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Sonnenfeld ML, Pappadis MR, Reistetter TA, Raji MA, Ottenbacher K, Al Snih S. Vision Impairment and Frailty Among Mexican American Older Adults: A Longitudinal Study. J Appl Gerontol 2024; 43:755-764. [PMID: 38412864 PMCID: PMC11052670 DOI: 10.1177/07334648241231374] [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] [Indexed: 02/29/2024] Open
Abstract
We examined the relationship between vision impairment (VI) and new-onset frailty among non-frail Mexican American older adults (≥70 years) at baseline and determined the differential impact of VI on each frailty criteria. Data were from an 18-year prospective cohort from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1998/1999, N = 1072 to 2016, N = 175). Frailty was defined as ≥3 criteria: unintentional weight loss of >10 pounds, weakness, exhaustion, low physical activity, and slowness. VI was defined as difficulty in recognizing a friend at arm's length's away, across the room, or across the street. We found that participants with VI (near or distant) and distant VI had greater odds of frailty (near or distant VI, OR = 1.89, 95% CI = 1.30-2.73 and distant VI, OR = 1.95, 95% CI = 1.34-2.86, respectively) after controlling for covariates over time. Early screening (optimal management) of VI may prevent or delay onset of frailty among older Mexican Americans.
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Affiliation(s)
- Mandi L Sonnenfeld
- Michael E. DeBakey Veterans Affairs Medical Center, Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Houston, TX, USA
| | - Monique R Pappadis
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Timothy A Reistetter
- Department of Occupational Therapy, School of Health Professions, UT Health San Antonio, San Antonio, TX, USA
| | - Mukaila A Raji
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Kenneth Ottenbacher
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Soham Al Snih
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
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Kuo YF, Kim E, Westra J, Wilkes D, Raji MA. Pain Control Associated With Gabapentinoid Prescription After Elective Total Knee Arthroplasty. J Arthroplasty 2024; 39:941-947.e1. [PMID: 37871858 DOI: 10.1016/j.arth.2023.10.028] [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: 06/09/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Gabapentinoid (GABA) prescribing has substantially increased as a nonopioid analgesics for surgical conditions. We examined the effectiveness of GABA use for postoperative pain control among patients receiving total knee arthroplasty (TKA). METHODS This retrospective cohort study using 2016 to 2019 data from a 20% national sample of Medicare enrollees included patients aged 66 and over years who received an elective TKA, were discharged to home, received home health care, and had both admission and discharge assessments of pain (n = 35,186). Study outcomes were pain score difference between admission and discharge and less-than-daily pain interfering with activity at discharge. Opioid and GABA prescriptions after surgery and receipt of nerve block within 3 days of surgery were also assessed. RESULTS There were 30% of patients who had a pain score decrease of 3 to 4 levels and 55.8% had pain score decreases of 1 to 2 levels. In multivariable analyses, receiving a nerve block was significantly associated with pain score reduction. A GABA prescription increased the magnitude of pain score reduction among those receiving a nerve block. Results from inverse probability weighted analysis with propensity score showed that coprescribing of GABA and low-dose opioid was associated with significantly lower pain scores. CONCLUSIONS Post-TKA opioid use was not associated with pain score reduction. Receiving a nerve block was associated with a modest pain score reduction. Co-prescribing GABA with low-dose opioid or receiving a nerve block was associated with increasing magnitudes of pain reduction. Further research should identify alternatives to opioid use for managing postoperative TKA pain.
