Clinical, Economic, and Humanistic Outcomes Associated with Obesity Among People with Bipolar I Disorder in the United States: Analysis of National Health and Wellness Survey Data

Introduction

People living with bipolar I disorder (BD-I) have an increased risk for obesity compared with the general population that may be related to genetic, lifestyle, and treatment factors. Few studies have examined possible effects of obesity on those living with BD-I. This study examined relationships between obesity and clinical, humanistic, and economic outcomes among adults with BD-I.

Methods

This retrospective, cross-sectional study analyzed survey responses from a nationally representative sample of US adults participating in the 2016 or 2020 National Health and Wellness Survey. Respondents (18-64 years) with a self-reported physician diagnosis of BD-I were included and categorized by body mass index: underweight/normal weight (<25 kg/m2), overweight (25 to <30 kg/m2), or obese (≥30 kg/m2). Adjusted analyses assessed comorbidities, health-related quality of life (HRQoL), work productivity, health care resource utilization (HCRU), and economic outcomes.

Results

In total, responses from 1,853 participants were analyzed; most were female (65%) and white (62%). Respondents with obesity had the highest prevalence of medical comorbidities, including high blood pressure (52%), sleep apnea (37%), hypercholesterolemia (34%), and type 2 diabetes (12%). Obesity was generally associated with the lowest scores of physical health and HRQoL. Activity impairment scores were highest among respondents with obesity, as were numbers of hospitalizations and emergency department visits in the previous 6 months. Respondents with obesity incurred higher annual indirect and direct medical costs ($28,178 and $37,771, respectively) when compared with the underweight/normal weight ($23,823 and $32,227, respectively) and overweight ($24,312 and $35,231, respectively) groups.

Conclusion

In this nationally representative sample, obesity was associated with several outcomes that may negatively affect people living with BD-I, including medical comorbidities, higher HCRU, HRQoL impairments, and greater indirect and direct medical costs. These findings highlight the importance of considering the presence of or risk for obesity and associated medical comorbidities when treating BD-I.

A Retrospective, Longitudinal, Claims-Based Comparison of Concomitant Diagnoses Between Individuals with and Without Down Syndrome

BACKGROUND

Individuals with Down syndrome (DS) experience various comorbidities in excess of the prevalence seen among the non-DS population. However, the extent of the excess burden of comorbidities specifically within commercially and publicly insured DS populations aged < 21 years is not currently known.

OBJECTIVES

To (a) describe the most common diagnoses among individuals with DS who have either commercial or Medicaid insurance and (b) compare the prevalence of those diagnoses between DS cases and non-DS controls.

METHODS

This was a longitudinal, retrospective study using health care claims of commercially insured and Medicaid-insured individuals in the Truven Health MarketScan Databases from 2008 to 2015. Individuals aged < 2, 2-5, 6-11, and 12-20 years with a DS diagnosis (cases; commercial: n = 15,948; Medicaid: n = 11,958) were matched to individuals without DS (controls; commercial: n = 47,844; Medicaid: n = 35,874) using a 1:3 ratio. The annual number of diagnoses was compared between cases and controls within age groups using t-tests, and the prevalence of the most common diagnoses was compared using chi-square tests.

RESULTS

Cases in all age groups in both databases had more diagnoses annually than controls (mean =9-17 per year vs. 4-10 per year, P < 0.001), and the number of diagnoses decreased with age for cases and controls. Among the most common case diagnoses were upper respiratory infections (28.9%-59.1% vs. 19.5%-52.9%); suppurative otitis media (25.1%-56.8% vs. 8.7%-51.2%); nutrition/metabolic/developmental symptoms (37.9%-50.4% vs. 7.7%-10.6%); delays in development (22.8%-52.8% vs. 4.1%-10.9%); and general symptoms (35.1%-47.2% vs. 22.1%-37.2%), and the prevalence of each was greater among cases versus controls in all age groups in both databases (P < 0.001). The most common diagnoses among controls included some of the same as among cases, as well as acute pharyngitis (18.7%-31.8% vs. 19.2%-30.5%); allergic rhinitis (19.9%-24.3% vs. 15.3%-20.7%); viral/chlamydial infections (24.2%-26.6% vs. 17.7%-23.5%); and joint disorders (11.6% vs. 16.6%), and most were significantly more prevalent among cases (P < 0.05).

