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Sonoda K, Sales J, Bello JK, Grucza RA, Scherrer JF. Colorectal Cancer Screening Among Individuals With a Substance Use Disorder: A Retrospective Cohort Study. AJPM Focus 2024; 3:100218. [PMID: 38596162 PMCID: PMC11001631 DOI: 10.1016/j.focus.2024.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Introduction There is limited evidence on colorectal cancer screening among individuals with a substance use disorder. This study aims to investigate the association between personal history of a substance use disorder and colorectal cancer colonoscopy screening completion rates. Methods This retrospective cohort study analyzed 176,300 patients, of whom 171,973 had no substance use disorder and 4,327 had a substance use disorder diagnosis from electronic health record data (January 1, 2008-December 31, 2022) in a Midwestern healthcare system. Baseline was January 1, 2013, and a 10-year follow-up period ran through December 31, 2022. The outcome was receipt of colonoscopy in the 10-year follow-up period. Patients were aged 50-65 years at baseline, meaning that they were eligible for a colonoscopy through the entirety of the 10-year follow-up period. Covariates included demographics (age, race, and neighborhood SES), health services utilization, psychiatric and physical comorbidities, and prior colonoscopy or fecal occult blood testing. Entropy balancing was used to control for confounding in weighted log-binomial models calculating RR and 95% CIs. Results Patients were on average aged 57.1 (±4.5) years, 58.2% were female, 81.0% were White, and 16.9% were of Black race. The most prevalent comorbidities were obesity (29.6%) and hypertension (29.4%), followed by smoking/nicotine dependence (21.0%). The most prevalent psychiatric comorbidity was depression (6.4%), followed by anxiety disorder (4.5%). During the 10-year follow-up period, 40.3% of eligible patients completed a colorectal cancer colonoscopy screening test, and individuals with a substance use disorder diagnosis were significantly less likely to receive a colorectal cancer colonoscopy screening test both prior to and after controlling for confounding (RR=0.73; 95% CI=0.70, 0.77 and RR=0.81; 95% CI=0.74, 0.89, respectively). Results were not modified by sex, race, psychiatric comorbidity, or neighborhood SES. Conclusions Personal history of substance use disorder was independently associated with lower screening completion rates. Healthcare professionals should recognize unique barriers among individuals with substance use disorder and then address them individually as a multidisciplinary team in the outpatient setting to reduce this health disparity.
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Affiliation(s)
- Kento Sonoda
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Joanne Sales
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Jennifer K. Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Richard A. Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, Missouri
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, Missouri
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Secrest S, Miller-Matero LR, Chrusciel T, Salas J, Sullivan MD, Zabel C, Lustman P, Ahmedani B, Carpenter RW, Scherrer JF. Baseline Characteristics From a New Longitudinal Cohort of Patients With Noncancer Pain and Chronic Opioid Use in the United States. J Pain 2024; 25:984-999. [PMID: 37907114 PMCID: PMC10960712 DOI: 10.1016/j.jpain.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/12/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023]
Abstract
Retrospective cohort studies have consistently observed that long-term prescription opioid use is a risk factor for new major depressive episodes. However, prospective studies are needed to confirm these findings and establish evidence for causation. The Prescription Opioids and Depression Pathways cohort study is designed for this purpose. The present report describes the baseline sample and associations between participant characteristics and odds of daily versus nondaily opioid use. Second, we report associations between participant characteristics and odds of depression, dysthymia, anhedonia, and vital exhaustion. Patients with noncancer pain were eligible if they started a new period of prescription opioid use lasting 30 to 90 days. Participants were 54.8 (standard deviation ± 11.3) years of age, 57.3% female and 73% White race. Less than college education was more common among daily versus nondaily opioid users (32.4% vs 27.3%; P = .0008), as was back pain (64.2% vs 51.3%; P < .0001), any nonopioid substance use disorder (12.8% vs 4.8%; P < .0001), and current smoking (30.7% vs 18.4% P < .0001). High pain interference (50.9% vs 28.4%; P < .0001) was significantly associated with depression, as was having more pain sites (6.9 ± 3.6 vs 5.7 ± 3.6; P < .0001), and benzodiazepine comedication (38.2% vs 23.4%; P < .0001). High pain interference was significantly more common among those with anhedonia (46.8% vs 27.4%; P < .0001), and more pain sites (7.0 ± 3.7 vs 5.6 ± 3.6; P < .0001) were associated with anhedonia. Having more pain sites (7.9 ± 3.6 vs 5.5 ± 3.50; P < .0001) was associated with vital exhaustion, as was back pain (71.9% vs 56.8%; P = .0001) and benzodiazepine comedication (42.8% vs 22.8%; P < .0001). Patients using prescription opioids for noncancer pain have complex pain, psychiatric, and substance use disorder comorbidities. Longitudinal data will reveal whether long-term opioid therapy leads to depression or other mood disturbances such as anhedonia and vital exhaustion. PERSPECTIVE: This study reports baseline characteristics of a new prospective, noncancer pain cohort study. Risk factors for adverse opioid outcomes were most common in those with depression and vital exhaustion and less common in dysthymia and anhedonia. Baseline data highlight the complexity of patients receiving long-term opioid therapy for noncancer pain.
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Affiliation(s)
- Scott Secrest
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO. 63110 U.S.A
| | - Lisa R. Miller-Matero
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI. 48202
| | - Timothy Chrusciel
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO. 63110 U.S.A
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4 Floor, St. Louis, MO. 63104 U.S.A
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO. 63104 U.S.A
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO. 63110 U.S.A
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4 Floor, St. Louis, MO. 63104 U.S.A
| | - Mark D. Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle WA. 98195
| | - Celeste Zabel
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI. 48202
| | - Patrick Lustman
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Blvd, Suite 301, St. Louis, MO. 63108
| | - Brian Ahmedani
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI. 48202
| | - Ryan W. Carpenter
- Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Blvd., Saint Louis, MO. 63121
| | - Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO. 63110 U.S.A
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd. St. Louis, MO 63104 U.S.A
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4 Floor, St. Louis, MO. 63104 U.S.A
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Davidson WM, Mahavni A, Chrusciel T, Salas J, Miller-Matero LR, Sullivan MD, Zabel C, Lustman PJ, Ahmedani BK, Scherrer JF. Characteristics of patients with non-cancer pain and long-term prescription opioid use who have used medical versus recreational marijuana. J Cannabis Res 2024; 6:7. [PMID: 38383471 PMCID: PMC10882913 DOI: 10.1186/s42238-024-00218-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE Marijuana use is increasingly common among patients with chronic non-cancer pain (CNCP) and long-term opioid therapy (LTOT). We determined if lifetime recreational and medical marijuana use were associated with more frequent and higher dose prescription opioid use. DESIGN Cross-sectional SUBJECTS: Eligible patients (n=1,037), who had a new period of prescription opioid use lasting 30-90 days, were recruited from two midwestern health care systems to a study of long-term prescription opioid use and mental health outcomes. The present cross-sectional analyses uses baseline data from this on-going cohort study. METHODS Primary exposures were participant reported lifetime recreational and medical marijuana use versus no lifetime marijuana use. Prescription opioid characteristics included daily versus non-daily opioid use and ≥50 morphine milligram equivalent (MME) dose per day vs. <50 MME. Multivariate, logistic regression models estimated the association between lifetime recreational and medical marijuana use vs. no use and odds of daily and higher dose prescription opioid use, before and after adjusting for confounding. RESULTS The sample was an average of 54.9 (SD±11.3) years of age, 57.3% identified as female gender, 75.2% identified as White, and 22.5% identified as Black race. Among all participants, 44.4% were never marijuana users, 21.3% were recreational only, 7.7% medical only and 26.6% were both recreational and medical marijuana users. After controlling for all confounders, lifetime recreational marijuana use, as compared to no use, was significantly associated with increased odds of daily prescription opioid use (OR=1.61; 95%CI:1.02-2.54). There was no association between lifetime recreational or medical marijuana use and daily opioid dose. CONCLUSION Lifetime medical marijuana use is not linked to current opioid dose, but lifetime recreational use is associated with more than a 60% odds of being a daily prescription opioid user. Screening for lifetime recreational marijuana use may identify patients with chronic pain who are vulnerable to daily opioid use which increases risk for adverse opioid outcomes. Prospective data is needed to determine how marijuana use influences the course of LTOT and vice versa.
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Affiliation(s)
- Whitney M Davidson
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, 3rd Floor, St. Louis, MO, 63110, USA
| | - Anika Mahavni
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, 3rd Floor, St. Louis, MO, 63110, USA
| | - Timothy Chrusciel
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, 3rd Floor, St. Louis, MO, 63110, USA
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO, 63104, USA
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO, 63104, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, 3rd Floor, St. Louis, MO, 63110, USA
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO, 63104, USA
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Celeste Zabel
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Blvd, Suite 301, St. Louis, MO, 63108, USA
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, 3rd Floor, St. Louis, MO, 63110, USA.
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd., St. Louis, MO, 63104, USA.
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO, 63104, USA.
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO, 63104, USA.
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Miller-Matero LR, Yaldo M, Chohan S, Zabel C, Patel S, Chrusciel T, Salas J, Wilson L, Sullivan MD, Ahmedani BK, Lustman PJ, Scherrer JF. Factors Associated With Interest in Engaging in Psychological Interventions for Pain Management. Clin J Pain 2024; 40:67-71. [PMID: 37819213 PMCID: PMC10842945 DOI: 10.1097/ajp.0000000000001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Engagement in evidence-based psychological interventions for pain management is low. Identifying characteristics associated with interest in interventions can inform approaches to increase uptake and engagement. The purpose of this study was to examine factors associated with interest in psychological interventions among persons with chronic noncancer pain receiving prescription opioids. METHODS Participants with chronic noncancer pain and a new 30 to 90 day opioid prescription were recruited from 2 health systems. Participants (N=845) completed measures regarding pain, opioid use, psychiatric symptoms, emotional support, and interest in psychological interventions for pain management. RESULTS There were 245 (29.0%) participants who reported a high interest in psychological interventions for pain management. In bivariate analyses, variables associated with interest included younger age, female sex, greater pain severity, greater pain interference, greater number of pain sites, lower emotional support, depression, anxiety, and post-traumatic stress disorder ( P <0.05). In a multivariate model, greater pain severity (odds ratio [OR]=1.17; CI: 1.04-1.32), depression (OR=2.10; CI: 1.39-3.16), post-traumatic stress disorder (OR=1.85; CI: 1.19-2.95), and lower emotional support (OR=0.69; CI: 0.5-0.97) remained statistically significant. DISCUSSION The rate of interest in psychological interventions for pain management was low, which may indicate that patients initiating opioid treatment of chronic noncancer pain have low interest in psychological interventions. Greater pain severity and psychiatric distress were related to interest, and patients with these characteristics may especially benefit from psychological interventions. Providers may want to refer to psychological interventions before or when opioids are initiated. Additional work is needed to determine whether this would reduce long-term opioid use.
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Affiliation(s)
- Lisa R. Miller-Matero
- Henry Ford Health, Behavioral Health Services
- Henry Ford Health, Center for Health Policy and Health Services Research
| | - Marissa Yaldo
- Henry Ford Health, Center for Health Policy and Health Services Research
| | | | - Celeste Zabel
- Henry Ford Health, Center for Health Policy and Health Services Research
| | | | - Timothy Chrusciel
- Department of Family and Community Medicine, Saint Louis University School of Medicine
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine
| | - Lauren Wilson
- Department of Family and Community Medicine, Saint Louis University School of Medicine
| | - Mark D. Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine
| | - Brian K. Ahmedani
- Henry Ford Health, Behavioral Health Services
- Henry Ford Health, Center for Health Policy and Health Services Research
| | | | - Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine
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Salas J, Wang W, Schnurr PP, Cohen BE, Freedland KE, Jaffe AS, Lustman PJ, Friedman M, Scherrer JF. Severity of posttraumatic stress disorder, type 2 diabetes outcomes and all-cause mortality: A retrospective cohort study. J Psychosom Res 2023; 175:111510. [PMID: 37827022 PMCID: PMC10842322 DOI: 10.1016/j.jpsychores.2023.111510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Some evidence suggests patients with comorbid PTSD and type 2 diabetes (T2D) have worse T2D outcomes than those with T2D alone. However, there is no evidence regarding PTSD severity and risk for starting insulin, hyperglycemia, microvascular complications, and all-cause mortality. METHODS In this retrospective cohort study, Veterans Health Affairs (VHA) medical record data from fiscal year (FY) 2012 to FY2022 were used to identify eligible patients (n = 23,161) who had a PTSD diagnosis, ≥1 PTSD Checklist score, controlled T2D (HbA1c ≤ 7.5) without microvascular complications at baseline. PTSD Checklist for DSM-5 (PCL-5) scores defined mild, moderate, and severe PTSD. Competing risk and survival models estimated the association between PTSD severity and T2D outcomes before and after controlling for confounding. RESULTS Most (70%) patients were ≥ 50 years of age, 88% were male, 64.2% were of white race and 17.1% had mild, 67.4% moderate and 15.5% severe PTSD. After control for confounding, as compared to mild PTSD, moderate (HR = 1.05; 95% CI:1.01-1.11) and severe PTSD (HR = 1.15; 95%CI:1.07-1.23) were significantly associated with increased risk for microvascular complication. Hyperarousal was associated with a 42% lower risk of starting insulin. Negative mood was associated with a 16% increased risk for any microvascular complication. Severe PTSD was associated with a lower risk for all-cause mortality (HR = 0.76; 95%CI:0.63-0.91). CONCLUSIONS Patients with comorbid PTSD and T2D have an increased risk for microvascular complications. However, they have lower mortality risk perhaps due to more health care use and earlier chronic disease detection. PTSD screening among patients with T2D may be warranted.
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Affiliation(s)
- Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States; The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States
| | - Wenjin Wang
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States
| | - Paula P Schnurr
- National Center for PTSD, White River Junction, VT, and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Beth E Cohen
- Department of Medicine, University of California San Francisco School of Medicine and San Francisco VAMC, San Francisco, CA, United States
| | - Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Allan S Jaffe
- Department of Cardiovascular Medicine and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Matthew Friedman
- National Center for PTSD, White River Junction, VT, and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States; The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States; Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Saint Louis University, St. Louis, MO, United States.