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Affiliation(s)
- Yong-Fang Kuo
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas; Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston, Texas; Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas
| | - Emily Kim
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Jordan Westra
- Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas
| | - Denise Wilkes
- Department and Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Mukaila A Raji
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
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Chou LN, Raji MA, Yu X, Kuo YF. Trends in Diabetes Medication Taking and Incidence of Depression in Patients with Type 2 Diabetes: A Retrospective Cohort Study from 2010 to 2018. Int J Behav Med 2024; 31:192-201. [PMID: 36952218 DOI: 10.1007/s12529-023-10172-3] [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] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND This study examined the trends in diabetes medication taking and its association with the incidence of depression in patients with type 2 diabetes (T2D). METHOD A retrospective cohort of Medicare enrollees with regular care in 2010 was defined from 100% Texas Medicare claims. The impact of medication taking on incident depression was evaluated from 2010 to 2018. Cox proportional hazards regressions were used to estimate the association between medication taking and depression. RESULTS A total of 72,461 patients with T2D and with regular care were analyzed. Among 60,216 treated patients, the regular medication taking rate slightly increased from 60.8 to 63.2% during the study period. Patients with regular medication taking at baseline had a 9% lower risk of developing depression (hazard ratio [HR]: 0.91, 95% confidence interval [CI]: 0.89-0.94), and the magnitude of the association increased after adjustment of the model for time-varied medication taking (HR: 0.82, 95% CI: 0.79-0.85). The presence of nephropathy had the greatest mediating effect (23.2%) on the association of medication taking and depression. CONCLUSION We demonstrated a steady but modest increase in regular diabetes medication taking over a 9-year period and a significant relationship between medication taking and incident depression in patients with T2D.
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Affiliation(s)
- Lin-Na Chou
- Graduate School of Biomedical Science, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-1148, USA.
| | - Mukaila A Raji
- Graduate School of Biomedical Science, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-1148, USA
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center On Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Xiaoying Yu
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Graduate School of Biomedical Science, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-1148, USA
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center On Aging, University of Texas Medical Branch, Galveston, TX, USA
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, TX, USA
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Rajagopal S, Westra J, Raji MA, Wilkes D, Kuo YF. Access to Medications for Opioid Use Disorder During COVID-19: Retrospective Study of Commercially Insured Patients from 2019-2022. Am J Prev Med 2024; 66:635-644. [PMID: 37979624 DOI: 10.1016/j.amepre.2023.11.011] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION This study assesses disparities in medications for opioid use disorder in adults with opioid use disorder and examines the associations between state-level COVID-19 lockdown and telehealth policies and medications for opioid use disorder utilization rates during the COVID-19 pandemic. METHODS This retrospective cohort study of 396,872 adults with opioid use disorder analyzed monthly medications for opioid use disorder utilization rates between January 2019 and June 2022 using data from Clinformatics Data Mart Database. Primary outcome measure was monthly medications for opioid use disorder utilization rates. Variables of interest were patients' demographics and state-level characteristics (telehealth policies for controlled substance prescribing, COVID-19 lockdown policy, and registered buprenorphine providers/100,000). In multivariable analyses, time trend was grouped into four time periods: before COVID-19, early COVID-19, early vaccine, and Omicron-related COVID-19 surge and thereafter. RESULTS Medications for opioid use disorder rates increased from a 1.2% change in slope monthly on a log scale to 2% monthly from February 2021 to October 2021, after which the utilization rate increased to a lesser degree. Women had 28% lower odds of receiving medications for opioid use disorder than men; Hispanic, Black, and Asian patients had 40%, 34%, and 32% lower odds of receiving medications for opioid use disorder than White patients, respectively. These sex and racial disparities persisted throughout the pandemic. Regional medications for opioid use disorder rate differences, mediated by buprenorphine providers/100,000 state population, decreased during the pandemic. States with telehealth policies for controlled substance prescribing had greater percentages of patients on medications for opioid use disorder (11.7%) than states without such policies (10.4%). CONCLUSIONS Monthly medications for opioid use disorder rates increased during the pandemic, with higher rates in men, White individuals, and residents of the Northeast region. States with policies permitting telehealth prescribing of controlled substances also had higher medications for opioid use disorder rates, supporting a future expansion of medications for opioid use disorder-related telehealth to improve access to care.
