorbidity in primary care in Singapore: Results of an online Delphi study. PLoS One 2022; 17:e0278559. [PMID: 36455000 PMCID: PMC9714819 DOI: 10.1371/journal.pone.0278559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
Multimorbidity, common in the primary care setting, has diverse implications for both the patient and the healthcare system. However, there is no consensus on the definition of multimorbidity globally. Thus, we aimed to conduct a Delphi study to gain consensus on the definition of multimorbidity, the list and number of chronic conditions used for defining multimorbidity in the Singapore primary care setting. Our Delphi study comprised three rounds of online voting from purposively sampled family physicians in public and private settings. Delphi round 1 included open-ended questions for idea generation. The subsequent two rounds used questions with pre-selected options. Consensus was achieved based on a pre-defined criteria following an iterative process. The response rates for the three rounds were 61.7% (37/60), 86.5% (32/37) and 93.8% (30/32), respectively. Among 40 panellists who responded, 46.0% were 31-40 years old, 64.9% were male and 73.0% were from the public primary healthcare setting. Based on the findings of rounds 1, 2 and 3, consensus on the definition of a chronic condition, multimorbidity and finalised list of chronic conditions were achieved. For a condition to be chronic, it should last for six months or more, be recurrent or persistent, impact patients across multiple domains and require long-term management. The consensus-derived definition of multimorbidity is the presence of three or more chronic conditions from a finalised list of 23 chronic conditions. We anticipate that our findings will inform multimorbidity conceptualisation at the national level, standardise multimorbidity measurement in primary care and facilitate resource allocation for patients with multimorbidity.
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Ricket IM, Brown JR, MacKenzie TA, Ma Y, Grewal D, Ailawadi KL, Emond JA. Quantifying differences in packaged food and drink purchases among households with diet-related cardiometabolic multi-morbidity: a cross-sectional analysis. BMC Public Health 2022; 22:2101. [PMID: 36397061 PMCID: PMC9670385 DOI: 10.1186/s12889-022-14626-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diet is important for chronic disease management, with limited research understanding dietary choices among those with multi-morbidity, the state of having 2 or more chronic conditions. The objective of this study was to identify associations between packaged food and drink purchases and diet-related cardiometabolic multi-morbidity (DRCMM). METHODS Cross-sectional associations between packaged food and drink purchases and household DRCMM were investigated using a national sample of U.S. households participating in a research marketing study. DRCMM households were defined as household head(s) self-reporting 2 or more diet-related chronic conditions. Separate multivariable logistic regression models were used to model the associations between household DRCMM status and total servings of, and total calories and nutrients from, packaged food and drinks purchased per month, as well as the nutrient density (protein, carbohydrates, and fat per serving) of packaged food and drinks purchased per month, adjusted for household size. RESULTS Among eligible households, 3795 (16.8%) had DRCMM. On average, households with DRCMM versus without purchased 14.8 more servings per capita, per month, from packaged foods and drinks (p < 0.001). DRCMM households were 1.01 times more likely to purchase fat and carbohydrates in lieu of protein across all packaged food and drinks (p = 0.002, p = 0.000, respectively). DRCMM households averaged fewer grams per serving of protein, carbohydrates, and fat per month across all food and drink purchases (all p < 0.001). When carbonated soft drinks and juices were excluded, the same associations for grams of protein and carbohydrates per serving per month were seen (both p < 0.001) but the association for grams of fat per serving per month attenuated. CONCLUSIONS DRCMM households purchased greater quantities of packaged food and drinks per capita than non-DRCMM households, which contributed to more fat, carbohydrates, and sodium in the home. However, food and drinks in DRCMM homes on average were lower in nutrient-density. Future studies are needed to understand the motivations for packaged food and drink choices among households with DRCMM to inform interventions targeting the home food environment.