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Brieler JA, Salas J, Amick ME, Sheth P, Keegan-Garrett EA, Morley JE, Scherrer JF. Anxiety disorders, benzodiazepine prescription, and incident dementia. J Am Geriatr Soc 2023; 71:3376-3389. [PMID: 37503956 DOI: 10.1111/jgs.18515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/26/2023] [Accepted: 06/24/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Prescribing benzodiazepines to older patients is controversial. Anxiety disorders and benzodiazepines have been associated with dementia, but literature is inconsistent. It is unknown if anxiety treated with a benzodiazepine, compared to anxiety disorder alone is associated with dementia risk. METHODS A retrospective cohort study (n = 72,496) was conducted using electronic health data from 2014 to 2021. Entropy balancing controlled for bias by indication and other confounding factors. PARTICIPANTS Eligible patients were ≥65 years old, had clinic encounters before and after index date and were free of dementia for 2 years prior to index date. Of the 72,496 eligible patients, 85.6% were White and 59.9% were female. Mean age was 74.1 (SD ± 7.1) years. EXPOSURE Anxiety disorder was a composite of generalized anxiety disorder, anxiety not otherwise specified, panic disorder, and social phobia. Sustained benzodiazepine use was defined as at least two separate prescription orders in any 6-month period. MAIN OUTCOME AND MEASURES ICD-9 or ICD-10 dementia diagnoses. RESULTS Six percent of eligible patients had an anxiety diagnosis and 3.6% received sustained benzodiazepine prescriptions. There were 6640 (9.2%) incident dementia events. After controlling for confounders, both sustained benzodiazepine use (HR 1.28, 95% CI: 1.11-1.47) and a diagnosis of anxiety (HR 1.19, 95% CI: 1.06-1.33) were associated with incident dementia in patients aged 65-75. Anxiety disorder with sustained benzodiazepine, compared to anxiety disorder alone, was not associated with incident dementia (HR 1.18, 95% CI: 0.92-1.51) after controlling for confounding. Results were not significant when limiting the sample to those ≥75 years of age. CONCLUSIONS Benzodiazepines and anxiety disorders are associated with increased risk for dementia. In patients with anxiety disorders, benzodiazepines were not associated with additional dementia risk. Further research is warranted to determine if benzodiazepines are associated with a reduced or increased risk for dementia compared to other anxiolytic medications in patients with anxiety disorders.
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Affiliation(s)
- Jay A Brieler
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
- Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri, USA
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Matthew E Amick
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Poorva Sheth
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Elizabeth A Keegan-Garrett
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - John E Morley
- School of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Saint Louis University School of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
- Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri, USA
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
- Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Saint Louis University, St. Louis, Missouri, USA
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Salas J, Morley JE, Hoft DF, Scherrer JF. Lower risk for COVID-19 hospitalization among patients in the United States with past vaccinations for herpes zoster and tetanus, diphtheria and pertussis. Prev Med Rep 2023; 35:102302. [PMID: 37441187 PMCID: PMC10290736 DOI: 10.1016/j.pmedr.2023.102302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Influenza, tetanus, diphtheria, and herpes zoster (HZ) vaccination received within 10 years of the COVID-19 pandemic have been associated with less severe COVID-19 infection. We expanded on this evidence to determine if a receiving two different vaccinations (i.e., HZ and tetanus, diphtheria, and pertussis (Tdap)) was associated with a lower risk for COVID-19 hospitalization. De-identified medical record data from a large mid-western health care system was used to determine if, compared to those with neither HZ or Tdap vaccination, patients with either HZ or Tdap and patients with both HZ and Tdap vaccination had lower risk for COVID-19 hospitalization between 4/1/2020 and 12/31/2020. Confounding was controlled using entropy balancing. Patients (n = 363,293) were 71.5 (±8.4) years of age, 57.8% female and 89.2% White race. Prior to controlling for confounding, as compared to patients without either vaccination, those that had either HZ or Tdap were significantly less likely to have a COVID-19 hospitalization (RR = 0.85; 95 %CI: 0.75-0.95). The risk for hospitalization decreased further among those with both HZ and Tdap vaccination (RR = 0.45; 95 %CI:0.28-0.71). After controlling for confounding, including healthy patient bias, receiving both vs. neither vaccinations remained significantly associated with a lower risk of COVID-19 hospitalization (RR = 0.48; 95 %CI: 0.26-0.90). Receiving both Tdap and HZ vaccination is associated with lower risk for COVID-19 hospitalization. Whether there is any benefit of past vaccination exposure in COVID-19 vaccinated patients should be investigated.
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Affiliation(s)
- Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, United States
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO 63104, United States
| | - John E. Morley
- Saint Louis University, School of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Saint Louis University, School of Medicine. 1402 South Grand Blvd, St. Louis, MO, United States
| | - Daniel F. Hoft
- Saint Louis University, School of Medicine, Department of Internal Medicine Division of Infectious Diseases, Allergy, and Immunology, Saint Louis, MO, United States
- Saint Louis University, Department of Molecular Microbiology & Immunology, Saint Louis, MO, United States
| | - Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, United States
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO 63104, United States
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd., St. Louis, MO 63104, United States
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Tucker J, Salas J, Secrest S, Scherrer JF. Erectile dysfunction associated with undiagnosed prediabetes and type 2 diabetes in young adult males: A retrospective cohort study. Prev Med 2023; 174:107646. [PMID: 37499919 DOI: 10.1016/j.ypmed.2023.107646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/15/2023] [Accepted: 07/23/2023] [Indexed: 07/29/2023]
Abstract
Erectile dysfunction (ED) is a common comorbidity in type 2 diabetes (T2D). ED has been studied as an outcome in diabetes, but it is not known if ED is a risk factor for T2D. We determined if patients with ED have an increased risk for prediabetes and/or T2D and measured the duration between ED and prediabetes/T2D diagnosis. Retrospective cohort study using de-identified medical record data from a large mid-western health care system to measure ED, T2D and potential confounding factors. Patients were 18 to 40 years of age because we were interested in early onset pre-diabetes/T2D. Eligible patients had ED and were free of prediabetes, hyperglycemia and T2D at index. Entropy balancing controlled for confounding. Modified Poisson regression models with robust error variances calculated relative risk (RR) and 95% confidence intervals for the association of ED and pre-diabetes/T2D. Patients' mean age was 28.3 (±7.0) years, 81.7% were White and 14.0% were Black. After controlling for confounding, ED was associated with increased risk for prediabetes/T2D (RR = 1.34; 95%CI:1.16-1.55). This association was similar to that between ED and T2D alone (RR = 1.38; 95% CI: 1.10-1.74). About 30% had ED and prediabetes/T2D diagnosed on the same day and nearly 75% were diagnosed within a year of ED. ED is a marker for undiagnosed prediabetes/T2D and a risk factor for near term onset of prediabetes/T2D. ED may offer the opportunity for earlier detection and diagnoses of T2D, particularly in younger men. Younger patients presenting with ED should be screened for hyperglycemia.
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Affiliation(s)
- Jane Tucker
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4(th) Floor, St. Louis, MO 63104, USA
| | - Scott Secrest
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4(th) Floor, St. Louis, MO 63104, USA; Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd, St. Louis, MO 63104, USA.
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Scherrer JF, Sullivan MD, LaRochelle MR, Grucza R. Validating opioid use disorder diagnoses in administrative data: a commentary on existing evidence and future directions. Addict Sci Clin Pract 2023; 18:49. [PMID: 37592369 PMCID: PMC10433556 DOI: 10.1186/s13722-023-00405-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND A valid opioid use disorder (OUD) identification algorithm for use in administrative medical record data would enhance investigators' ability to study consequences of OUD, OUD treatment seeking and treatment outcomes. MAIN BODY Existing studies indicate ICD-9 and ICD-10 codes for opioid abuse and dependence do not accurately measure OUD. However, critical appraisal of existing literature suggests alternative validation methods would improve the validity of OUD identification algorithms in administrative data. Chart abstraction may not be sufficient to validate OUD, and primary data collection via structured diagnostic interviews might be an ideal gold standard. CONCLUSION AND COMMENTARY Generating valid OUD identification algorithms is critical for OUD research and quality measurement in real world health care settings.
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Affiliation(s)
- Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, USA.
- Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Saint Louis University, St. Louis, MO, USA.
- The AHEAD Institute, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, USA.
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Marc R LaRochelle
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Richard Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, USA
- The AHEAD Institute, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, USA
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10
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Poynton-Smith E, Orrell M, Morley JE, Scherrer JF. Could routine vaccinations prevent dementia? Int J Geriatr Psychiatry 2023; 38:e5978. [PMID: 37491706 DOI: 10.1002/gps.5978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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11
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Messias E, Salas J, Wilson L, Scherrer JF. Temporal Location of Changes in the US Suicide Rate by Age, Ethnicity, and Race: A Joinpoint Analysis 1999-2020. J Nerv Ment Dis 2023; 211:530-536. [PMID: 37040181 PMCID: PMC10309088 DOI: 10.1097/nmd.0000000000001653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
ABSTRACT Suicide rates differ over time. Our objective was to determine when significant changes occurred by age, race, and ethnicity in the United States between 1999 and 2020. National Center for Health Statistics WONDER data were used in joinpoint regression. The annual percent change in suicide rate increased for all race, ethnic, and age groups, except for those 65 years and older. For American Indian/Alaska Natives, the largest increase occurred between 2010 and 2020 for those with ages 25 to 34 years. For Asian/Pacific Islander, the largest increase occurred among those 15 to 24 years old between 2011 and 2016. For Black/African-Americans, the largest increases occurred between 2010 and 2020 among 15- to 34-year-olds. For Whites, the largest increase occurred between 2014 and 2017 among 15- to 24-year-olds. Between 2018 and 2020, suicide rates significantly declined among Whites 45 to 64 years of age. Among Hispanics, significant increases in suicide rate occurred between 2012 and 2020 among those with ages 15 to 44 years. Between 1999 and 2020, the contour of suicide burden varied by age groups, race, and ethnicity.
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Affiliation(s)
- Erick Messias
- Department of Psychiatry and Behavioral Neuroscience
| | - Joanne Salas
- Department of Family and Community Medicine, School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Lauren Wilson
- Department of Family and Community Medicine, School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Jeffrey F. Scherrer
- Department of Psychiatry and Behavioral Neuroscience
- Department of Family and Community Medicine, School of Medicine, Saint Louis University, St. Louis, Missouri
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12
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Barnes JM, Graboyes EM, Adjei Boakye E, Kent EE, Scherrer JF, Park EM, Rosenstein DL, Mowery YM, Chino JP, Brizel DM, Osazuwa-Peters N. The Affordable Care Act and suicide incidence among adults with cancer. J Cancer Surviv 2023; 17:449-459. [PMID: 35368225 DOI: 10.1007/s11764-022-01205-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/23/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with cancer are at an increased suicide risk, and socioeconomic deprivation may further exacerbate that risk. The Affordable Care Act (ACA) expanded insurance coverage options for low-income individuals and mandated coverage of mental health care. Our objective was to quantify associations of the ACA with suicide incidence among patients with cancer. METHODS We identified US patients with cancer aged 18-74 years diagnosed with cancer from 2011 to 2016 from the Surveillance, Epidemiology, and End Results database. The primary outcome was the 1-year incidence of suicide based on cumulative incidence analyses. Difference-in-differences (DID) analyses compared changes in suicide incidence from 2011-2013 (pre-ACA) to 2014-2016 (post-ACA) in Medicaid expansion relative to non-expansion states. We conducted falsification tests with 65-74-year-old patients with cancer, who are Medicare-eligible and not expected to benefit from ACA provisions. RESULTS We identified 1,263,717 patients with cancer, 812 of whom died by suicide. In DID analyses, there was no change in suicide incidence after 2014 in Medicaid expansion vs. non-expansion states for nonelderly (18-64 years) patients with cancer (p = .41), but there was a decrease in suicide incidence among young adults (18-39 years) (- 64.36 per 100,000, 95% CI = - 125.96 to - 2.76, p = .041). There were no ACA-associated changes in suicide incidence among 65-74-year-old patients with cancer. CONCLUSIONS We found an ACA-associated decrease in the incidence of suicide for some nonelderly patients with cancer, particularly young adults in Medicaid expansion vs. non-expansion states. Expanding access to health care may decrease the risk of suicide among cancer survivors.
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Affiliation(s)
- Justin M Barnes
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA
- Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Erin E Kent
- Departments of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Eliza M Park
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Comprehensive Cancer Support Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald L Rosenstein
- Comprehensive Cancer Support Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Departments of Psychiatry and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yvonne M Mowery
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, USA
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Junzo P Chino
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | - David M Brizel
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, USA
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Banks TJ, Nguyen TD, Uhlmann JK, Nair SS, Scherrer JF. Predicting opioid use disorder before and after the opioid prescribing peak in the United States: A machine learning tool using electronic healthcare records. Health Informatics J 2023; 29:14604582231168826. [PMID: 37042333 PMCID: PMC10158959 DOI: 10.1177/14604582231168826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Existing predictive models of opioid use disorder (OUD) may change as the rate of opioid prescribing decreases. Using Veterans Administration's EHR data, we developed machine-learning predictive models of new OUD diagnoses and ranked the importance of patient features based on their ability to predict a new OUD diagnosis in 2000-2012 and 2013-2021. Using patient characteristics, the three separate machine learning techniques were comparable in predicting OUD, achieving an accuracy of >80%. Using the random forest classifier, opioid prescription features such as early refills and length of prescription consistently ranked among the top five factors that predict new OUD. Younger age was positively associated with new OUD, and older age inversely associated with new OUD. Age stratification revealed prior substance abuse and alcohol dependency as more impactful in predicting OUD for younger patients. There was no significant difference in the set of factors associated with new OUD in 2000-2012 compared to 2013-2021. Characteristics of opioid prescriptions are the most impactful variables that predict new OUD both before and after the peak in opioid prescribing rates. Predictive models should be tailored to age groups. Further research is warranted to determine if machine learning models perform better when tailored to other patient subgroups.