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Affiliation(s)
- Shilpa Rajagopal
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Jordan Westra
- Department of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas
| | - Mukaila A Raji
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center On Aging, University of Texas Medical Branch, Galveston, Texas
| | - Denise Wilkes
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Yong-Fang Kuo
- Department of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas; Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center On Aging, University of Texas Medical Branch, Galveston, Texas.
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Taha SA, Westra JR, Tacker DH, Raji MA, Kuo YF. Trends in co-prescribed opioids and benzodiazepines, non-prescribed opioids and benzodiazepines, and schedule-I drugs in the United States, 2013 to 2019. Prev Med Rep 2024; 38:102584. [PMID: 38292029 PMCID: PMC10827545 DOI: 10.1016/j.pmedr.2023.102584] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/22/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
Concurrent opioid and benzodiazepine users are at increased risk of overdose death, compared to opioid-only users. The objective of this study was to understand recent time trends in opioid and benzodiazepine concurrent use, misuse, and schedule-I drug use, and how these differ by age, sex and geographic region. Commercial, United States medical insurance claims data and urine drug test results from 2013 to 2019 were used to study the outcomes of concurrent use (n = 756,258), schedule-I drug use (n = 746,672) and prescription misuse (n = 452,523). Drug use outcomes were studied at quarterly time points for each year. Data analysis included joinpoint regression models to estimate quarterly drug use rates, determined by positive urine tests for corresponding drug categories, and was conducted from November 2021 through January 2022. Concurrent use decreased from 19.3% to 9.8%, misuse generally decreased from 75.6% to 55.1%, and schedule-I use increased from 8.9% to 13.8%, from 2013 to 2019. Concurrent use decreased at greater rates after 2016, after the Centers for Disease Control and Food and Drug Administration guidelines against concurrent use were released, while schedule-I use increased, notably after the 2014 hydrocodone reschedule. This indicates a potential shift from prescription use to non-prescribed drug use, where most affected groups included males, younger individuals, and those residing in Northeastern regions. Study results support public health initiatives focused on policy that increases access to multimodal pain management and substance use disorder management programs-critical steps in preventing patients from seeking non-prescribed drugs for self- medicating due to pain or addiction.
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Affiliation(s)
- Shaden A. Taha
- Center for Metabolic Health, University of Texas Medical Branch, Galveston, TX, USA
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Jordan R. Westra
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Danyel H. Tacker
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University, WV, USA
| | - Mukaila A. Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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Pritchard KT, Baillargeon J, Lee WC, Doulatram G, Raji MA, Kuo YF. Inequitable access to nonpharmacologic pain treatment providers among cancer-free U.S. adults. Prev Med 2024; 178:107809. [PMID: 38072313 PMCID: PMC10872296 DOI: 10.1016/j.ypmed.2023.107809] [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: 02/03/2023] [Revised: 11/01/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE Using evidence-based nonpharmacologic pain treatments may prevent opioid overuse and associated adverse outcomes. There is limited data on the impact of access-promoting social determinants of health (SDoH: education, income, transportation) on use of nonpharmacologic pain treatments. Our objective was to examine the relationship between SDoH and use of nonpharmacologic pain treatment providers. Our goal was to understand policy-actionable factors contributing to inequity in pain treatment. METHODS Based on Andersen's Health Utilization Model, this cross-sectional analysis of 2016-2019 Medical Expenditure Panel Survey data evaluated whether use of outpatient nonpharmacologic pain treatment providers is driven by enabling (i.e., advantageous socioeconomic resources) or need (i.e., perceived disability and diagnosed disease) factors. The study sample (unweighted n = 28,188) represented a weighted N = 81,912,730 noninstitutionalized, cancer-free, U.S. adults with pain interference. The primary outcome measured use of nonpharmacologic providers relative to exclusive prescription opioid use or no treatment (i.e., neither opioids nor nonpharmacologic). To quantify equitable access, we compared the variance-between access-promoting enabling factors versus medical need factors-that explained utilization. RESULTS Compared to enabling factors, need factors explained twice the variance predicting pain treatment utilization. Still, the adjusted odds of using nonpharmacologic providers instead of opioids alone were 39% lower among respondents identifying as Black (95% Confidence Interval [CI], 0.49-0.76) and respondents residing in the U.S. South (95% CI, 0.51-0.74). Higher education (95% CI, 1.72-2.79) and income (95% CI, 1.68-2.42) both facilitated using nonpharmacologic providers instead of opioids. CONCLUSIONS These findings highlight the substantial influence access-promoting SDoH have on pain treatment utilization.