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Affiliation(s)
- Iben M Ricket
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Jeremiah R Brown
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Todd A MacKenzie
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Yu Ma
- Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada
| | - Dhruv Grewal
- Marketing Division, Babson College, Babson Park, MA, USA
| | | | - Jennifer A Emond
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Lee AYL, Wong AKC, Hung TTM, Yan J, Yang S. Nurse-led Telehealth Intervention for Rehabilitation (Telerehabilitation) Among Community-Dwelling Patients With Chronic Diseases: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e40364. [PMID: 36322107 PMCID: PMC9669889 DOI: 10.2196/40364] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/22/2022] [Accepted: 10/10/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic diseases are putting huge pressure on health care systems. Nurses are widely recognized as one of the competent health care providers who offer comprehensive care to patients during rehabilitation after hospitalization. In recent years, telerehabilitation has opened a new pathway for nurses to manage chronic diseases at a distance; however, it remains unclear which chronic disease patients benefit the most from this innovative delivery mode. OBJECTIVE This study aims to summarize current components of community-based, nurse-led telerehabilitation programs using the chronic care model; evaluate the effectiveness of nurse-led telerehabilitation programs compared with traditional face-to-face rehabilitation programs; and compare the effects of telerehabilitation on patients with different chronic diseases. METHODS A systematic review and meta-analysis were performed using 6 databases for articles published from 2015 to 2021. Studies comparing the effectiveness of telehealth rehabilitation with face-to-face rehabilitation for people with hypertension, cardiac diseases, chronic respiratory diseases, diabetes, cancer, or stroke were included. Quality of life was the primary outcome. Secondary outcomes included physical indicators, self-care, psychological impacts, and health-resource use. The revised Cochrane risk of bias tool for randomized trials was employed to assess the methodological quality of the included studies. A meta-analysis was conducted using a random-effects model and illustrated with forest plots. RESULTS A total of 26 studies were included in the meta-analysis. Telephone follow-ups were the most commonly used telerehabilitation delivery approach. Chronic care model components, such as nurses-patient communication, self-management support, and regular follow-up, were involved in all telerehabilitation programs. Compared with traditional face-to-face rehabilitation groups, statistically significant improvements in quality of life (cardiac diseases: standard mean difference [SMD] 0.45; 95% CI 0.09 to 0.81; P=.01; heterogeneity: X21=1.9; I2=48%; P=.16; chronic respiratory diseases: SMD 0.18; 95% CI 0.05 to 0.31; P=.007; heterogeneity: X22=1.7; I2=0%; P=.43) and self-care (cardiac diseases: MD 5.49; 95% CI 2.95 to 8.03; P<.001; heterogeneity: X25=6.5; I2=23%; P=.26; diabetes: SMD 1.20; 95% CI 0.55 to 1.84; P<.001; heterogeneity: X24=46.3; I2=91%; P<.001) were observed in the groups that used telerehabilitation. For patients with any of the 6 targeted chronic diseases, those with hypertension and diabetes experienced significant improvements in their blood pressure (systolic blood pressure: MD 10.48; 95% CI 2.68 to 18.28; P=.008; heterogeneity: X21=2.2; I2=54%; P=0.14; diastolic blood pressure: MD 1.52; 95% CI -10.08 to 13.11, P=.80; heterogeneity: X21=11.5; I2=91%; P<.001), and hemoglobin A1c (MD 0.19; 95% CI -0.19 to 0.57 P=.32; heterogeneity: X24=12.4; I2=68%; P=.01) levels. Despite these positive findings, telerehabilitation was found to have no statistically significant effect on improving patients' anxiety level, depression level, or hospital admission rate. CONCLUSIONS This review showed that telerehabilitation programs could be beneficial to patients with chronic disease in the community. However, better designed nurse-led telerehabilitation programs are needed, such as those involving the transfer of nurse-patient clinical data. The heterogeneity between studies was moderate to high. Future research could integrate the chronic care model with telerehabilitation to maximize its benefits for community-dwelling patients with chronic diseases. TRIAL REGISTRATION International Prospective Register of Systematic Reviews CRD42022324676; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=324676.
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Affiliation(s)
- Athena Yin Lam Lee
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | | - Tommy Tsz Man Hung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jing Yan
- Zhejiang Hospital, Zhejiang, China
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Rosen CB, Roberts SE, Wirtalla CJ, Ramadan OI, Keele LJ, Kaufman EJ, Halpern SD, Kelz RR. Analyzing Impact of Multimorbidity on Long-Term Outcomes after Emergency General Surgery: A Retrospective Observational Cohort Study. J Am Coll Surg 2022; 235:724-735. [PMID: 36250697 PMCID: PMC9583235 DOI: 10.1097/xcs.0000000000000303] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the impact of multimorbidity on long-term outcomes for older emergency general surgery patients. STUDY DESIGN Medicare beneficiaries, age 65 and older, who underwent operative management of an emergency general surgery condition were identified using Centers for Medicare & Medicaid claims data. Patients were classified as multimorbid based on the presence of a Qualifying Comorbidity Set (a specific combination of comorbid conditions known to be associated with increased risk of in-hospital mortality in the general surgery setting) and compared with those without multimorbidity. Risk-adjusted outcomes through 180 days after discharge from index hospitalization were calculated using linear and logistic regressions. RESULTS Of 174,891 included patients, 45.5% were identified as multimorbid. Multimorbid patients had higher rates of mortality during index hospitalization (5.9% vs 0.7%, odds ratio [OR] 3.05, p < 0.001) and through 6 months (17.1% vs 3.4%, OR 2.33, p < 0.001) after discharge. Multimorbid patients experienced higher rates of readmission at 1 month (22.9% vs 11.4%, OR 1.48, p < 0.001) and 6 months (38.2% vs 21.2%, OR 1.48, p < 0.001) after discharge, lower rates of discharge to home (42.5% vs 74.2%, OR 0.52, p < 0.001), higher rates of discharge to rehabilitation/nursing facility (28.3% vs 11.3%, OR 1.62, p < 0.001), greater than double the use of home oxygen, walker, wheelchair, bedside commode, and hospital bed (p < 0.001), longer length of index hospitalization (1.33 additional in-patient days, p < 0.001), and higher costs through 6 months ($5,162 additional, p < 0.001). CONCLUSIONS Older, multimorbid patients experience worse outcomes, including survival and independent function, after emergency general surgery than nonmultimorbid patients through 6 months after discharge from index hospitalization. This information is important for setting recovery expectations for high-risk patients to improve shared decision-making.