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Affiliation(s)
- Tyler J Banks
- Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
| | - Tung D Nguyen
- Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
| | - Jeffery K Uhlmann
- Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
| | - Satish S Nair
- Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
| | - Jeffrey F Scherrer
- Saint Louis University School of Medicine, Medicine, Saint Louis, MO, USA
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14
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Scherrer JF, Miller-Matero LR, Sullivan MD, Chrusciel T, Salas J, Davidson W, Zabel C, Wilson L, Lustman P, Ahmedani B. A Preliminary Study of Stress, Mental Health, and Pain Related to the COVID-19 Pandemic and Odds of Persistent Prescription Opioid Use. J Gen Intern Med 2023; 38:1016-1023. [PMID: 36385413 PMCID: PMC9668385 DOI: 10.1007/s11606-022-07940-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The COVID-19 pandemic has been associated with increased opioid prescribing. It is not known if perceived COVID-19 related stress is associated with increased odds of long-term opioid use. OBJECTIVE To determine if greater COVID-19-related stress and worsening pain attributed to the pandemic was associated with LTOT over a 6-month observation period. DESIGN Longitudinal cohort. PARTICIPANTS Patients (n=477) from two midwestern health care systems, with any acute or chronic non-cancer pain, starting a new period of 30-90-day prescription opioid use, were invited to participate in the Prescription Opioids and Depression Pathways Cohort Study, a longitudinal survey study of pain, opioid use, and mental health outcomes. MAIN MEASURES Baseline and 6-month follow-up assessments were used to measure the association between perceived COVID-19 stressors, the perception that pain was made worse by the pandemic and the odds of persistent opioid use, i.e., remaining a prescription opioid user at 6-month follow-up. Multivariate models controlled for demographics, opioid dose, and change in pain characteristics, mental health measures, and social support. KEY RESULTS Participants were, on average, 53.9 (±11.4) years of age, 67.1% White race, and 70.9% female. The most frequently endorsed COVID-19 stressor was "worry about health of self/others" (85.7% endorsed) and the least endorsed was "worsened pain due to pandemic" (26.2%). After adjusting for all covariates, "worsened pain due to pandemic" (OR=2.88; 95%CI: 1.33-6.22), change in pain interference (OR=1.20; 95%CI: 1.04-1.38), and change in vital exhaustion (OR=0.90; 95%CI: 0.82-0.99) remained significantly associated with persistent opioid use. CONCLUSIONS Patients who attribute worsening pain to the COVID-19 pandemic are more likely to be persistent opioid users. Further research is warranted to identify mechanisms underlying this association. Clinicians may consider discussing pain in the context of the pandemic to identify patients at high risk for persistent opioid use.
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Affiliation(s)
- Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, USA.
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, USA.
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, Detroit, MI, USA
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, USA
| | - Timothy Chrusciel
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, USA
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Whitney Davidson
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Celeste Zabel
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, Detroit, MI, USA
| | - Lauren Wilson
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Patrick Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian Ahmedani
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, Detroit, MI, USA
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15
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Brieler JA, Salas J, Keegan-Garrett E, Scherrer JF. Achievement of glycemic control and antidepressant medication use in comorbid depression and type 2 diabetes. J Affect Disord 2023; 324:1-7. [PMID: 36566931 DOI: 10.1016/j.jad.2022.12.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 11/22/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Existing studies designed to determine if depression treatment in patients with type 2 diabetes (T2D) is associated with improved glycemic control have produced inconsistent results. The present study investigated the link between acute phase antidepressant medication treatment and achievement of glycemic control in patients with T2D using nationally distributed electronic health record data. METHODS A retrospective cohort study (n = 7332) was conducted using nationally distributed Optum® de-identified electronic health record data from 2010 to 2018. Eligible patients were 18-64 years old and had T2D, depression, and poor glycemic control. Antidepressant medication treatment was categorized into acute phase treatment (≥12 weeks), less than acute phase (<12 weeks) or no treatment. Glycemic control was defined as HbA1c < 7.0 % (53 mmol/mol). Propensity scores (PS) and inverse probability of treatment weighting (IPTW) controlled for confounding. Extended Cox models measured the association between duration of antidepressant medication treatment and glycemic control at 0 to 36 months, 36 to 72 months and ≥72 months. RESULTS After controlling for confounding, compared to no treatment, acute phase treatment was significantly associated with achieving glycemic control within 36 months (HR 1.17, 95 % CI 1.02-1.34). No association was observed beyond 36 months. There was no association between acute vs. less than acute phase treatment and glycemic control. LIMITATIONS We were unable to measure decreased depression severity which could contribute to glycemic control. CONCLUSIONS For patients with T2D and hyperglycemia, acute phase antidepressant medication may enable glycemic control. Further research is needed to establish mechanisms for this association.
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Affiliation(s)
- Jay A Brieler
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Elizabeth Keegan-Garrett
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 S Grand Blvd, St. Louis, MO 63104, USA
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16
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Drallmeier T, Salas J, Keegan Garrett E, Meyr A, Tucker J, Scherrer JF. Differences Between General Internal Medicine and Family Medicine Physicians' Initiation of Pre-Exposure Prophylaxis. J Prim Care Community Health 2023; 14:21501319231201784. [PMID: 37795848 PMCID: PMC10557417 DOI: 10.1177/21501319231201784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Preexposure Prophylaxis (PrEP) is under-utilized in primary care. Given differences in treatment approaches for other conditions between family medicine (FM) and general internal medicine (GIM), this study compared PrEP-prescribing between FM and GIM physicians. METHODS De-identified electronic health record data from a multi-state health care system was used in this retrospective observational study. The time period from 1/1/13 to 9/30/21 was used to identify PrEP eligible patients using measures of current sexually transmitted disease and condomless sex at the time of eligibility. Receipt of PrEP was measured in the 12 months after PrEP eligibility. The odds of receiving PrEP in GIM as compared to FM was computed before and after adjusting for demographics and physical and psychiatric comorbidities. RESULTS The majority of eligible patients were 18 to 39 years of age, 60.9% were female and 71.6% were White race. Among PrEP eligible patients, 1.1% received PrEP in the first year after index date. Receiving PrEP was significantly more likely among patients treated in GIM versus FM (OR = 2.30; 95% CI:1.63-3.25). After adjusting for covariates, this association remained statistically significant (OR = 2.02; 95% CI:1.41-2.89). CONCLUSIONS PrEP is grossly under-utilized in primary care. The majority of Americans enter the health care system through primary care and not through HIV providers or other specialties. Therefore, educational interventions are needed to increase confidence and knowledge and to encourage PrEP prescribing by FM and GIM physicians.
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Affiliation(s)
| | - Joanne Salas
- Saint Louis University School of Medicine, MO, USA
| | | | - Ashley Meyr
- Saint Louis University School of Medicine, MO, USA
| | - Jane Tucker
- Saint Louis University School of Medicine, MO, USA
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17
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Scherrer JF, Salas J, Grucza R, Wilens T, Quinn PD, Sullivan MD, Rossom RC, Wright E, Piper B, Sanchez K, Lapham G. Prescription stimulant use during long-term opioid therapy and risk for opioid use disorder. Drug Alcohol Depend Rep 2022; 5:100122. [PMID: 36844161 PMCID: PMC9949323 DOI: 10.1016/j.dadr.2022.100122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
Background Concurrent therapeutic prescribing of prescription stimulants with opioid analgesics is increasing in the United States. Stimulant medication use is associated with increased risk for long-term opioid therapy (LTOT), and LTOT is associated with increased risk for opioid use disorder (OUD). Aims To determine if stimulant prescriptions among those with LTOT (≥90 days) are associated with greater risk for opioid use disorder (OUD). Methods This retrospective cohort study from 2010 to 2018 used a United States, nationally distributed Optum© analytics Integrated Claims-Clinical dataset. Patients ≥18 years of age, and free of prevalent OUD in the two years prior to index were eligible. All patients had a new ≥90-day opioid prescription. The index date was day 91. We compared risk for new OUD diagnoses in patients with and without a prescription stimulant overlapping LTOT. Entropy balancing and weighting controlled for confounding factors. Results Patients (n = 5,712), were 57.7 (SD±14.9) years of age on average, majority female (59.8%) and 73.3% White race. Among patients with LTOT, 2.8% had overlapping stimulant prescriptions. Before controlling for confounding, dual stimulant-opioid prescriptions, compared to opioid only, were associated with OUD risk (HR = 1.75; 95%CI:1.17-2.61). After controlling for confounding, this association was no longer present (HR = 0.89; 95%CI:0.47-1.71). Results did not differ in sensitivity analyses limiting the cohort to those <56 years of age. Conclusions Dual stimulant use among patients with LTOT does not increase risk for OUD. Stimulants prescribed for ADHD and other conditions may not worsen opioid outcomes for some patients with LTOT.
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Affiliation(s)
- Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, U.S.A.,Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd., St. Louis, MO 63104, U.S.A.,Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO 63104, U.S.A.,Corresponding author at: Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, 3rd Floor, St. Louis, MO 63110, U.S.A..
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, U.S.A.,Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd., St. Louis, MO 63104, U.S.A
| | - Richard Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, U.S.A.,Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO 63104, U.S.A.,Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO 63104, U.S.A
| | - Timothy Wilens
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, U.S.A.,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, U.S.A
| | - Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, 1025 E. 7th St., Room 116, Bloomington, IN 47405, U.S.A
| | - Mark D. Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, U.S.A
| | - Rebecca C. Rossom
- HealthPartners Institute, 8170 33rd Ave S, MS21112R, Minneapolis, MN 55425, U.S.A
| | - Eric Wright
- Center for Pharmacy Innovation and Outcomes, Geisinger Precision Health Center, 190 Welles St., Forty Fort, PA 18704, U.S.A
| | - Brian Piper
- Center for Pharmacy Innovation and Outcomes, Geisinger Precision Health Center, 190 Welles St., Forty Fort, PA 18704, U.S.A.,Geisinger Commonwealth School of Medicine, Medical Sciences Building, 525 Pine St., Office 2108, Scranton, PA 18509, U.S.A
| | - Katherine Sanchez
- Trauma Research Consortium, Baylor Scott and White Research Institute, 3600 Gaston Ave., Barnett Tower, Suite 1202, Dallas, Texas 75246, U.S.A
| | - Gwen Lapham
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste. 1600, Seattle, WA 98101, U.S.A
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18
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Drallmeier T, Garrett EK, Meyr A, Salas J, Scherrer JF. Demographic factors, psychiatric and physical comorbidities associated with starting preexposure prophylaxis in a nationally distributed cohort. Prev Med 2022; 164:107344. [PMID: 36368340 DOI: 10.1016/j.ypmed.2022.107344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/01/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022]
Abstract
Due to a large number of small studies and limited control for confounding, existing evidence regarding patient characteristics associated with PrEP initiation is inconsistent. We used a large electronic health record cohort to determine which demographic, physical morbidity and psychiatric conditions are associated with PrEP initiation. Eligible adult (≥18 years) patients were selected from the Optum® de-identified Electronic Health Record dataset (2010-2018). Non-HIV sexually transmitted diseases and high risk sexual behavior was used to identify patients eligible for PrEP. A fully adjusted Poisson regression model estimated the association between age, gender, race, insurance status, comorbidity index, depression, anxiety, dysthymia, severe mental illness, substance use disorder and nicotine dependence/smoking and rate of PrEP initiation. The cohort (n = 30,909) was mostly under 40 years of age (64.3%), 67.6% were female and 58.2% were White. The cumulative incidence of PrEP initiation was 1.3% (n = 408). Patients ≥60 years of age, compared to 18-29 year olds and Black compared to White patients had significantly lower rates of PrEP initiation. Anxiety disorder was significantly associated with higher rate of PrEP initiation (RR = 1.67; 95%CI:1.20-2.33) and nicotine dependence/smoking with a lower rate (RR = 0.73; 95%CI:0.54-0.97). PrEP is underutilized, and a race disparity exists in PrEP initiation. In the context of existing research, nicotine dependence/smoking is the patient characteristic most consistently associated lower rates of starting PrEP. Given the high prevalence of smoking in PrEP eligible patients, physicians may want to integrate discussions of smoking cessation in patient-provider decisions to start PrEP.
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Affiliation(s)
- Theresa Drallmeier
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA.
| | - Elizabeth Keegan Garrett
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Ashley Meyr
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4(th) Floor, St. Louis, MO 63104, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd., St. Louis, MO 63104, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4(th) Floor, St. Louis, MO 63104, USA
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19
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Chruciel T, Quinn PD, Salas J, Scherrer JF. The Prevalence of Non-cancer Pain Diagnoses in Adults with ADHD. Pain Med 2022; 24:570-572. [PMID: 36271863 DOI: 10.1093/pm/pnac159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Timothy Chruciel
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO. 63104 U.S.A.,Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4 Floor, St. Louis, MO. 63104 U.S.A
| | - Patrick D Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, 1025 E. 7 St. Room 116, Bloomington, IN 47405, U.S.A
| | - Joanne Salas
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4 Floor, St. Louis, MO. 63104 U.S.A.,Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO. 63110 U.S.A
| | - Jeffrey F Scherrer
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4 Floor, St. Louis, MO. 63104 U.S.A.,Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO. 63110 U.S.A.,Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd. St. Louis, MO 63104 U.S.A
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20
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Richter RR, Chrusciel T, Salsich G, Austin T, Scherrer JF. Disparities Exist in Physical Therapy Utilization and Time to Utilization Between Black and White Patients With Musculoskeletal Pain. Phys Ther 2022; 102:6649124. [PMID: 35871435 DOI: 10.1093/ptj/pzac095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 01/24/2022] [Accepted: 04/05/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Black patients are less likely than White patients to receive physical therapy for musculoskeletal pain conditions. Current evidence, however, is limited to self-reported conditions and health services use. The purpose of this study was to use a large electronic health record database to determine whether a race disparity existed in use of physical therapy within 90 days of a new musculoskeletal diagnosis. METHODS Eligible patients (n = 52,384) were sampled from an Optum deidentified electronic health record database of 5 million adults distributed throughout the United States. In this database, patients were designated as "Black" and "White." Patients were eligible if they had a new diagnosis for musculoskeletal neck, shoulder, back, or knee pain between January 1, 2012, and December 31, 2017. Logistic regression and Cox proportional hazard models were computed before and after adjusting for covariates to estimate the association between race and receipt of physical therapy services within 90 days of musculoskeletal pain diagnoses. RESULTS Patients were on average 47.5 (SD = 14.9) years of age, 12.8% were Black, 87.2% were White, and 52.7% were female. Ten percent of Black patients and 15.5% of White patients received physical therapy services within 90 days of musculoskeletal pain diagnoses. After adjusting for covariates, White patients were 57% more likely (odds ratio = 1.57; 95% CI = 1.44-1.71) to receive physical therapy compared with Black patients and had significantly shorter time to physical therapy than Black patients (hazard ratio = 1.53; 95% CI = 1.42-1.66). CONCLUSIONS In a nationally distributed cohort, Black patients were less likely than White patients to utilize physical therapy and had a longer time to utilization of physical therapy for musculoskeletal pain. IMPACT These findings highlight the need to determine the mechanisms underlying the observed disparities and how these disparities influence health outcomes.