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Affiliation(s)
- Kevin T Pritchard
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Jacques Baillargeon
- Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
| | - Wei-Chen Lee
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Gulshan Doulatram
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA.
| | - Mukaila A Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Yong-Fang Kuo
- Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
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Kim E, Raji MA, Westra J, Wilkes D, Kuo YF. Comparative effectiveness of pain control between opioids and gabapentinoids in older patients with chronic pain. Pain 2024; 165:144-152. [PMID: 37561652 PMCID: PMC10838352 DOI: 10.1097/j.pain.0000000000003006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/16/2023] [Indexed: 08/12/2023]
Abstract
ABSTRACT Gabapentinoid (GABA) prescribing has substantially increased while opioid prescribing has decreased since the 2016 Centers for Disease Control and Prevention Guidelines restricted opioid prescribing for chronic pain. The shift to GABA assumes equal analgesic effectiveness to opioids, but no comparative analgesic effectiveness data exist to support this assumption. We compared GABA to opioids by assessing changes in pain interfering with activities (activity-limiting pain) over time in patients with chronic pain. We used 2017 to 2019 data from a 20% national sample of Medicare beneficiaries diagnosed with chronic pain who initiated a GABA or opioid prescription for ≥30 continuous days and received home health care in the study year. The main outcome was the difference in reduction in pain score from pre- to post-prescription assessments between the 2 groups. Within a 60-day window before-and-after drug initiation, our sample comprised 3208 GABA users and 2846 opioid users. Reduction in post-prescription scores of pain-related interference with activities to less-than-daily pain was 48.1% in the GABA group and 41.7% in the opioid group; this remained significant (odds ratio = 1.29, 95% confidence interval: 1.17-1.43, P < 0.0001) after adjustment for patient demographics and comorbidities. The adjusted difference in reduced pain-related interference score between the 2 groups was -0.10 points on a 0 to 4 scale ( P = 0.01). Gabapentinoid use had greater odds of less-than-daily pain post-prescription, in a dose-dependent manner. Thus, GABA use was associated with a larger reduction in chronic pain than opioids, with a larger effect at higher GABA dosage. Future research is needed on functional outcomes in patients with chronic pain prescribed GABA or opioids.
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Affiliation(s)
- Emily Kim
- School of Medicine, University of Texas Medical Branch, Galveston, TX, 77555
| | - Mukaila A Raji
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, 77555
- Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston, TX, 77555
| | - Jordan Westra
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, 77555
| | - Denise Wilkes
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, 77555
| | - Yong-Fang Kuo
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, 77555
- Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston, TX, 77555
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, 77555
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Kuo YF, Polychronopoulou E, Raji MA. Signal detection of adverse events associated with gabapentinoid use for chronic pain. Pharmacoepidemiol Drug Saf 2024; 33:e5685. [PMID: 37640024 PMCID: PMC10844952 DOI: 10.1002/pds.5685] [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: 01/19/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Gabapentinoids (GABA) prescribing as a potential and conceivably safer substitute for opioids has substantially increased. Understanding all potential adverse drug events (ADEs) associated with GABA will guide clinical decision-making for pain management. METHODS A 20% sample of Medicare enrollees with new chronic pain diagnoses in 2017-2018 was selected. GABA users were those with >=30 consecutive days prescription in a year without opioid prescription. Opioid users were similarly defined. The control group used neither of these drugs. Propensity score match across three groups based on demographics and comorbidity was performed. We used proportional reporting ratio (PRR), Gamma Poisson Shrinker, and tree-based scan statistic (TBSS) to detect ADEs within 3, 6, and 12 months of follow-up. RESULTS Immunity disorder was detected within 3 months of follow-up by PRR compared to opioid use (PRR:2.33), and by all three methods compared to controls. Complications of transplanted organs/tissues and schizophrenia spectrum/other psychotic disorders were consistently detected by PRR and TBSS within 3 months. Skin disorders were detected by TBSS; and stroke was detected by PRR within 3 months compared to opioid use (PRR:4.74). Some malignancies were detected by PRR within 12 months. Other signals detected in GABA users were neuropathy and nerve disorders. CONCLUSIONS Our study identified expected and unexpected ADE signals in GABA users. Neurological signals likely related to indications for GABA use. Signals for immunity, mental/behavior, and skin disorders were found in the FDA adverse event reporting system database. Unexpected signals of stroke and cancer require further confirmatory analyses to verify.