CONCLUSIONS

Commercially insured and Medicaid-insured individuals aged < 21 years with DS experience a greater number and prevalence of concomitant diagnoses compared with non-DS individuals. Awareness of these common diagnoses could help facilitate the optimal care of these individuals by the pediatric health care community.

DISCLOSURES

This study was sponsored and funded by Genentech. Truven Health Analytics, an IBM Company, receives payment from Genentech to conduct research, including the research for this study. Truven Health Analytics also receives payment from other pharmaceutical companies to conduct research. Kong and Evans are employed by Truven Health Analytics. Csoboth is employed by Genentech. Brixner reports fees paid to the University of Utah by Truven Health Analytics on her behalf for work related to this study. Hurley reports fees from Genentech for work on this study and for work outside of this study. At the time of this study, Visootsak was employed by F. Hoffman-LaRoche Pharmaceuticals, parent company of Genentech. All authors, including those affiliated with the study sponsor, were involved in the design of the study, interpretation of the data, writing of the manuscript, and the decision to submit the manuscript for publication. Study concept and design were contributed by Kong, Hurley, and Brixner, along with Evans. Kong and Evans collected the data, and data interpretation was performed by Csoboth, Visootsak, Brixner, and Hurley, with assistance from Kong. The manuscript was written by Evans, Kong, Hurley, and Brixner and revised by Kong, Hurley, Evans, and Brixner, with assistance from Csoboth and Visootsak.

The humanistic and economic burden of providing care for a patient with schizophrenia

BACKGROUND

Schizophrenia is a debilitating disorder that often requires the affected individual to receive part- or full-time care from a caregiver.

AIMS

The purpose of this study was to examine the humanistic and economic burden of caring for an individual with Schizophrenia with regard to the measures of quality of life (QoL), work productivity, healthcare resource use and estimated economic costs.

METHODS

Data for this study came from the 2012 US National Health and Wellness Survey (NHWS; n = 71,149). Specifically, this analysis focused on those individuals in the survey who indicated that they were currently the primary caregiver for an individual with Schizophrenia (C-SCZ; n = 174). These individuals were matched via two separate 1:2 propensity score matches with both caregivers of other disorders (C-Other; n = 294) and non-caregivers (Non-C; n = 294) on significant covariates. Individuals were then compared across the outcomes of QoL, work productivity, healthcare resource use and estimated economic costs.

RESULTS

C-SCZ respondents had worse outcomes on all outcomes measured than C-Other respondents and Non-C respondents even when controlling for significant differences between the groups on sociodemographic characteristics. However, due to the small sample sizes, these comparisons were only significant in most cases for the C-SCZ to Non-C comparisons.

CONCLUSION

Results indicate that caregivers of those with Schizophrenia experience a heightened humanistic and economic burden, especially relative to the burden experienced by non-caregivers. The fact that Schizophrenia not only affects the individual but also those who care for that individual is underscored by these results.

[Sleep disorders and physical abuse: a nation-wide representative study in Hungary]

OBJECTIVES

Violence against women has been declared a major public health concern. The relationship between physical abuse and physical and psychological symptoms is well-known, however data regarding the association between physical abuse and sleep disorders are limited. Our aim is to document the prevalence of reported abuse and investigate the association between physical abuse and insomnia among females.

METHODS

Cross-sectional analyses were conducted on the female sample (N=6987) of the Hungarostudy 2002, a nationwide representative survey. The survey contained sociodemographic questions and a Hungarian version of Athen Insomnia Scale (AIS).

RESULTS

We found higher (>10) AIS scores and all of the items of AIS reported higher prevalence among abused women's group than non-abused women. Physical abuse was found to be associated with sleep disturbances (OR=1,707), problems with staying asleep (OR=1,552) and decrease of daytime performance (OR=2,024) after controlling the potential risk factors.