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Affiliation(s)
- Randy R Richter
- Department of Physical Therapy and Athletic Training, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | - Timothy Chrusciel
- Department of Health and Clinical Outcomes Research, Salus Center, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Gretchen Salsich
- Department of Physical Therapy and Athletic Training, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | - Tricia Austin
- Department of Physical Therapy and Athletic Training, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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21
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Scherrer JF, Salas J, Miller-Matero LR, Sullivan MD, Ballantyne JC, Debar L, Grucza RA, Lustman PJ, Ahmedani B. Long-term prescription opioid users' risk for new-onset depression increases with frequency of use. Pain 2022; 163:1581-1589. [PMID: 34855645 DOI: 10.1097/j.pain.0000000000002547] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Long-term opioid therapy (LTOT) is associated with increased risk for depression. It is not known if the frequency of opioid use during LTOT is associated with new-onset depression. We used Optum's de-identified Integrated Claims-Clinical dataset (2010-2018) to create a cohort of 5146 patients, 18 to 80 years of age, with an encounter or claims in the year before new LTOT. New LTOT was defined by >90-day opioid use after remaining opioid free for 6 months. Opioid use frequency during the first 90 days of LTOT was categorized into occasional use (<50% days covered), intermittent use (50% to <80% days covered), frequent use (80% to <90% days covered), and daily use (≥90% days covered). Propensity scores and inverse probability of exposure weighting controlled for confounding in models estimating risk for new-onset depression. Patients were on average 54.5 (SD ± 13.6) years of age, 55.7% were female, 72.5% were White, and 9.5% were African American. After controlling for confounding, daily users (hazard ratio = 1.40; 95% confidence interval: 1.14-1.73) and frequent users (hazard ratio = 1.34; 95% confidence interval: 1.05-1.71) were significantly more likely to develop new-onset depression compared with occasional users. This association remained after accounting for the contribution of post-index pain diagnoses and opioid use disorder. In LTOT, risk for new depression episodes is up to 40% greater in near-daily users compared with occasional users. Patients could reduce depression risk by avoiding opioid use on as many low pain days as possible. Repeated screening for depression during LTOT is warranted.
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Affiliation(s)
- Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health System, One Ford Place, Detroit, MI, United States
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, United States
| | - Jane C Ballantyne
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Lynn Debar
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Richard A Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Brian Ahmedani
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health System, One Ford Place, Detroit, MI, United States
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22
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Messias E, Salas J, Scherrer JF. Patient characteristics prior to suicide attempts among Hispanics compared to non-Hispanic whites in the United States. J Affect Disord 2022; 308:130-133. [PMID: 35429527 DOI: 10.1016/j.jad.2022.04.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/17/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suicide rates among Hispanics in the United States are much lower than rates among Whites. The reasons for this difference are uncertain, therefore we compared patient characteristics between Hispanic and White patients with a suicide attempt. METHODS Patients with a suicide attempt (n = 8641) between 2012 and 2018 were identified by ICD-9 and ICD-10 codes in a nationally distributed electronic health record data base. Patient demographics, geographic region, health services use, depression treatment, psychiatric and physical comorbidities were measured in the 2 years prior to a suicide attempt. RESULTS Most patients with a suicide attempt were White (78.6%) and 6.2% were Hispanic, a majority were 36-64 years of age and 57.3% were female. Younger age and lack of health insurance were significantly (p < .0001) more common among Hispanic compared to White patients with a suicide attempt. Depression treatment was significantly (p < .0001) less common among Hispanic vs. White patients. Sleep disorder and all psychiatric and substance use disorders, except for drug use disorder, were significantly (p-value range: 0.026-<0.0001) more prevalent in the two years before suicide attempt in White patients. CONCLUSIONS Diagnosed psychopathology is more common among White vs. Hispanic patients who attempt suicide. Lack of insurance and low depression treatment rates may be associated with suicide attempt among Hispanics. Additional research is needed to determine the mix of factors that predict suicide attempt among Whites, Hispanics, and other minorities.
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Affiliation(s)
- Erick Messias
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1402 South Grand, St. Louis, MO 63104, United States of America.
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, United States of America; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, United States of America
| | - Jeffrey F Scherrer
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1402 South Grand, St. Louis, MO 63104, United States of America; Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, United States of America; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, United States of America
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23
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van den Berk Clark C, Kansara V, Fedorova M, Ju T, Renirie T, Lee J, Kao J, Opada ET, Scherrer JF. How does PTSD treatment affect cardiovascular, diabetes and metabolic disease risk factors and outcomes? A systematic review. J Psychosom Res 2022; 157:110793. [PMID: 35339907 PMCID: PMC9149090 DOI: 10.1016/j.jpsychores.2022.110793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Prior research indicates PTSD is associated with cardiovascular and metabolic disease. A number of different treatments for PTSD can be effective in reducing PTSD symptoms. The aim of this study is to systematically review studies which determine whether treatment for PTSD is associated with better cardiovascular and metabolic outcomes. METHOD Five different databases were searched in a systematic manner, and 11 relevant studies were recovered and analyzed. FINDINGS Treatments associated with PTSD improvement and found to be effective in improving cardiovascular or metabolic outcomes among individuals with PTSD include cognitive behavioral therapy (heart rate variability and blood pressure), prolonged exposure (heart rate and heart rate variability) and SSRIs (blood pressure). CONCLUSIONS Multiple PTSD treatment modalities were associated with improved cardiovascular health and reduced risk of cardiovascular-related mortality. Given the small sample sizes, lack of follow-up studies and the extensive use of military populations in studies on PTSD and chronic diseases, these results should be interpreted with caution. More studies are needed that assess and verify whether PTSD treatments mitigate the risk for metabolic, diabetic and cardiovascular disease.
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Affiliation(s)
- Carissa van den Berk Clark
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America.
| | - Vruta Kansara
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
| | - Margarita Fedorova
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
| | - Tiffany Ju
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
| | - Tess Renirie
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
| | - Jaewon Lee
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
| | - Jesse Kao
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
| | - Emmanuel T Opada
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
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24
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Mintz CM, Xu KY, Presnall NJ, Hartz SM, Levin FR, Scherrer JF, Bierut LJ, Grucza RA. Analysis of Stimulant Prescriptions and Drug-Related Poisoning Risk Among Persons Receiving Buprenorphine Treatment for Opioid Use Disorder. JAMA Netw Open 2022; 5:e2211634. [PMID: 35544135 PMCID: PMC9096599 DOI: 10.1001/jamanetworkopen.2022.11634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Stimulant medication use is common among individuals receiving buprenorphine for opioid use disorder (OUD). Associations between prescription stimulant use and treatment outcomes in this population have been understudied. OBJECTIVES To investigate whether use of prescription stimulants was associated with (1) drug-related poisoning and (2) buprenorphine treatment retention. DESIGN, SETTING, AND PARTICIPANTS This retrospective, recurrent-event cohort study with a case-crossover design used a secondary analysis of administrative claims data from IBM MarketScan Commercial and Multi-State Medicaid databases from January 1, 2006, to December 31, 2016. Primary analyses were conducted from March 1 through August 31, 2021. Individuals aged 12 to 64 years with an OUD diagnosis and prescribed buprenorphine who experienced at least 1 drug-related poisoning were included in the analysis. Unit of observation was the person-day. EXPOSURES Days of active stimulant prescriptions. MAIN OUTCOMES AND MEASURES Primary outcomes were drug-related poisoning and buprenorphine treatment retention. Drug-related poisonings were defined using International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes; treatment retention was defined by continuous treatment claims until a 45-day gap was observed. RESULTS There were 13 778 567 person-days of observation time among 22 946 individuals (mean [SD] age, 32.8 [11.8] years; 50.3% men) who experienced a drug-related poisoning. Stimulant treatment days were associated with 19% increased odds of drug-related poisoning (odds ratio [OR], 1.19 [95% CI, 1.06-1.34]) compared with nontreatment days; buprenorphine treatment days were associated with 38% decreased odds of poisoning (OR, 0.62 [95% CI, 0.59-0.65]). There were no significant interaction effects between use of stimulants and buprenorphine. Stimulant treatment days were associated with decreased odds of attrition from buprenorphine treatment (OR, 0.64 [95% CI, 0.59-0.70]), indicating that stimulants were associated with 36% longer mean exposure to buprenorphine and its concomitant protection. CONCLUSIONS AND RELEVANCE Among persons with OUD, use of prescription stimulants was associated with a modest increase in per-day risk of drug-related poisoning, but this risk was offset by the association between stimulant use and improved retention to buprenorphine treatment, which is associated with protection against overdose.
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Affiliation(s)
- Carrie M. Mintz
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Kevin Y. Xu
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Ned J. Presnall
- Department of Social Work, Washington University in St Louis, St Louis, Missouri
| | - Sarah M. Hartz
- Department of Social Work, Washington University in St Louis, St Louis, Missouri
| | - Frances R. Levin
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York
- Division of Substance Use Disorders, New York State Psychiatric Institute, New York, New York
| | - Jeffrey F. Scherrer
- Department of Family and Community Medicine, St Louis University, St. Louis, Missouri
- Department of Health and Outcomes Research, St. Louis University, St Louis, Missouri
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Richard A. Grucza
- Department of Family and Community Medicine, St Louis University, St. Louis, Missouri
- Department of Health and Outcomes Research, St. Louis University, St Louis, Missouri
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25
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Scherrer JF, Miller-Matero LR, Salas J, Sullivan MD, Secrest S, Autio K, Wilson L, Amick M, DeBar L, Lustman PJ, Gebauer S, Ahmedani B. Characteristics of Patients with Non-Cancer Pain and Perceived Severity of COVID-19 Related Stress. Mo Med 2022; 119:229-236. [PMID: 36035570 PMCID: PMC9324720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
UNLABELLED Synopsis Patients with non-cancer pain reported increased pain and pain interference during the first months of the COVID-19 pandemic. We determined if pain, prescription opioid use, and comorbidities were associated with perceived COVID-19-related stress as the pandemic peaked. Analysis of survey data revealed that depression/anxiety, pain severity, and pain interference were most strongly and consistently associated with greater stress due to COVID-19 related changes in lifestyle, worsening of emotional/mental health and worsening pain. Identifying specific stressful experiences that most impacted patients with non-cancer pain may help target public health and treatment interventions. BACKGROUND During the first months of the COVID-19 pandemic, patients with chronic pain reported increased pain severity and interference. This study measured the association between pain, prescription opioid use, and comorbidities with perceived COVID-19-related stress as the pandemic peaked in the United States. METHODS From 9/2020 to 3/2021, the first 149 subjects from a prospective cohort study of non-cancer pain, completed a survey which contained the Complementary and Integrative Research (CAIR) Pandemic Impact Questionnaire (C-PIQ). Respondents also reported whether the pandemic has contributed to their pain or opioid use. Bivariate comparisons explored patient characteristics with each CAIR domain. RESULTS Respondents mean age was 54.6 (±11.3) years, 69.8% were female, 64.6% were White. Respondent characteristics were not associated with reading/watching/thinking about the pandemic or with worry about health. Depression/anxiety (p=0.003), using any prescription opioid in the prior three months (p=0.009), higher morphine milligram equivalent used (p=0.005), higher pain severity (p=0.011), and higher pain interference (p=0.0004) were all positively and significantly associated with moderate to severe stress due to COVID-19 related lifestyle changes. Depression/anxiety, pain severity, and pain interference were positively associated with COVID-19-related worsening emotional/mental health. Depression/anxiety were significantly (p<0.0001) associated with reporting that the pandemic made their pain worse. CONCLUSION Depression, anxiety, pain severity, and pain interference were most strongly and consistently associated with COVID-19 changes in way of life, worsening of emotional/mental health, and worsening pain. Identifying specific stressful experiences that most impacted patients with noncancer pain may inform public health and treatment interventions.
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Affiliation(s)
- Jeffrey F Scherrer
- Department of Family & Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health System, One Ford Place, Detroit, Michigan
| | - Joanne Salas
- Department of Family & Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, Washington
| | - Scott Secrest
- Department of Family & Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Kirsti Autio
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health System, One Ford Place, Detroit, Michigan
| | - Lauren Wilson
- Department of Family & Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Matthew Amick
- Department of Family & Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Lynn DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Sarah Gebauer
- Department of Family & Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Brian Ahmedani
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health System, One Ford Place, Detroit, Michigan
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26
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Affiliation(s)
- Mark Spigt
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,General Practice Research Unit, Department of Community Medicine, The Arctic University of Tromsø, Tromsø, Norway
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States.,Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO, United States
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27
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Bates N, Bello JK, Osazuwa-Peters N, Sullivan MD, Scherrer JF. Depression and Long-Term Prescription Opioid Use and Opioid Use Disorder: Implications for Pain Management in Cancer. Curr Treat Options Oncol 2022; 23:348-358. [PMID: 35254595 PMCID: PMC8899439 DOI: 10.1007/s11864-022-00954-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 01/22/2023]
Abstract
OPINION STATEMENT Preventing depression in cancer patients on long-term opioid therapy should begin with depression screening before opioid initiation and repeated screening during treatment. In weighing the high morbidity of depression and opioid use disorder in patients with chronic cancer pain against a dearth of evidence-based therapies studied in this population, patients and clinicians are left to choose among imperfect but necessary treatment options. When possible, we advise engaging psychiatric and pain/palliative specialists through collaborative care models and recommending mindfulness and psychotherapy to all patients with significant depression alongside cancer pain. Medications for depression should be reserved for moderate to severe symptoms. We recommend escitalopram/citalopram or sertraline among selective serotonin reuptake inhibitors (SSRIs), or the serotonin and norepinephrine reuptake inhibitors (SNRIs) duloxetine, venlafaxine, or desvenlafaxine if patients have a significant component of neuropathic pain or fibromyalgia. Tricyclic antidepressants (TCAs) (consider nortriptyline or desipramine, which have better anticholinergic profiles) should be considered for patients who do not respond to or tolerate SSRI/SNRIs. Existing evidence is inadequate to definitively recommend methylphenidate or novel agents, such as ketamine or psilocybin, as adjunctive treatments for cancer-related depression and pain. Physicians who treat patients with cancer pain should utilize universal precautions to limit the risk of non-medical opioid use (non-medical opioid use). Patients should be screened for non-medical opioid use behaviors at initial consultation and at regular intervals during treatment using a non-judgmental approach that reduces stigma. Co-management with an addiction specialist may be indicated for patients at high risk of non-medical opioid use and opioid use disorder. Buprenorphine and methadone are indicated for the treatment of opioid use disorder, and while they have not been systematically studied for treatment of opioid use disorder in patients with cancer pain, they do provide analgesia for cancer pain. While an interdisciplinary team approach to manage psychological stress may be beneficial, this may not be possible for patients treated outside of comprehensive cancer centers.