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Affiliation(s)
- Yong-Fang Kuo
- Department of Internal Medicine and Sealy Center on Aging,
University of Texas Medical Branch, Galveston, TX, USA
- Department of Biostatistics and Data Science, University of
Texas Medical Branch, Galveston, TX, USA
- Office of Biostatistics, University of Texas Medical
Branch, Galveston, TX, USA
| | | | - Mukaila A Raji
- Department of Internal Medicine and Sealy Center on Aging,
University of Texas Medical Branch, Galveston, TX, USA
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Pritchard KT, Baillargeon J, Westra J, Li CY, Mroz T, Reistetter TA, Lee WC, Raji MA, Kuo YF. The Impact of High- Versus Low-Dose Home Rehabilitation for Functional Independence after Hip or Knee Replacement. J Am Med Dir Assoc 2024; 25:118-120. [PMID: 37567241 PMCID: PMC11103588 DOI: 10.1016/j.jamda.2023.06.039] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 08/13/2023]
Affiliation(s)
- Kevin T Pritchard
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Jacques Baillargeon
- Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Jordan Westra
- Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Chih-Ying Li
- Department of Occupational Therapy, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Tracy Mroz
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Timothy A Reistetter
- Department of Occupational Therapy, School of Health Professions, University of Texas Health Science Center, San Antonio, TX, USA
| | - Wei-Chen Lee
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Mukaila A Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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Baillargeon J, Linthicum LC, Murray OJ, Raji MA, Kuo YF, Pulvino JS, Milani SA, Williams B, Baillargeon GR, Blair PA, Kristen Peek M, Penn JV. The Prevalence of Cognitive Impairment and Dementia in Incarcerated Older Adults. J Gerontol B Psychol Sci Soc Sci 2023; 78:2141-2146. [PMID: 37793395 DOI: 10.1093/geronb/gbad136] [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: 06/09/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVES In view of the growing number of older incarcerated persons in the United States, cognitive impairment represents one of the most challenging and costly health care issues facing the U.S. correctional system. This study examined the prevalence and correlates of this growing public health issue in the nation's largest prison system. METHODS In this study of a random sample of 143 older (≥55 years) adults incarcerated in the Texas prison system, we assessed-using the Montreal Cognitive Assessment (MoCA)-the percentage of inmates who met the MoCA thresholds for mild cognitive impairment (MCI; <23) and dementia (<18). Due to sample size limitations, our multivariable analysis assessed the binary outcome, MoCA <23. RESULTS Overall, 35.0% of our random sample of incarcerated older adults in Texas met the threshold for MCI and 9.1% met the threshold for dementia. After adjusting for covariates, study participants who were Black (odds ratio [OR] = 4.12, 95% confidence interval [CI] = 1.57-10.82), Hispanic (OR = 4.34, 95% CI = 1.46-12.93), and those with a diagnosis of major depressive disorder (8.56, 95% CI = 1.21-60.72) all had higher prevalence of a positive screen for MCI or dementia. Dementia was underdiagnosed in our study sample of incarcerated adults, with 15.4% of MoCA-diagnosed dementia patients having a dementia diagnosis documented in their medical records. DISCUSSION Future studies of cognitive impairment in prisons and jails can inform health care planning and resource allocation, such as expansion of access to palliative care, advance care planning, and targeted cognitive screening in older age groups.