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Affiliation(s)
- Claire B Rosen
- Department of Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | - Sanford E Roberts
- Department of Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | - Chris J Wirtalla
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | - Omar I Ramadan
- Department of Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
| | - Luke J Keele
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | - Elinore J Kaufman
- Department of Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
| | - Scott D Halpern
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
- Department of Medicine, Hospital of the University of Pennsylvania; Philadelphia, PA
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, PA
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Guiding Principles for Managing Co-occurring Alcohol/Other Drug and Mental Health Conditions: a Scoping Review. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00926-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AbstractThis scoping review aimed to synthesise the published literature on guiding principles for managing co-occurring alcohol/other drug (AOD) and mental health conditions in AOD treatment settings. Systematic search of key electronic databases (January 1, 2010, to February 17, 2021) produced 4583 articles, and independent title/abstract and full text screening left 43 articles for inclusion. Fifteen guiding principles were identified, most commonly: build a strong therapeutic relationship (n = 24 articles), provide holistic care (n = 12), involve peer support (n = 7), ensure continuity of care (n = 6), support the professional development and competence of workers (n = 6), and provide trauma-informed care (n = 5). Remaining principles were identified in < 5 articles. Limited empirical literature examined the impact of guiding principles on patient- and treatment-related outcomes. This review provides the first comprehensive synthesis of the international literature to derive guiding principles for managing co-occurring AOD and mental health conditions in AOD treatment. Further empirical research is needed to determine the effectiveness of principles at improving outcomes.
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LeResche L. Commentary: The Changing Face of Dentistry. JDR Clin Trans Res 2022; 7:40S-46S. [PMID: 36121135 DOI: 10.1177/23800844221116840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
KNOWLEDGE TRANSFER STATEMENT This article reviews social, economic, and technological trends affecting the future of dentistry. These trends have important implications for the training of dentists and the organization of dental care with the aim of improving the oral health of the public. Clinical and translational research has an essential role to play in developing the interventions and evidence base for these improvements.
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Affiliation(s)
- L LeResche
- Department of Oral Medicine, University of Washington, Seattle, WA, USA
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Leung LB, Rubenstein LV, Jaske E, Taylor L, Post EP, Nelson KM, Rosland AM. Association of Integrated Mental Health Services with Physical Health Quality Among VA Primary Care Patients. J Gen Intern Med 2022; 37:3331-3337. [PMID: 35141854 PMCID: PMC9550947 DOI: 10.1007/s11606-021-07287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Integrated care for comorbid depression and chronic medical disease improved physical and mental health outcomes in randomized controlled trials. The Veterans Health Administration (VA) implemented Primary Care-Mental Health Integration (PC-MHI) across all primary care clinics nationally to increase access to mental/behavioral health treatment, alongside physical health management. OBJECTIVE To examine whether widespread, pragmatic PC-MHI implementation was associated with improved care quality for chronic medical diseases. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 828,050 primary care patients with at least one quality metric among 396 VA clinics providing PC-MHI services between October 2013 and September 2016. MAIN MEASURE(S) For outcome measures, chart abstractors rated whether diabetes and cardiovascular quality metrics were met for patients at each clinic as part of VA's established quality reporting program. The explanatory variable was the proportion of primary care patients seen by integrated mental health specialists in each clinic annually. Multilevel logistic regression models examined associations between clinic PC-MHI proportion and patient-level quality metrics, adjusting for regional, patient, and time-level effects and clinic and patient characteristics. KEY RESULTS Median proportion of patients seen in PC-MHI per clinic was 6.4% (IQR=4.7-8.7%). Nineteen percent of patients with diabetes had poor glycemic control (hemoglobin A1c >9%). Five percent had severely elevated blood pressure (>160/100 mmHg). Each two-fold increase in clinic PC-MHI proportion was associated with 2% lower adjusted odds of poor glycemic control (95% CI=0.96-0.99; p=0.046) in diabetes. While there was no association with quality for patients diagnosed with hypertension, patients without diagnosed hypertension had 5% (CI=0.92-0.99; p=0.046) lower adjusted odds of having elevated blood pressures. CONCLUSIONS AND RELEVANCE Primary care clinics where integrated mental health care reached a greater proportion of patients achieved modest albeit statistically significant gains in key chronic care quality metrics, providing optimism about the expected effects of large-scale PC-MHI implementation on physical health.