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Affiliation(s)
- Nicole Bates
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA. .,Department of Psychosocial Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave E, MS K2-231, PO Box 19023, Seattle, WA, 98109-1023, USA.
| | - Jennifer K Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, St. Louis, MO, 63110, USA
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, 27710-4000, USA.,Duke Cancer Institute, Durham, NC, 27710, USA
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, St. Louis, MO, 63110, USA.,The Advanced HEAlth Data (AHEAD) Research Institute at Saint Louis University, Saint Louis University School of Medicine, 3545 Lafayette Ave., St. Louis, MO, 63104, USA
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Breeden M, Gillis A, Salas J, Scherrer JF. Antidepressant treatment and blood pressure control in patients with comorbid depression and treatment resistant hypertension. J Psychosom Res 2022; 153:110692. [PMID: 34906849 DOI: 10.1016/j.jpsychores.2021.110692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/12/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Though inconsistent, the majority of studies support an association between depression and incident hypertension and poor blood pressure control. However, none have investigated whether antidepressant medication (ADM) therapy is associated with blood pressure control in patients with comorbid depression and treatment resistant hypertension. METHODS Optum® de-identified Electronic Health Record data (2010-2018) were used to create a retrospective cohort of patients (≥18 years of age) with comorbid depression and treatment resistant hypertension. Patients were categorized into adequate ADM, inadequate ADM and no ADM treatment. A modified Poisson regression approach with robust error variance was used to estimate the association between ADM status and blood pressure control before and after adjusting for covariates. RESULTS Patients were, on average, 55.7 (SD ± 9.9) years of age, 63.9% were female, 76.2% were white and 19.2% Black race. In crude models, inadequate ADM (RR = 1.06; 95%CI:1.01-1.11) and adequate ADM (RR = 1.08; 95%CI:1.03-1.14), compared to no ADM treatment, were associated with blood pressure control. After adjusting for covariates this relationship was attenuated and no longer significant. CONCLUSIONS The modest association between ADM therapy and blood pressure control in patients with treatment resistant hypertension is largely explained by traditional risk factors for hypertension such as obesity and older age. Treating depression is not a robust factor in blood pressure control among those with treatment resistant hypertension.
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Affiliation(s)
- Matthew Breeden
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA.
| | - Auston Gillis
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
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Wiemken TL, Salas J, Morley JE, Hoft DF, Jacobs C, Scherrer JF. Comparison of rates of dementia among older adult recipients of two, one, or no vaccinations. J Am Geriatr Soc 2021; 70:1157-1168. [PMID: 34897645 PMCID: PMC9300193 DOI: 10.1111/jgs.17606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022]
Abstract
Background Multiple types of vaccinations are associated with lower risk for dementia, but it is not known if receiving more than one vaccination type is associated with a greater decrease in incident dementia as compared with receiving only one type. We determined if dementia risk is lowest in patients who receive both herpes zoster (HZ) and tetanus, diphtheria, pertussis (Tdap) vaccinations as compared with receipt of only one or the other type of vaccination. Methods Primary analysis in a Veterans Health Administration (VA) cohort was replicated in private sector medical claims data. Eligible patients were ≥65 years of age and free of dementia for 2 years prior to baseline (VHA n = 80,070; MarketScan n = 129,200). At index, patients either had both HZ and Tdap, only HZ, only Tdap, or neither vaccination. Confounding was controlled with generalized boosted propensity scores and inverse probability of treatment weighting. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between vaccination status and incident dementia. Results VHA patients' mean age was 76.8 ± 7.6 years, 4.4% were female and 90.9% were White, and MarketScan patients' mean age was 70.5 ± 5.9 and 65.4% were female. In both cohorts, having both HZ and Tdap vaccinations compared with no vaccination was significantly associated with lower dementia risk (VHA HR = 0.50; 95% CI: 0.43–0.59; MarketScan HR = 0.58; 95% CI: 0.38–0.89). In both cohorts, compared with neither vaccination, patients with only one or the other vaccination types had a significantly lower risk for dementia. Incident dementia was lower in patients with both vaccinations versus only one vaccination type. Conclusions and Relevance Receiving two types of vaccinations versus one type was associated with lower dementia risk. Vaccinations may have non‐specific associations with incident dementia. Low cost and accessible, common adult vaccinations may be an overlooked intervention for reducing dementia risk.
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Affiliation(s)
- Timothy L Wiemken
- Department of Internal Medicine, Division of Infectious Diseases, Allergy, and Immunology, Saint Louis University, School of Medicine, Saint Louis, Missouri, USA.,The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University, School of Medicine, St. Louis, Missouri, USA
| | - Joanne Salas
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University, School of Medicine, St. Louis, Missouri, USA.,Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,Research Service, Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri, USA
| | - John E Morley
- Department of Internal Medicine, Division of Geriatric Medicine, Saint Louis University, School of Medicine, St. Louis, Missouri, USA
| | - Daniel F Hoft
- Department of Internal Medicine, Division of Infectious Diseases, Allergy, and Immunology, Saint Louis University, School of Medicine, Saint Louis, Missouri, USA.,Department of Molecular Microbiology & Immunology, Saint Louis University, Saint Louis, Missouri, USA
| | - Christine Jacobs
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Jeffrey F Scherrer
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University, School of Medicine, St. Louis, Missouri, USA.,Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,Research Service, Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri, USA
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Scherrer JF, Salas J, Wiemken TL, Hoft DF, Jacobs C, Morley JE. Impact of herpes zoster vaccination on incident dementia: A retrospective study in two patient cohorts. PLoS One 2021; 16:e0257405. [PMID: 34788293 PMCID: PMC8597989 DOI: 10.1371/journal.pone.0257405] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/31/2021] [Indexed: 12/31/2022] Open
Abstract
Background Herpes zoster (HZ) infection increases dementia risk, but it is not known if herpes zoster vaccination is associated with lower risk for dementia. We determined if HZ vaccination, compared to no HZ vaccination, is associated with lower risk for incident dementia. Methods and findings Data was obtained from Veterans Health Affairs (VHA) medical records (10/1/2008–9/30/2019) with replication in MarketScan® commercial and Medicare claims (1/1/2009-12/31/2018). Eligible patients were ≥65 years of age and free of dementia for two years prior to baseline (VHA n = 136,016; MarketScan n = 172,790). Two index periods (either start of 2011 or 2012) were defined, where patients either had or did not have a HZ vaccination. Confounding was controlled with propensity scores and inverse probability of treatment weighting. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between HZ vaccination and incident dementia in all patients and in age (65–69, 70–74, ≥75) and race (White, Black, Other) sub-groups. Sensitivity analysis measured the association between HZ vaccination and incident Alzheimer’s dementia (AD). HZ vaccination at index versus no HZ vaccination throughout follow-up. VHA patients mean age was 75.7 (SD±7.4) years, 4.0% were female, 91.2% white and 20.2% had HZ vaccination. MarketScan patients mean age was 69.9 (SD±5.7) years, 65.0% were female and 14.2% had HZ vaccination. In both cohorts, HZ vaccination compared with no vaccination, was significantly associated with lower dementia risk (VHA HR = 0.69; 95%CI: 0.67–0.72; MarketScan HR = 0.65; 95%CI:0.57–0.74). HZ vaccination was not related to dementia risk in MarketScan patients aged 65–69 years. No difference in HZ vaccination to dementia effects were found by race. HZ vaccination was associated with lower risk for AD. Conclusions HZ vaccination is associated with reduced risk of dementia. Vaccination may provide nonspecific neuroprotection by training the immune system to limit damaging inflammation, or specific neuroprotection that prevents viral cytopathic effects.
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Affiliation(s)
- Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States of America
- Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States of America
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, MO, United States of America
- * E-mail:
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States of America
- Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States of America
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, MO, United States of America
| | - Timothy L. Wiemken
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, MO, United States of America
- Department of Health and Clinical Outcomes Research, School of Medicine, Saint Louis University, Saint Louis, MO, United States of America
- Division of Infectious Diseases, Allergy, and Immunology, Department of Internal Medicine, Department of Medicine, School of Medicine, Saint Louis University, Saint Louis, MO, United States of America
- Saint Louis University Systems Infection Prevention Center, Center for Specialized Medicine, St. Louis, MO, United States of America
| | - Daniel F. Hoft
- Division of Infectious Diseases, Allergy, and Immunology, Department of Internal Medicine, Department of Medicine, School of Medicine, Saint Louis University, Saint Louis, MO, United States of America
- Saint Louis University Systems Infection Prevention Center, Center for Specialized Medicine, St. Louis, MO, United States of America
- Department of Molecular Microbiology & Immunology, Saint Louis University, Saint Louis, MO, United States of America
| | - Christine Jacobs
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States of America
- The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, MO, United States of America
| | - John E. Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States of America
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van den Berk-Clark C, Pickard J, Davis D, Scherrer JF. The Role of Impulsive Decision Making on Health Behavior Related to Cardiovascular Disease Risk Among Older Adults With Hypertension. J Gerontol Nurs 2021; 47:22-30. [PMID: 34704864 DOI: 10.3928/00989134-20211013-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to investigate whether older adults who are more impulsive also tend to engage in more health behaviors associated with increased risk for cardiovascular disease (CVD). We analyzed data from the Health and Retirement Study. Logistic regression analysis was performed to determine the likelihood of medication adherence, alcohol consumption, and exercise among older adults with hypertension. Adjusted regression results revealed higher impulsive decision making was associated with greater likelihood of obesity (odds ratio [OR] = 2.96, 95% confidence interval [CI] [1.00, 8.92]), lower likelihood of medication adherence (OR = 0.37, 95% CI [0.15, 0.92]), and regular drinking (OR = 0.36, 95% CI [0.15, 0.87]). Higher impulsive decision making was associated with lower likelihood of regular exercise only in unadjusted models. Older adults with hypertension who had higher impulsive decision making engaged in health behaviors associated with increased risk for CVD. Health care providers should consider the range of strategies offered through behavioral economics to improve health in these at-risk populations. [Journal of Gerontological Nursing, 47(11), 22-30.].
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Wiemken TL, Salas J, Hoft DF, Jacobs C, Morley JE, Scherrer JF. Dementia risk following influenza vaccination in a large veteran cohort. Vaccine 2021; 39:5524-5531. [PMID: 34420785 DOI: 10.1016/j.vaccine.2021.08.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/28/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Two Taiwan based studies indicated influenza vaccinations are associated with lower risk for dementia in patient cohorts with chronic disease. We determined if such associations exist in a large, nationally distributed sample of U.S. patients not selected for chronic disease. METHODS Data was obtained from Veterans Health Administration medical records (9/1/2009 - 8/31/19). Eligible patients were ≥65 years of age and free of dementia for two years prior to enrollment through the end of the first influenza season (9/1/2009 to 3/1/2012). Competing risk models estimated the risk of dementia in those with influenza vaccination (n = 66,822) compared to those without vaccination (n = 56,925). Propensity scores and inverse probability of treatment weighting controlled for confounding. RESULTS On average, patients were 75.5 (±7.3) years of age, 3.8% were female and 91.6% were white race. After controlling for confounding, patients with influenza vaccination were significantly less likely to develop dementia compared to patients without vaccination (HR = 0.86; 95 %CI:0.83-0.88). Patients with 1, 2 or 3-5 vaccines vs. none had similar risks for dementia and patients with ≥ 6 influenza vaccines vs. none had a significant lower risk for dementia (HR = 0.88, 95 %CI: 0.83-0.94). CONCLUSIONS Repeated receipt of influenza vaccinations, compared to remaining unvaccinated, is associated with lower risk for dementia. This is consistent with the hypotheses that vaccinations may reduce risk of dementia by training the immune system and not by preventing specific infectious disease. If vaccines are identified as causative factors in reducing incident dementia, they offer an inexpensive, low-risk intervention with effects greater than any existing preventive measure.
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Affiliation(s)
- Timothy L Wiemken
- Saint Louis University, School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Allergy, and Immunology, Saint Louis, MO, United States; The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University, School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States.