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Affiliation(s)
- Jacques Baillargeon
- Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Lannette C Linthicum
- Department of Health Services, Texas Department of Criminal Justice, Huntsville, Texas, USA
| | - Owen J Murray
- Correctional Managed Care Division, University of Texas Medical Branch, Galveston, Texas, USA
| | - Mukaila A Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Yong-Fang Kuo
- Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - John S Pulvino
- Correctional Managed Care Division, University of Texas Medical Branch, Galveston, Texas, USA
| | - Sadaf A Milani
- Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Brie Williams
- Division of Geriatrics, University of California at San Francisco, San Francisco, California, USA
| | - Gwen R Baillargeon
- Correctional Managed Care Division, University of Texas Medical Branch, Galveston, Texas, USA
| | - Patricia A Blair
- School of Nursing, University of Texas Medical Branch, Galveston, Texas, USA
| | - M Kristen Peek
- Department of Population Health Sciences, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Joseph V Penn
- Correctional Managed Care Division, University of Texas Medical Branch, Galveston, Texas, USA
- Department of Psychiatry, University of Texas Medical Branch, Galveston, Texas, USA
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Nicot-Cartsonis MS, Digbeu BDE, Raji MA, Kuo YF. Disparities in Late-Stage Breast and Colorectal Cancer Diagnosis Among Hispanic, Non-Hispanic White, and Non-Hispanic Black Patients: a Retrospective Cohort Study of Texas Medicare Beneficiaries. J Racial Ethn Health Disparities 2023; 10:3168-3177. [PMID: 36575329 PMCID: PMC9794104 DOI: 10.1007/s40615-022-01491-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Disparities in late-stage breast or colorectal cancer diagnosis in younger populations are associated with social determinants of health (SDOH; education, poverty, housing, employment). We hypothesized that, in older Medicare beneficiaries, disparities in late-stage cancer diagnosis between Hispanic, non-Hispanic Black (NHB), and non-Hispanic White (NHW) patients would be associated with SDOH, comorbidities, and primary care physician (PCP) access. METHODS We analyzed 2005-2017 Texas Cancer Registry data linked with Medicare data for patients aged ≥ 66 (n = 86,501). Variables included age at diagnosis, sex, comorbidities, poverty level, education, PCP, and relevant cancer screening within 1 year. RESULTS For breast cancer in women (Hispanic, n = 6380; NHW, n = 39,225; NHB, n = 4055), a fully adjusted model showed significantly higher odds of late-stage cancer diagnosis only in NHB patients (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.01-1.22) compared with NHW; adjustment for comorbidities and SDOH partially decreased the odds of late-stage diagnosis relative to NHWs. Interaction terms between race-ethnicity and poverty were not significant. For colorectal cancer, a fully adjusted multivariate model showed significantly higher odds of late-stage diagnosis only among NHBs (n = 3318, OR 1.29, 95% CI 1.19-1.40) relative to NHWs (n = 27,470); adjustment for SDOH partially decreased the odds of late-stage diagnosis in NHB patients. Interaction terms between race-ethnicity and poverty were not significant. CONCLUSION Racial disparities in late-stage breast and colorectal cancer diagnoses remain after adjustment for SDOH and clinically relevant factors, underscoring the need to optimize access to screening and timely cancer treatment in racial/ethnic minorities.
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Affiliation(s)
| | - Biai D E Digbeu
- Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston, TX, USA
| | - Mukaila A Raji
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center On Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston, TX, USA.