CONCLUSION

Women experiencing physical abuse have a significantly higher risk of sleep disorders. The relationship between physical abuse and insomnia deserves further investigation in order to determine the possible pathways of this association.

Work-related stress factors and menstrual pain: a nation-wide representative survey

While imposing research has been conducted with respect to the biological determinants of painful menstruation, little is known about the psychosocial factors, including work-related stress that might influence menstrual pain. We conducted a study in which we aimed to determine besides the prevalence of dysmenorrhoea whether menstrual pain was associated with job control, co-worker social support, job security and dissatisfaction with the job. Data of 2772 working women aged 18-55 years, participants in the Hungarostudy 2002 nation-wide representative survey was analyzed. Binary logistic regression was used to determine the association between work stress factors and menstrual pain. Altogether 15.5% of women reported to experience menstrual pain that limits their daily activity. Low job control, low co-worker social support and low job security were found to be associated with a higher risk for menstrual pain even after controlling for the effect of age, educational attainment, parity status, smoking, body-mass index and treatment for gynecological problems. Job dissatisfaction was also related to dysmenorrhoea, albeit not significantly. The relationship between work-related psychosocial factors and painful menstruation deserves further investigation in order to determine the possible pathways of this association.

The relationship of biological and psychological risk factors of cardiovascular disorders in a large-scale national representative community survey

A large-scale national representative community survey of 11,122 persons aged more than 35 years included the investigation of the coincidence of depressive symptoms, vital exhaustion, cardiovascular disorders, stroke, and myocardial infarction. A total of 20.3% of the survey participants reported having experienced a cardiovascular disorder (CVD). Of the subjects reporting a CVD, 52.1% exhibited depressive symptoms (22.0% subthreshold depressive symptoms, 30.1% clinical depression), and 69.7% exhibited vital exhaustion. The authors investigated 3 cardiovascular subgroups: (1) subjects having experienced a myocardial infarction (MI), (2) subjects having experienced stroke, and (3) subjects with a CVD but no experience of either an MI or a stroke. The frequency and severity of depressive symptoms did not differ significantly in the 3 subgroups. CVD subjects with no MI or stroke had almost as high frequencies of depressive symptoms and vital exhaustion as patients who experienced stroke or MI. The strength of relationships between these psychological variables and CVDs do not differ significantly from the relationships between hypertension or diabetes and CVDs. Depressive symptoms and increased vital exhaustion have exceptionally high comorbidity with CVDs. The authors detected the same high comorbidity among patients with a milder CVD and without stroke or MI. The assessment and management of depressive symptoms and vital exhaustion should be routine procedure in clinical cardiology.

Self-rated health and health damaging behaviour among young women in Hungary in connection with family background

OBJECTIVES

To describe the relationship of subjective health and harmful lifestyle with familial risk factors, such as low parental educational level, parental psychiatric disorder reported by their offspring, alcohol use, and divorce.

METHODS

3615 hungarian women aged 15-24 in 1998. The questionnaire addressed socio-economic factors, physical and mental health, and health damaging behaviours.

RESULTS

Low self-rated health (OR: 2.32; Cl: 1.54-3.47; p < 0.001) or at least five health complaints (OR: 2.09; CI: 1.68-2.60; p < 0.001) were significantly more common among women with reported parental psychiatric disorder. Drug use (OR: 2.35; CI: 1.86-2.98; p < 0.001) and regular or excessive alcohol consumption (OR: 1.86; CI: 1.46-2.37) was in strongest association with parental high education.

CONCLUSIONS

Family related social problems, especially reported parental psychiatric disorders, regular alcohol consumption, and educational level, are important factors to be taken into account when planning specific interventions for young women.

[The prevalence of suicide ideas and their psychosocial backgrounds among physicians]

AIMS

A growing body of evidence in the literature suggests that the prevalence of psychiatric morbidity including suicide is high among physicians. Suicidal ideas are the most important predictors of suicides and suicide attempts. The prevalence of suicidal ideas is higher among physicians compared to the general population. Our goal was to search the factors of suicidal ideas among Hungarian physicians on basis of nationwide representative survey, helping to elaborate prevention programs.