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University, School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States; The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University, School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States
| | - Daniel F Hoft
- Saint Louis University, School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Allergy, and Immunology, Saint Louis, MO, United States; Saint Louis University, Department of Molecular Microbiology & Immunology, Saint Louis, MO, United States
| | - Christine Jacobs
- Department of Family and Community Medicine, Saint Louis University, School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States
| | - John E Morley
- Saint Louis University, School of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, 1402 South Grand Blvd, St. Louis, MO, United States
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University, School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States; The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University, School of Medicine, 1402 South Grand Blvd, St. Louis, MO, United States
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Salas J, Gebauer S, Gillis A, van den Berk-Clark C, Schneider FD, Schnurr PP, Friedman MJ, Norman SB, Tuerk PW, Cohen BE, Lustman PJ, Scherrer JF. Increased Smoking Cessation among Veterans with Large Decreases in Posttraumatic Stress Disorder Severity. Nicotine Tob Res 2021; 24:178-185. [PMID: 34477205 DOI: 10.1093/ntr/ntab179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Improvement in posttraumatic stress disorder (PTSD) is associated with better health behavior such as better medication adherence and greater use of nutrition and weight loss programs. However, it is not known if reducing PTSD severity is associated with smoking cessation, a poor health behavior common in patients with PTSD. METHODS Veterans Health Affairs (VHA) medical record data (2008 to 2015) were used to identify patients with PTSD diagnosed in specialty care. Clinically meaningful PTSD improvement, was defined as ≥20 point PTSD Checklist (PCL) decrease from the first PCL ≥ 50 and the last available PCL within 12 months and at least 8 weeks later. The association between clinically meaningful PTSD improvement and smoking cessation within 2-years after baseline among 449 smokers was estimated in Cox proportional hazard models. Entropy balancing controlled for confounding. RESULTS On average, patients were 39.4 (SD=12.9) years of age, 86.6% were male and 71.5% were white. We observed clinically meaningful PTSD improvement in 19.8% of participants. Overall, 19.4% quit smoking in year 1 and 16.6% in year 2. More patients with vs. without clinically meaningful PTSD improvement stopped smoking (n=36, cumulative incidence=40.5% vs. 111, cumulative incidence=30.8%; respectively). After controlling for confounding, patients with vs. without clinically meaningful PTSD improvement were more likely to stop smoking within 2-years (HR=1.57; 95%CI:1.04-2.36). CONCLUSIONS Patients with clinically meaningful PTSD improvement were significantly more likely to stop smoking. Further research should determine if targeted interventions are needed or whether improvement in PTSD symptoms is sufficient to enable smoking cessation. IMPLICATIONS Patients with PTSD are more likely to develop chronic health conditions such as heart disease and diabetes. Poor health behaviors, including smoking, partly explain the risk for chronic disease in this patient population. Our results demonstrate that clinically meaningful PTSD improvement is followed by greater likelihood of smoking cessation. Thus, PTSD treatment may enable healthier behaviors and reduce risk for smoking related disease.
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Affiliation(s)
- Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104, United States.,Harry S. Truman Veterans Administration Medical Center. Columbia, MO, United States
| | - Sarah Gebauer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104, United States.,Harry S. Truman Veterans Administration Medical Center. Columbia, MO, United States
| | - Auston Gillis
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104, United States
| | - Carissa van den Berk-Clark
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104, United States
| | - F David Schneider
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Paula P Schnurr
- National Center for PTSD and Department of Psychiatry, Geisel School of Medicine at Dartmouth, United States
| | - Matthew J Friedman
- National Center for PTSD and Department of Psychiatry, Geisel School of Medicine at Dartmouth, United States
| | - Sonya B Norman
- National Center for PTSD and Department of Psychiatry, University of California San Diego, United States
| | - Peter W Tuerk
- Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville, VA. United States
| | - Beth E Cohen
- Department of Medicine, University of California San Francisco School of Medicine and San Francisco VAMC, United States
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis MO. and The Bell Street Clinic Opioid Addiction Treatment Programs, VA St. Louis Healthcare System, St. Louis, MO, United States
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104, United States.,Harry S. Truman Veterans Administration Medical Center. Columbia, MO, United States
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Salas J, Li X, Xian H, Sullivan MD, Ballantyne JC, Lustman PJ, Grucza R, Scherrer JF. Opioid dosing among patients with 3 or more years of continuous prescription opioid use before and after the CDC opioid prescribing guideline. Int J Drug Policy 2021; 97:103308. [PMID: 34098282 DOI: 10.1016/j.drugpo.2021.103308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Opioid doses declined after the Centers for Disease Control (CDC) opioid prescribing guideline was published. However, it is unknown if dose declines occurred in patients with ≥ 3 years of continuous opioid use. METHODS Optum® de-identified integrated Electronic Health Record and claims data were used to create an adult sample (n = 400) with continuous opioid use for 18 months before and after the guideline publication. Based on the morphine milligram equivalent (MME) distribution at Month 1, patients were categorized into 1-50, 51-100, 101-200, and >200 mg baseline MME. Interrupted time series analysis using segmented mixed linear regression models stratified on baseline MME estimated average monthly changes in MME in the 18-months pre- and post-guideline, before and after adjusting for time-varying pain conditions, psychiatric disorders and benzodiazepine prescription. RESULTS Patients were 59.6 (SD±11.8) years of age, 55.8% female and 84.0% white race. For 1-50 MME, monthly dose slope was significantly (p<0.0001) flatter post-guideline (pre b = 0.34 MME/month vs. post b = 0.12 MME/month). For 51-100 MME, the pre- and post-guideline dose slopes did not significantly differ (pre b = 0.60 MME/month vs. post b = 0.27 MME/month). For 101-200 MME, post-guideline dose slope was significantly (p<0.0001) steeper and decreasing post-guideline (pre b = 0.11 MME/month vs. post b= -1.33 MME/month). Among >200 MME, dose decreased in the pre- and post-guideline periods, and post-guideline decline was significantly (p<0.0001) steeper (b= -1. 86 MME/month vs. b= -4.13 MME/month). CONCLUSIONS Among patients on multiyear opioid therapy, the CDC guideline was associated with a modest change in dosing, except for patients on very high doses. The guideline was not associated with decreasing MME among lower-dose, long-term users.
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Affiliation(s)
- Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis MO. 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis MO. 63110, USA.
| | - Xue Li
- College of Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO 63104, USA
| | - Hong Xian
- College of Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO 63104, USA
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle WA. 98195, USA
| | - Jane C Ballantyne
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, Seattle WA. 98195, USA
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO. 63110, USA; The Bell Street Clinic Opioid Addiction Treatment Programs, VA St. Louis Healthcare System, 915 North Grand Blvd, St. Louis, MO. 63106, USA
| | - Richard Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis MO. 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis MO. 63110, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis MO. 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis MO. 63110, USA
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Abstract
Almeida-Meza et al found an inverse correlation between cognitive reserve (associated with educational level, complexity of occupations and leisure activities) and dementia incidence. We suggest clarifying studies using their data-set and consider what can be done to modify socioeconomic inequalities that affect cognitive reserve or to slow early dementia.
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Affiliation(s)
- Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, Missouri, USA
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Tucker J, Salas J, Zhang Z, Grucza R, Scherrer JF. Provider specialty and odds of a new codeine, hydrocodone, oxycodone and tramadol prescription before and after the CDC opioid prescribing guideline publication. Prev Med 2021; 146:106466. [PMID: 33636196 DOI: 10.1016/j.ypmed.2021.106466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 11/19/2022]
Abstract
The CDC Guideline for Prescribing Opioids for Chronic Pain cautioned against high dose prescribing but did not provide guidance on type of opioid for new pain episodes. We determined if new prescriptions for Schedule II opioids vs. tramadol decreased in the 18 months after vs. before the CDC guideline and if this decrease was associated with physician specialty. New opioid prescriptions, provider type and covariates were measured using a nationally distributed, Optum® de-identified Electronic Health Record (EHR) data base. Eligible patients were free of cancer and HIV and started a new prescription for Schedule II opioids (i.e. codeine, hydrocodone, oxycodone) or Schedule IV (tramadol) in the 18 months before (n = 141,219) or 18 months after (n = 138,216) guideline publication. Fully adjusted multilevel multinomial models estimated the association between provider type (anesthesiology/pain medicine, surgical specialty, emergency, hospital, primary care, other specialty and unknown) before and after adjusting for covariates. New oxycodone prescriptions were most common among surgical and anesthesia/pain management, and new tramadol prescriptions were most common in primary care. The greatest decreases in odds of a Schedule II opioid vs. tramadol were observed in emergency care (oxycodone vs. tramadol OR = 0.82; 95%CI:0.76-0.88) and primary care (hydrocodone vs. tramadol OR = 0.85; 95%CI:0.81-0.89). Surgical specialists were least likely to start opioid therapy with tramadol. In the 18 months after vs. before the CDC guideline, emergency care and primary care providers increased tramadol prescribing. Guidelines tailored to specialists that frequently begin opioid therapy with oxycodone may enhance safe opioid prescribing.
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Affiliation(s)
- Jane Tucker
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States of America
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States of America; AHEAD Institute, Saint Louis University School of Medicine, Salus Center, 4th Floor, 3545, Lafayette Ave., St. Louis, MO 63104, United States of America
| | - Zidong Zhang
- AHEAD Institute, Saint Louis University School of Medicine, Salus Center, 4th Floor, 3545, Lafayette Ave., St. Louis, MO 63104, United States of America
| | - Richard Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States of America; AHEAD Institute, Saint Louis University School of Medicine, Salus Center, 4th Floor, 3545, Lafayette Ave., St. Louis, MO 63104, United States of America
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO 63104, United States of America; AHEAD Institute, Saint Louis University School of Medicine, Salus Center, 4th Floor, 3545, Lafayette Ave., St. Louis, MO 63104, United States of America.
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Scherrer JF, Salas J, Wiemken TL, Jacobs C, Morley JE, Hoft DF. Lower Risk for Dementia Following Adult Tetanus, Diphtheria, and Pertussis (Tdap) Vaccination. J Gerontol A Biol Sci Med Sci 2021; 76:1436-1443. [PMID: 33856020 DOI: 10.1093/gerona/glab115] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Adult vaccinations may reduce risk for dementia. However, it has not been established whether tetanus, diphtheria, pertussis (Tdap) vaccination is associated with incident dementia. METHODS Hypotheses were tested in a Veterans Health Affairs (VHA) cohort and replicated in a MarketScan medical claims cohort. Patients were at least 65 years of age and free of dementia for 2 years prior to index date. Patients either had or did not have a Tdap vaccination by the start of either of the 2 index periods (2011 or 2012). Follow-up continued through 2018. Controls had no Tdap vaccination for the duration of follow-up. Confounding was controlled using entropy balancing. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between Tdap vaccination and incident dementia in all patients and age subgroups (65-69, 70-74, and ≥75 years). RESULTS VHA patients were, on average, 75.6 (SD ± 7.5) years of age, 4% female, and 91.2% were White. MarketScan patients were 69.8 (SD ± 5.6) years of age, on average and 65.4% were female. After controlling for confounding, patients with, compared to without, Tdap vaccination had a significantly lower risk for dementia in both cohorts (VHA: hazard ratio [HR] = 0.58; 95% confidence interval [CI]:0.54-0.63 and MarketScan: HR = 0.58; 95% CI:0.48-0.70). CONCLUSIONS Tdap vaccination was associated with a 42% lower dementia risk in 2 cohorts with different clinical and sociodemographic characteristics. Several vaccine types are linked to decreased dementia risk, suggesting that these associations are due to nonspecific effects on inflammation rather than vaccine-induced pathogen-specific protective effects.
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Affiliation(s)
- Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Missouri, USA.,Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri, USA.,The AHEAD Institute, Saint Louis University School of Medicine, Missouri, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Missouri, USA.,Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri, USA.,The AHEAD Institute, Saint Louis University School of Medicine, Missouri, USA
| | - Timothy L Wiemken
- The AHEAD Institute, Saint Louis University School of Medicine, Missouri, USA.,Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, Missouri, USA.,Division of Infectious Diseases, Allergy, and Immunology, Department of Internal Medicine, Saint Louis University School of Medicine, Missouri, USA.,Saint Louis University Systems Infection Prevention Center, Center for Specialized Medicine, Missouri, USA
| | - Christine Jacobs
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Missouri, USA.,The AHEAD Institute, Saint Louis University School of Medicine, Missouri, USA
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, Missouri, USA
| | - Daniel F Hoft
- Division of Infectious Diseases, Allergy, and Immunology, Department of Internal Medicine, Saint Louis University School of Medicine, Missouri, USA.,Saint Louis University Systems Infection Prevention Center, Center for Specialized Medicine, Missouri, USA.,Departments of Internal Medicine and Molecular Microbiology and Immunology, Saint Louis University, Missouri, USA
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Scherrer JF, Salas J, Grucza R, Sullivan MD, Lustman PJ, Copeland LA, Ballantyne JC. Depression and Buprenorphine Treatment in Patients with Non-cancer Pain and Prescription Opioid Dependence without Comorbid Substance Use Disorders. J Affect Disord 2021; 278:563-569. [PMID: 33022442 DOI: 10.1016/j.jad.2020.09.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/02/2020] [Accepted: 09/15/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Depression occurs in 40% of patients with prescription opioid dependence (POD). Existing studies of the association between depression and buprenorphine (BUP) treatment for POD are inconsistent and often include patients with comorbid substance use disorders (SUD). We estimated the association between depression and BUP use in patients with pain and POD and free of comorbid SUD. METHODS Optum® de-identified Electronic Health Record dataset from 2010 to 2018 was used to identify 5,529 patients with chronic pain, with and without depression, receiving prescription opioids and free of substance use disorder diagnoses for one year before POD diagnoses. Unadjusted and adjusted Cox proportional hazard models and negative binomial regression models were computed to estimate the association between depression and time to BUP start, number of BUP prescriptions in the year after BUP start and time to >30 day BUP gap. RESULTS Patients' mean age was 52.4 (SD±15.3) years, 62% were female and 84% were white and 4.9% (n=270) started BUP. Depression was not associated with BUP initiation.. Among BUP starters, depression vs. no depression, was significantly associated with receiving 29% fewer BUP prescriptions (RR=0.71; 95%CI: 0.51-0.98) and an increased risk for > 30 day gap (HR=1.76; 95%CI:1.01-3.09). LIMITATIONS Missing data prevented measuring BUP dose. CONCLUSIONS Depression is likely associated with earlier BUP treatment dropout. Depression related medication non-adherence or possible worsening of depression following BUP taper could explain results. Research is needed to determine if depression severity is associated with BUP dose trajectories and multi-year BUP retention..
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Affiliation(s)
- Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis MO. 63104.