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
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Onwudebe C, Al Snih S, Raji MA, Milani SA. Diabetes Complications and Pain Among Mexican Americans Aged 80 and Older. Innov Aging 2023; 7:igad099. [PMID: 38094936 PMCID: PMC10714911 DOI: 10.1093/geroni/igad099] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Diabetes is common among Hispanic older adults; however, the association between diabetic complications and pain has not been widely studied in this population. Our objective was to examine the association between diabetes complications and pain over 6 years among Mexican Americans aged 80 years and older. Research Design and Methods We used data from Waves 7 to 9 (2010-2016) of the Hispanic Established Population for the Epidemiologic Study of the Elderly (n = 853). Participants were categorized as having no diabetes, diabetes without complications, and diabetes with complications. Pain was defined as reporting pain when standing or walking (pain on weight-bearing) and having pain that limited daily activities (pain interference). We used generalized estimating equations to estimate the odds of pain over 6 years as a function of diabetes status controlling for socioeconomic and health characteristics. Results At baseline, the mean age was 85.7 (standard deviation = 3.9) years, 65.2% female, 68.5% had no diabetes, 14.7% had diabetes without complications, and 16.9% had diabetes with complications. Those with diabetes without complications had lower odds of reporting pain on weight-bearing and pain interference, compared to those with no diabetes. Among those reporting diabetes (n = 269), those with complications had higher odds of pain on weight-bearing and pain interference, compared to those without complications. Those with both micro and macro complications had over 2 times the odds of pain, compared to those having no complications. Discussion and Implications The lower burden of pain in those with diabetes but no complications may reflect optimal management of diabetes. Routine screening and treatment of pain in patients with diabetes complications can mitigate excess disability and increase the quality of life for patients with diabetes.
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Affiliation(s)
- Chinedu Onwudebe
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Soham Al Snih
- Department of Population Health & Health Disparities, University of Texas Medical Branch, Galveston, Texas, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA
| | - Mukaila A Raji
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Sadaf Arefi Milani
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA
- Department of Epidemiology, University of Texas Medical Branch, Galveston, Texas, USA
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Sood A, Kuo YF, Westra J, Raji MA. Disease-Modifying Antirheumatic Drug Use and Its Effect on Long-term Opioid Use in Patients With Rheumatoid Arthritis. J Clin Rheumatol 2023; 29:262-267. [PMID: 37092898 PMCID: PMC10545291 DOI: 10.1097/rhu.0000000000001972] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND/OBJECTIVES The prevalence of chronic pain is high in patients with rheumatoid arthritis (RA), increasing the risk for opioid use. The objective of this study was to assess disease-modifying antirheumatic drug (DMARD) use and its effect on long-term opioid use in patients with RA. METHODS This cohort study included Medicare beneficiaries with diagnosis of RA who received at least 30-day consecutive prescription of opioids in 2017 (n = 23,608). The patients were grouped into non-DMARD and DMARD users, who were further subdivided into regimens set forth by the American College of Rheumatology. The outcome measured was long-term opioid use in 2018 defined as at least 90-day consecutive prescription of opioids. Dose and duration of opioid use were also assessed. A multivariable model identifying factors associated with non-DMARD use was also performed. RESULTS Compared with non-DMARD users, the odds of long-term opioid use were significantly lower among DMARD users (odds ratio, 0.89; 95% confidence interval, 0.83-0.95). All regimens except non-tumor necrosis factor biologic + methotrexate were associated with lower odds of long-term opioid use relative to non-DMARD users. The mean total morphine milligram equivalent, morphine milligram equivalent per day, and total days of opioid use were lower among DMARD users compared with non-DMARD users. Older age, male sex, Black race, psychiatric and medical comorbidities, and not being seen by a rheumatologist were significantly associated with non-DMARD use. CONCLUSION Disease-modifying antirheumatic drug use was associated with lower odds of long-term opioid use among RA patients with baseline opioid prescription. Factors associated with non-DMARD use represent a window of opportunity for intervention to improve pain-related quality of life in patients living with RA.