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Affiliation(s)
- Lucinda B Leung
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (111G), Los Angeles, CA, 90073, USA. .,Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Lisa V Rubenstein
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.,Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, CA, USA
| | - Erin Jaske
- VA Puget Sound Health Care System, Seattle, WA, USA
| | | | - Edward P Post
- VA Ann Arbor, Center for Clinical Management Research, Ann Arbor, MI, USA.,Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Karin M Nelson
- VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, University of Washington Medical School, Seattle, WA, USA
| | - Ann-Marie Rosland
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Suls JM, Alfano C, Yap C. Personalized (N-of-1) Trials for Patient-Centered Treatments of Multimorbidity. HARVARD DATA SCIENCE REVIEW 2022; 4:10.1162/99608f92.d99e6ff5. [PMID: 38009131 PMCID: PMC10673634 DOI: 10.1162/99608f92.d99e6ff5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
Treatment of patients who suffer from concurrent health conditions is not well served by (1) evidence-based clinical guidelines that mainly specify treatment of single conditions and (2) conventional randomized controlled trials (RCTs) that identify treatments as safe and effective on average. Clinical decision-making based on the average patient effect may be inappropriate for treatment of those with multimorbidity who experience burdens and obstacles that may be unique to their personal situation. We describe how the personalized (N-of-1) trials can be integrated with an automatic platform and virtual/remote technologies to improve patient-centered care for those living with multimorbidity. To illustrate, we present a hypothetical clinical scenario-survivors of both coronavirus disease 2019 (COVID-19) and cancer who chronically suffer from sleeplessness and fatigue. Then, we will describe how the four standard phases of conventional RCT development can be modified for personalized trials and applied to the multimorbidity clinical scenario, outline how personalized trials can be adapted and extended to compare the benefits of personalized trials versus between-subject trial design, and explain how personalized trials can address special problems associated with multimorbidity for which conventional trials are poorly suited.
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Affiliation(s)
- Jerry M Suls
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health; Manhasset, NY, USA
| | - Catherine Alfano
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health; Manhasset, NY, USA
- Northwell Health Cancer Institute; Manhasset, NY, USA
| | - Christina Yap
- Clinical Trials and Statistics Unit, The Institute of Cancer Research; London, UK
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Larkin J, Walsh B, Moriarty F, Clyne B, Harrington P, Smith SM. What is the impact of multimorbidity on out-of-pocket healthcare expenditure among community-dwelling older adults in Ireland? A cross-sectional study. BMJ Open 2022; 12:e060502. [PMID: 36581975 PMCID: PMC9438209 DOI: 10.1136/bmjopen-2021-060502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Individuals with multimorbidity use more health services and take more medicines. This can lead to high out-of-pocket (OOP) healthcare expenditure. This study, therefore, aimed to assess the association between multimorbidity (two or more chronic conditions) and OOP healthcare expenditure in a nationally representative sample of adults aged 50 years or over. DESIGN Cross-sectional analysis of data collected in 2016 from wave 4 of The Irish Longitudinal Study on Ageing.SettingIreland.ParticipantsCommunity-dwelling adults aged 50 years and over.MethodA generalised linear model with log-link and gamma distributed errors was fitted to assess the association between multimorbidity and OOP healthcare expenditure (including general practitioner, emergency department, outpatients, specialist consultations, hospital admissions, home care and prescription drugs). RESULTS Overall, 3453 (58.5%) participants had multimorbidity. Among those with any OOP healthcare expenditure, individuals with multimorbidity spent more on average per annum (€806.8 for two conditions, €885.8 for three or more conditions), than individuals with no conditions (€580.3). Pharmacy-dispensed medicine expenditure was the largest component of expenditure. People with multimorbidity on average spent more of their equivalised household income on healthcare (7.1% for two conditions, 9.7% for three or more conditions), than people with no conditions (5.0%). A strong positive association was found between number of conditions and OOP healthcare expenditure (p<0.001) and between having private health insurance and OOP healthcare expenditure (p<0.001). A strong negative association was found between eligibility for free primary/hospital care and heavily subsidised medicines and OOP healthcare expenditure (p<0.001). CONCLUSIONS This study suggests that having multimorbidity in Ireland increases OOP healthcare expenditure, which is problematic for those with more conditions who have lower incomes. This highlights the need for this financial burden to be considered when designing healthcare/funding systems to address multimorbidity, so that access to essential healthcare can be maximised for those with greatest need.
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Affiliation(s)
- James Larkin
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Brendan Walsh
- Social Research Division, The Economic and Social Research Institute, Dublin, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Patricia Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
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