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis MO. 63104
| | - Richard Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis MO. 63104
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle WA. 98195
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO. 63110; The Bell Street Clinic Opioid Addiction Treatment Programs, VA St. Louis Healthcare System, St. Louis, MO. 63106
| | - Laurel A Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, MA 01053; Department of Quantitative Health Sciences, Univ. of Mass. Medical School, Worcester, MA 01605
| | - Jane C Ballantyne
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle WA 98195
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Scherrer JF, Sullivan MD. Is obesity associated with odds of prescription opioid use independent of depression? Pain 2021; 162:319. [PMID: 33323844 DOI: 10.1097/j.pain.0000000000002105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jeffrey F Scherrer
- Department of Family and Community Medicine,Saint Louis University School of Medicine,Louis, MO, United States
- AHEAD Institute, Saint Louis University School of Medicine,Salus Center, St. Louis, MO, United States
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Science,University of Washington School of Medicine,Seattle WA, United States
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Scherrer JF, Hoft DF, Salas J, Wiemken T, Morley JE. Editorial: Common Adult Vaccinations May Reduce Risk for Dementia. J Nutr Health Aging 2021; 25:1138-1139. [PMID: 34866139 DOI: 10.1007/s12603-021-1695-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J F Scherrer
- Jeffrey F. Scherrer, PhD, Saint Louis University School of Medicine, Family and Community Medicine, 1008 S. Spring, SLUCare Academic Pavilion, 3rd Floor St. Louis, MO 63110, , voice:314-977-8486
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Salas J, Norman SB, Tuerk PW, van den Berk-Clark C, Cohen BE, Schneider FD, Chard KM, Lustman PJ, Schnurr PP, Friedman MJ, Grucza R, Scherrer JF. PTSD improvement and substance use disorder treatment utilization in veterans: Evidence from medical record data. Drug Alcohol Depend 2021; 218:108365. [PMID: 33109460 PMCID: PMC7750304 DOI: 10.1016/j.drugalcdep.2020.108365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Clinical trials reveal posttraumatic stress disorder (PTSD) improvement leads to decreased substance use among patients with comorbid substance use disorder (SUD). Using administrative medical record data, we determined whether clinically meaningful PTSD Checklist (PCL) (≥20 points) score decreases were positively associated with SUD treatment utilization. METHODS We used a retrospective cohort of Veterans Health Affairs (VHA) medical record data (2008-2015). PTSD Checklist (PCL) scores were used to categorize patients into those with a clinically meaningful PTSD improvement (≥20 point decrease) or not (<20 point decrease or increase). PTSD and SUD were measured by ICD-9 codes. Propensity score weighting controlled for confounding in logistic and negative binomial models that estimated the association between clinically meaningful PTSD improvement and use of SUD treatment and number of SUD clinic visits. RESULTS The 699 eligible patients were, on average, 40.4 (±13.2) years old, 66.2% white and 33.1% were married. After controlling for confounding, there was a 56% increased odds of any SUD treatment utilization among those with a PCL decrease ≥20 vs < 20 (OR = 1.56; 95%CI = 1.04-2.33) but there was no association with number of SUD treatment visits. CONCLUSIONS Clinically meaningful reductions in PTSD symptoms were associated with any SUD treatment utilization but not amount of utilization. Improvement in PTSD symptoms, independent of the treatment modality, may enable SUD treatment seeking.
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Affiliation(s)
- Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States.
| | - Sonya B. Norman
- National Center for PTSD and Department of Psychiatry,
University of California San Diego, United States
| | - Peter W. Tuerk
- Sheila C. Johnson Center for Clinical Services, Department
of Human Services, University of Virginia, Charlottesville, VA. United States
| | - Carissa van den Berk-Clark
- Department of Family and Community Medicine, Saint Louis
University School of Medicine, St. Louis MO. 63104, United States
| | - Beth E. Cohen
- Department of Medicine, University of California San
Francisco School of Medicine and San Francisco VAMC, United States
| | - F. David Schneider
- Department of Family and Community Medicine, University of
Texas Southwestern Medical Center, Dallas, TX, United States
| | - Kathleen M. Chard
- Trauma Recovery Center Cincinnati VAMC and Department of
Psychiatry and Behavioral Neuroscience, University of Cincinnati, United
States
| | - Patrick J. Lustman
- Department of Psychiatry, Washington University School of
Medicine, St. Louis MO. and The Bell Street Clinic Opioid Addiction Treatment
Programs, VA St. Louis Healthcare System, St. Louis, MO, United States
| | - Paula P. Schnurr
- National Center for PTSD and Department of Psychiatry,
Geisel School of Medicine at Dartmouth, United States
| | - Matthew J. Friedman
- National Center for PTSD and Department of Psychiatry,
Geisel School of Medicine at Dartmouth, United States
| | - Richard Grucza
- Department of Family and Community Medicine, Saint Louis
University School of Medicine, St. Louis MO. 63104, United States
| | - Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis
University School of Medicine, St. Louis MO. 63104, United States,Harry S. Truman Veterans Administration Medical Center.
Columbia, MO, United States
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Salas J, Miller MB, Scherrer JF, Moore R, McCrae CS, Sullivan MD, Bucholz KK, Copeland LA, Ahmedani BK, Schneider FD, Lustman PJ. The association of opioid use duration and new depression episode among patients with and without insomnia. J Opioid Manag 2020; 16:317-328. [PMID: 33226089 DOI: 10.5055/jom.2020.0587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Insomnia commonly co-occurs with depression, chronic pain, and opioid use. Both insomnia and chronic opioid analgesic use (OAU) are independent risk factors for a new depression episode (NDE). This study determined if the association between longer OAU duration and NDE was stronger in those with versus without insomnia. DESIGN Retrospective cohort. SETTING Veterans Health Administration electronic medical records (2000-2012). PARTICIPANTS New opioid users in follow-up (2002-2012), free of depression for two years prior to follow-up, and aged 18-80 (n = 70,997). METHODS NDE was ≥ 2 ICD-9 codes in a 12-month period. Insomnia before OAU initiation was ≥1 ICD-9 code. Cox proportional hazard models stratified on insomnia assessed the relationship between initiating a 1-30, 31-90, or > 90 day period of OAU and NDE while controlling for confounders using inverse probability of treatment-weighted propensity scores (PS). RESULTS Compared to 1-30 day OAU, 31-90 day was associated with NDE in those without (HR = 1.20; 95 percent CI: 1.12-1.28) but not with insomnia (HR = 1.06; 95 percent CI: 0.86-1.32). Results showed a stronger effect of chronic (>90) OAU in those with insomnia (HR = 1.59; 95 percent CI: 1.27-1.98) compared to those without (HR = 1.31; 95 percent CI: 1.21-1.42). However, all stratum-specific effects were not significantly different (p = 0.136). CONCLUSIONS Although stratum-specific risks were statistically similar, there was evidence for a trend that chronic OAU is a stronger risk factor for NDE in those with versus without insomnia. Providers are encouraged to monitor sleep impairment among patients on opioid therapy, as sleep may be associated with greater risk for NDE in patients with chronic OAU.
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Affiliation(s)
- Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri; Harry S. Truman Memorial Veterans' Administration Medical Center, Columbia, Missouri
| | - Mary Beth Miller
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri; Harry S. Truman Memorial Veterans' Administration Medical Center, Columbia, Missouri
| | - Rachel Moore
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Christina S McCrae
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Health, University of Washington School of Medicine, Seattle, Washington
| | - Kathleen K Bucholz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Laurel A Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan; School of Social Work, Michigan State University, East Lansing, Michigan
| | - F David Schneider
- Department of Family and Community Medicine, University of Texas Southwestern, Dallas, Texas
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; The Bell Street Clinic, VA St. Louis Health Care System-John Cochran Division, St. Louis, Missouri
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Scherrer JF, Tucker J, Salas J, Zhang Z, Grucza R. Comparison of Opioids Prescribed for Patients at Risk for Opioid Misuse Before and After Publication of the Centers for Disease Control and Prevention's Opioid Prescribing Guidelines. JAMA Netw Open 2020; 3:e2027481. [PMID: 33263762 PMCID: PMC7711316 DOI: 10.1001/jamanetworkopen.2020.27481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
IMPORTANCE It is not known whether decreases in Schedule II (high abuse potential) vs Schedule IV (lower abuse potential) opioid prescriptions overall and among high-risk patients followed publication of the Centers for Disease Control and Prevention (CDC) opioid prescribing guideline on March 15, 2016. OBJECTIVES To compare the odds of new Schedule II opioid (codeine, hydrocodone, oxycodone) prescriptions vs Schedule IV opioid (tramadol) prescriptions in the 18-month periods before and after the CDC guideline release to determine whether new prescriptions for Schedule II opioids decreased relative to new prescriptions for tramadol and to assess whether patients with benzodiazepine prescriptions or those with depression, anxiety, or substance use disorders had a greater decrease in receipt of Schedule II vs Schedule IV opioids. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of Optum's deidentified Integrated Claims-Clinical data set for 5 million US adults 18 months before and 18 months after March 15, 2016. Eligible patients were 18 years or older, free of HIV and cancer diagnoses, and had a noncancer painful condition. Patients received new prescriptions for codeine, hydrocodone, oxycodone, or tramadol. Data were analyzed from September 5, 2014, to September 14, 2017. EXPOSURE The CDC opioid prescribing guideline published on March 15, 2016. MAIN OUTCOMES AND MEASURES The odds of prescriptions for each Schedule II opioid vs tramadol after guideline publication. RESULTS Data from 279 435 patients were included in the study. The mean (SD) age of patients was 52.9 (16.5) years; 61% were female and 79.4% were White. The prevalence of new prescriptions for each drug before and after guideline publication was as follows: codeine, 7.1% vs 7.0%; hydrocodone, 47.4% vs 45.6%; oxycodone, 22.4% vs 24.0%; and tramadol, 23.0% vs 23.4%. Overall, the odds of being prescribed hydrocodone or oxycodone vs tramadol significantly decreased after guideline publication (odds ratios, 0.95; 95% CI, 0.91-0.98 and 0.86; 95% CI, 0.82-0.90, respectively). Odds of being prescribed a Schedule II opioid vs tramadol after vs before guideline publication were similar in patients with and without benzodiazepine comedication or psychiatric disorders. CONCLUSIONS AND RELEVANCE In the 18 months after compared with the 18 months before publication of the CDC prescribing guideline, a 14% decrease in oxycodone prescriptions was observed relative to tramadol. Little change in prescriptions of other Schedule II opioids was observed. Schedule II opioids continue to be prescribed to high-risk patients 18 months after publication of the CDC guideline.
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Affiliation(s)
- Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Jane Tucker
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Zidong Zhang
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Richard Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri
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Day P, Secrest S, Davis D, Salas J, van den Berk-Clark C, Kale N, Hearing C, Schneider FD, Scherrer JF. Prescription opioid use duration and beliefs about pain and pain medication in primary care patients. J Opioid Manag 2020; 16:425-434. [PMID: 33428189 DOI: 10.5055/jom.2020.0600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Patient beliefs about pain and opioids have been reported from qualitative data. To overcome limitations of unstructured assessments and small sample sizes, we determined if pain and pain medication beliefs varied by chronic pain status and opioid analgesic use (OAU) duration in primary care patients. METHODS Cross-sectional survey data obtained in 2017 and 2018 from 735 patients ≥ 18 years of age. The eight-item Barriers Questionnaire (BQ) measured beliefs about pain and pain medication. Patients reported OAU and use of other pain treatments. Multiple linear regression models estimated the association between never OAU, 1-90 day OAU and >90 day OAU and each BQ item. RESULTS Overall, respondents were 49.1 (±15.4) years old, 38.7 percent white, 28.4 percent African-American, 23.5 percent Hispanic, and 68.6 percent female. About one-third never used opioids, 41.8 percent had 1-90 day OAU, and 21.6 percent had > 90 day OAU. Multiple linear regression analyses showed that compared to never OAU, > 90 day OAU had lower average agreement that analgesics are addictive (β = -0.50; 95 percent CI: -0.96, -0.03), and 1-90 day OAU (β = -0.53; 95 percent CI: -0.96, -0.10) and > 90 OAU (β = -0.55; 95 percent CI: -1.04, -0.06) had lower average agreement that analgesics make people do or say embarrassing things. CONCLUSIONS Patients with chronic OAU reported less concern about addiction and opioid-related behavior change. Never users were most likely to agree that opioids are addictive. There continues to be a need to educate patients about opioid risks. Assessing patients' beliefs may identify patients at risk for chronic OAU.
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Affiliation(s)
- Philip Day
- Assistant Professor, Department of Family and Community Medicine, University of Texas Southwestern, Dallas, Texas
| | - Scott Secrest
- Research Coordinator, Department of Family and Community Medicine, Saint Louis University School of Medi-cine, St. Louis, Missouri
| | - Dawn Davis
- Assistant Professor, Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Joanne Salas
- Senior Biostatistician, Department of Family and Community Medicine, Saint Louis University School of Medi-cine, St. Louis, Missouri
| | - Carissa van den Berk-Clark
- Assistant Professor, Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Neelima Kale
- Associate Professor, Department of Family and Community Medicine, University of Texas Southwest-ern, Dallas, Texas
| | - Catherine Hearing
- Research Assistant, Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - F David Schneider
- Chair and Professor, Department of Family and Community Medicine, University of Texas South-western, Dallas, Texas
| | - Jeffrey F Scherrer
- Research Director and Professor, Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
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Li X, Fu Q, Scherrer JF, Humphrey D, Leigh I. A temporal relationship between nonmedical opioid Use and major depression in the U.S.: A Prospective study from the National Epidemiological Survey on Alcohol and Related Conditions. J Affect Disord 2020; 273:298-303. [PMID: 32421616 DOI: 10.1016/j.jad.2020.04.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/18/2020] [Accepted: 04/27/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Given the existing strong cross-sectional relationship between nonmedical opioid use (NMOU) and major depressive disorder (MDD), this study focused on the temporal relationship between NMOU and major depression. METHODS Data sources were derived from Wave 1 and Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions. Logistic regression was applied to predicted NMOU at the follow-up survey based on baseline MDD diagnosis and symptoms of MDD among the sample without lifetime NMOU at baseline (N=32,982). In parallel, we examined the relationship between past year NMOU at baseline and new onset of MDD diagnosis (N=28,649) and between past year NMOU at baseline and new onset of symptoms of MDD (N=23,214) among people without major depression diagnosis or symptoms at baseline. RESULTS MDD diagnosis (aOR=1.68, 95% CI=1.43, 1.98) and symptoms of major depression (aOR=1.25, 95% CI=1.14, 1.38) at baseline were associated with higher odds of incident NMOU. The baseline NMOU was associated with lower odds incident MDD diagnosis (aOR=0.79, 95%CI=0.66, 0.94) in the adjusted model. However, the baseline NMOU was associated with higher odds of new onset of major depressive symptoms at wave 2 in the sample without baseline symptoms of MDD (aOR=1.42, 95%CI=1.23, 1.63). CONCLUSION Symptoms of MDD and MDD diagnosis increased the new onset of NMOU, while NMOU only increased the risks of new onset of symptoms of MDD.