METHODS

Data were collected from 298 female and 109 male physicians using questionnaires. 1,754 white-collar workers from a representative survey (Hungarostudy 2002) served as controls. Statistical analysis examined background factors of suicidal thoughts.

RESULTS

We found that the prevalence of suicidal ideas among both female (20,3%) and male physicians (12,1%) was significantly higher than that in the respective control groups (12,3% - 7,6%). Female physicians also exhibited significantly higher prevalence of suicidal ideas (p=0.0058 és OR=1,901). Suicidal ideas were associated with work-related stress. Correlation analyses confirmed a significant relationship between high prevalence of suicidal ideas and long working hours (>8 hours), severe anxiety and work-related stress, and role conflict. Further examination of the background factors of suicidal thoughts may help to elaborate more effective health-prevention and conflict-dealing methods.

Comorbidity of pain problems and depressive symptoms in young women: results from a cross-sectional survey among women aged 15-24 in Hungary

Frequent headaches and musculoskeletal pain problems were assessed as part of a cross-sectional health survey in a representative sample of 3615 young Hungarian women, aged 15-24 (mean age: 19.0 years). The representative sample was obtained by a multilevel stratified sampling procedure based on national statistical data, the refusal rate was 6%. Depressive symptomatology was assessed as well using the shortened form of the Beck Depression Inventory. The overall prevalence of frequent headaches was 43.8% in the sample, 25.8% of the investigated population reported chronic musculoskeletal pain problems. The co-prevalence rate of depression was significantly higher in the group of interviewees reporting pain problems, 11.2% in the group indicating frequent headaches (chi(2)=53.1, p<0.001), 10.3% in the group reporting musculoskeletal pain problems (chi(2)=12.4, p<0.001). In contrast, the prevalence of depressive symptomatology was 4.6% and 6.6% in the subgroups denying frequent headaches and musculoskeletal pain, respectively. The prevalence of chronic pain problems decreased with higher age, increased with the smaller size of residence and was lower in the non-student employment group, however, these differences across sociodemographic variables did not remain significant if tested by a multivariate logistic regression analysis. The high co-prevalence rates of depression in interviewees reporting chronic pain problem draws attention to the development of such secondary health problems and underscores the importance of early prevention. Epidemiological studies provide data for the better planning and management of prevention programs.

[Attendance of screening by young Gypsy women]

In the study, the authors surveyed young Gipsy women's attendance of screening, as compared to non-Gipsy women of similar age groups. The survey was based on a national representative sample consisting of 1599 persons selected from women belonging to the age group between 18 and 24 years: out of them 4.3%, that is, 69 persons identified themselves as Gipsies. Manifold difference was observed between the Gipsy and non-Gipsy respondents, with respect to their attendance of screening tests (dental, gynaecological, pulmonary screening, etc.): in all cases the Gipsy women had the more unfavourable indices and, the problem of pulmonary screening seems to be the most alarming one, since Gipsies are an ethnic group living under extremely bad social conditions, with an increased risk of being exposed to infections of tuberculosis.

[Smoking and alcohol abuse in the Hungarian population]

The mortality rate of middle-aged (55-64 years old) men in Hungary today is higher--even in absolute terms--than it was in the 1930s. Within this age-group the death rate is extremely high among the lower socio-economic classes. The odds ratio of the incidence of death is 1.8 times higher among males aged up to 74 years with no high-school education than the same age groups with higher education. Some 40% of these differences can be accounted to the self destructive behavioral risk factors (alcoholism, tobacco smoking) being more prevalent in the lower socio-economic groups. According to the results of the presented national representative survey counted in Hungary among 12.640 subjects in 1995, 45% of the males and 26.6% of the females smoked. Among the male and female cohorts under 45 years of age, 47.9% and 31.9% smoked respectively. Among the males the number of daily cigarette consumption and the volume of daily alcohol intake was inversely related to the educational level. This negative correlation was not so clear among the female probands. The health promotion programs can only achieve their goals if they are to target the psychological and motivational background of the self destructive behavioral risk factors.