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Affiliation(s)
- Xue Li
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Salus Center Suite 300, 3545 Lafayette Ave., St. Louis, Missouri, 63104, Saint Louis, Missouri, USA
| | - Qiang Fu
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Salus Center Suite 300, 3545 Lafayette Ave., St. Louis, Missouri, 63104, Saint Louis, Missouri, USA.
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, School of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Daniel Humphrey
- Department of Communication, Boston College, Boston, MA, USA
| | - Isabella Leigh
- Department of Communication, Boston College, Boston, MA, USA
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Zubatsky M, Witthaus M, Scherrer JF, Salas J, Gebauer S, Burge S, Schneider FD. The association between depression and type of treatments received for chronic low back pain. Fam Pract 2020; 37:348-354. [PMID: 31746992 PMCID: PMC7755115 DOI: 10.1093/fampra/cmz062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Depression is associated with receipt of opioids in non-cancer pain. OBJECTIVES To determine whether the receipt of opioid therapy modifies the relationship of depression and use of multiple non-opioid pain treatments. METHODS Patients (n = 320) with chronic low back pain (CLBP) were recruited from family medicine clinics and completed questionnaires that measured use of home remedies, physical treatments requiring a provider and non-opioid medication treatments. A binary variable defined use (yes/no) of all three non-opioid treatment categories. Depression (yes/no) was measured with the PHQ-2. The use of opioids (yes/no) was determined by medical record abstraction. Unadjusted and adjusted logistic regression models, stratified on opioid use, estimated the association between depression and use of all three non-opioid treatments. RESULTS Participants were mostly female (71.3%), non-white (57.5%) and 69.4% were aged 18 to 59 years. In adjusted analyses stratified by opioid use, depression was not significantly associated with using three non-opioid treatments (OR = 2.20; 95% CI = 0.80-6.07) among non-opioid users; but among opioid users, depression was significantly associated with using three non-opioid treatments (OR = 3.21; 95% CI: 1.14-8.99). These odds ratios were not significantly different between opioid users and non-users (P = 0.609). CONCLUSION There is modest evidence to conclude that patients with CLBP and comorbid depression, compared with those without depression, were more likely to try both opioid and non-opioid pain treatments. Non-response to other pain treatments may partly explain why depression is associated with greater prescription opioid use.
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Affiliation(s)
- Max Zubatsky
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Matthew Witthaus
- Family Medicine Center at University Village, University of Illinois Hospital, Chicago, IL, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Sarah Gebauer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Sandra Burge
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - F David Schneider
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Scherrer JF, Salas J, Schneider FD, Friedman MJ, van den Berk-Clark C, Chard KM, Norman SB, Lustman PJ, Tuerk P, Schnurr PP, Cohen BE. PTSD improvement and incident cardiovascular disease in more than 1000 veterans. J Psychosom Res 2020; 134:110128. [PMID: 32403058 PMCID: PMC7274904 DOI: 10.1016/j.jpsychores.2020.110128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with increased risk for cardiovascular disease (CVD). Whether clinically meaningful PTSD improvement is associated with lowering CVD risk is unknown. METHODS Eligible patients (n = 1079), were 30-70 years old, diagnosed with PTSD and used Veterans Health Affairs PTSD specialty clinics. Patients had a PTSD Checklist score (PCL) ≥ 50 between Fiscal Year (FY) 2008 and FY2012 and a second PCL score within 12 months and at least 8 weeks after the first PCL ≥ 50. Clinically meaningful PTSD improvement was defined by ≥20 point PCL decrease between the first and second PCL score. Patients were free of CVD diagnoses for 1 year prior to index. Index date was 12 months following the first PCL. Follow-up continued to FY2015. Cox proportional hazard models estimated the association between clinically meaningful PTSD improvement and incident CVD and incident ischemic heart disease (IHD). Sensitivity analysis stratified by age group (30-49 vs. 50-70 years) and depression. Confounding was controlled using propensity scores and inverse probability of exposure weighting. RESULTS Patients were 48.9 ± 10.9 years of age on average, 83.3% male, 60.1% white, and 29.5% black. After controlling for confounding, patients with vs. without PTSD improvement did not differ in CVD risk (HR = 1.08; 95%CI: 0.72-1.63). Results did not change after stratifying by age group or depression status. Results were similar for incident IHD. CONCLUSIONS Over a 2-7 year follow-up, we did not find an association between clinically meaningful PTSD improvement and incident CVD. Additional research is needed using longer follow-up.
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Affiliation(s)
- Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104,Harry S. Truman Veterans Administration Medical Center. Columbia, MO.,Corresponding author at: Family and Community Medicine, Saint Louis University School of Medicine, 1402 N. Grand Blvd, St. Louis, MO. 63104,
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104,Harry S. Truman Veterans Administration Medical Center. Columbia, MO
| | - F. David Schneider
- Department of Family and Community Medicine, University of Texas Southwestern, Dallas TX
| | - Matthew J. Friedman
- National Center for PTSD and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Carissa van den Berk-Clark
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104
| | - Kathleen M. Chard
- Trauma Recovery Center Cincinnati VAMC and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, OH
| | - Sonya B. Norman
- National Center for PTSD and Department of Psychiatry, University of California San Diego
| | - Patrick J. Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis MO.,The Bell Street Clinic Opioid Addiction Treatment Program, VA St. Louis Health Care System, St. Louis MO
| | - Peter Tuerk
- Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville, VA
| | - Paula P. Schnurr
- National Center for PTSD and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Beth E. Cohen
- Department of Medicine, University of California San Francisco School of Medicine and San Francisco VAMC, CA
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Harding BN, Floyd JS, Scherrer JF, Salas J, Morley JE, Farr SA, Dublin S. Methods to identify dementia in the electronic health record: Comparing cognitive test scores with dementia algorithms. Healthc (Amst) 2020; 8:100430. [PMID: 32553526 DOI: 10.1016/j.hjdsi.2020.100430] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/27/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Epidemiologic studies often use diagnosis codes to identify dementia outcomes. It remains unknown to what extent cognitive screening test results add value in identifying dementia cases in big data studies leveraging electronic health record (EHR) data. We examined test scores from EHR data and compared results with dementia algorithms. METHODS This retrospective cohort study included patients 60+ years of age from Kaiser Permanente Washington (KPWA) during 2013-2018 and the Veterans Health Affairs (VHA) during 2012-2015. Results from the Mini Mental State Examination (MMSE) and the Saint Louis University Mental Status Examination (SLUMS) cognitive screening exams, were classified as showing dementia or not. Multiple dementia algorithms were created using combinations of diagnosis codes, pharmacy records, and specialty care visits. Correlations between test scores and algorithms were assessed. RESULTS 3,690 of 112,917 KPWA patients and 2,981 of 102,981 VHA patients had cognitive test results in the EHR. In KPWA, dementia prevalence ranged from 6.4%-8.1% depending on the algorithm used and in the VHA, 8.9%-12.1%. The algorithm which best agreed with test scores required ≥2 dementia diagnosis codes in 12 months; at KPWA, 14.8% of people meeting this algorithm had an MMSE score, of whom 65% had a score indicating dementia. Within VHA, those figures were 6.2% and 77% respectively. CONCLUSIONS Although cognitive test results were rarely available, agreement was good with algorithms requiring ≥2 dementia diagnosis codes, supporting the accuracy of this algorithm. IMPLICATIONS These scores may add value in identifying dementia cases for EHR-based research studies.
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Affiliation(s)
- Barbara N Harding
- Department of Medicine, University of Washington, 1959 North East Pacific Street, Seattle, WA, 98195, USA; Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA.
| | - James S Floyd
- Department of Medicine, University of Washington, 1959 North East Pacific Street, Seattle, WA, 98195, USA; Department of Epidemiology, University of Washington, 1959 North East Pacific Street, Seattle, WA, 98195, USA; Cardiovascular Health Research Unit, University of Washington, 1730 Minor Ave, Seattle, WA, 98195, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA; Harry S. Truman Veterans Administration Medical Center, Research Service, 800 Hospital Drive, Columbia, MO, 65201, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA; Harry S. Truman Veterans Administration Medical Center, Research Service, 800 Hospital Drive, Columbia, MO, 65201, USA
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA
| | - Susan A Farr
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA; Saint Louis Veterans Affairs Medical Center, Research Service, John Cochran Division, 915 North Grand Blvd, St. Louis, MO, 63106, USA
| | - Sascha Dublin
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA; Department of Epidemiology, University of Washington, 1959 North East Pacific Street, Seattle, WA, 98195, USA
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Salas J, Morley JE, Scherrer JF, Floyd JS, Farr SA, Zubatsky M, Barthold D, Dublin S. Risk of incident dementia following metformin initiation compared with noninitiation or delay of antidiabetic medication therapy. Pharmacoepidemiol Drug Saf 2020; 29:623-634. [PMID: 32363681 DOI: 10.1002/pds.5014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 01/31/2020] [Accepted: 04/06/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Emerging evidence suggests metformin compared with sulfonylurea is associated with an 8% to 10% lower risk for dementia. Guidelines recommend metformin as initial diabetes treatment, but there is still the question of treatment timing. Thus, the risk of dementia associated with initiating metformin compared with not initiating or delaying treatment was examined. METHODS A retrospective cohort study (1996 to 2015) was conducted with electronic health records from Veteran Health Affairs (VHA; n = 112 845) and Kaiser Permanente Washington (KPW; n = 14 333) healthcare systems. Patients were aged ≥50 years, had a hemoglobin A1c (HbA1c) between 6.5 and <9.5 mg/dL, and did not have dementia or fills for antidiabetic medications before cohort entry. Initiators started metformin monotherapy and noninitiators used no antidiabetic medications in the 6 months after the first qualifying HbA1c. The primary outcome was incident dementia. Propensity scores and inverse probability of treatment weighting (IPTW) controlled for confounding in Cox proportional hazards models. RESULTS During a median follow-up of 6.2 years in VHA and 6.8 years in KPW, there were 7547 new dementia cases in VHA and 1090 in KPW. After IPTW, there was no association between initiation of metformin (vs no initial treatment) and incident dementia in VHA (HR = 1.04; 95% confidence interval [CI]: 0.95-1.13) or KPW (HR = 0.81; 95% CI: 0.51-1.28). Results did not differ by age, baseline HbA1c, or race. CONCLUSIONS Results do not support initiating metformin earlier to prevent cognitive decline and, thus, may dampen enthusiasm for metformin as a potential antidementia drug. Randomized clinical trials could help clarify the relationship between metformin and cognitive decline.
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Affiliation(s)
- Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,Harry S. Truman Veterans Administration Medical Center, Research Service, Columbia, Missouri, USA
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,Harry S. Truman Veterans Administration Medical Center, Research Service, Columbia, Missouri, USA
| | - James S Floyd
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Susan A Farr
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,Saint Louis Veterans Affairs Medical Center, Research Service, John Cochran Division, St. Louis, Missouri, USA
| | - Max Zubatsky
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Doug Barthold
- Department of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Sascha Dublin
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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Scherrer JF, Salas J, Friedman MJ, Cohen BE, Schneider FD, Lustman PJ, van den Berk-Clark C, Chard KM, Tuerk P, Norman SB, Schnurr PP. Clinically meaningful posttraumatic stress disorder (PTSD) improvement and incident hypertension, hyperlipidemia, and weight loss. Health Psychol 2020; 39:403-412. [PMID: 32223280 PMCID: PMC8340539 DOI: 10.1037/hea0000855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is associated with increased risk for cardiometabolic disease. Clinically meaningful PTSD improvement is associated with a lower risk for diabetes, but it is not known if similar associations exist for incident hypertension, hyperlipidemia, and clinically relevant weight loss (i.e., ≥5% loss). METHOD Medical record data from Veterans Health Affairs patients with clinic encounters between fiscal year (FY) 2008 to 2015 were used to identify patients with worsening or no PTSD improvement (i.e., PTSD checklist (PCL) score decrease <10), small (10-19 point PCL decrease), and large (≥20 point PCL decrease) PTSD improvement. To estimate the association between degree of PTSD improvement and incident hypertension (n = 979), incident hyperlipidemia (n = 1,139) and incident ≥5% weight loss (1,330), we computed Cox proportional hazard models, controlling for confounding using inverse probability of exposure weighting (IPEW). RESULTS Overall, patients were about 40 years of age, 80% male and 65% White. Worsening or no PCL change occurred in about 60%, small improvement in 20%, and large improvement in 20%. After weighting data, compared with worsening or no change, both small and large PTSD improvements were associated, albeit not significantly, with lower risks for hypertension (HR = 0.68; 95% confidence interval, CI [0.46, 1.01] and HR = 0.79; 95% CI [0.53, 1.18], respectively). In weighted data, PTSD improvement was not associated with incident hyperlipidemia or ≥5% weight loss. CONCLUSIONS We observed limited evidence for an association between PTSD improvement and decreased hypertension risk. PCL decreases were not associated with hyperlipidemia or ≥5% weight loss. Further studies that measure potential physical health benefits of change in specific PTSD symptoms are needed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104
- Harry S. Truman Veterans Administration Medical Center, Columbia, MO
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104
- Harry S. Truman Veterans Administration Medical Center, Columbia, MO
| | - Matthew J. Friedman
- National Center for PTSD and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Beth E. Cohen
- Department of Medicine, University of California San Francisco School of Medicine and San Francisco VAMC, San Francisco, CA
| | - F. David Schneider
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Patrick J. Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis MO
- The Bell Street Clinic Opioid Treatment Program, Mental Health Service, VA St. Louis Health Care System, St. Louis, MO
| | - Carissa van den Berk-Clark
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104
| | - Kathleen M. Chard
- Trauma Recovery Center Cincinnati VAMC and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH
| | - Peter Tuerk
- Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville, VA
| | - Sonya B. Norman
- National Center for PTSD, VA Center of Excellence for Stress and Mental Health and Department of Psychiatry, University of California San Diego
| | - Paula P. Schnurr
- National Center for PTSD and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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