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Affiliation(s)
- Akhil Sood
- Division of Immunology & Rheumatology, Stanford University School of Medicine, Palo Alto, CA 94304
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Yong-Fang Kuo
- Department of Preventive Medicine & Population Health, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Jordan Westra
- Department of Preventive Medicine & Population Health, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Mukaila A. Raji
- Department of Geriatric Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
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Sood A, Kuo YF, Sharma G, Raji MA. Author's Reply "Considerations Regarding a Cohort Study on Concomitant Use of Central Nervous System-Active Medications in Patients With COPD". Ann Pharmacother 2023; 57:995-996. [PMID: 36373620 DOI: 10.1177/10600280221136243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
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Bahrami K, Kuo YF, Digbeu B, Raji MA. Association of Medication-Assisted Therapy and Risk of Drug Overdose-Related Hospitalization or Emergency Room Visits in Patients With Opioid Use Disorder. Cureus 2023; 15:e44167. [PMID: 37753052 PMCID: PMC10519365 DOI: 10.7759/cureus.44167] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
Objective To examine the differential impacts of medication-assisted therapy (MAT) medications (naltrexone, methadone, and buprenorphine) on drug overdose-related hospitalizations or emergency room (ER) visits in patients with opioid use disorder (OUD). Patients and methods A retrospective cohort study was performed on patients 18 years or older diagnosed with OUD, using Optum's de-identified Clinformatics® Data Mart database. To ensure a new diagnosis of OUD from 2018 to 2019, each patient required one year of continuous enrollment before OUD diagnosis. The primary outcome was the incidence of drug overdose-related hospitalization or ER visits in the follow-up period. Patients were censored at loss of coverage or end of the study (9/30/2020). A multivariable Cox proportional hazard model was built to compare the outcomes across three MAT medications (buprenorphine, methadone, and naltrexone). Results Only 10.38% of the 145,317 OUD patients received MAT prescriptions in the 12 months after diagnosis. The majority of MAT users (77.8%) received buprenorphine. At one year of follow-up, the incidence of drug overdose-related hospitalization or ER visits varied by MAT drug type: naltrexone (14.26%), methadone (12.26%), and buprenorphine (10.23%). Compared to methadone drug users, buprenorphine users had a lower risk of negative outcomes (adjusted hazard ratio: 0.84; 95% confidence interval: 0.73-0.97). Conclusion Buprenorphine was associated with the lowest risk of drug overdose-related hospitalization or ER visits among the MAT drugs. However, only 10.38% of OUD patients received MAT. Increasing MAT availability to patients with OUD is a key step toward preventing relapse and reducing adverse health outcomes.
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Affiliation(s)
- Korosh Bahrami
- Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Yong-Fang Kuo
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Biai Digbeu
- Department of Biostatistics & Data Science, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Mukaila A Raji
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch at Galveston, Galveston, USA
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16
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Yu X, Kuo YF, Raji MA, Berenson AB, Baillargeon J, Giordano TP. Dementias Among Older Males and Females in the U.S. Medicare System With and Without HIV. J Acquir Immune Defic Syndr 2023; 93:107-115. [PMID: 36881792 PMCID: PMC10293071 DOI: 10.1097/qai.0000000000003184] [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: 09/16/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Despite the growing concern that people with HIV (PWH) will experience a disproportionate burden of dementia as they age, very few studies have examined the sex-specific prevalence of dementia, including Alzheimer disease and related dementias (AD/ADRD) among older PWH versus people without HIV (PWOH) using large national samples. METHODS We constructed successive cross-sectional cohorts including all PWH aged 65+ years from U.S. Medicare enrollees and PWOH in a 5% national sample of Medicare data from 2007 to 2019. All AD/ADRD cases were identified by ICD-9-CM/ICD-10-CM diagnosis codes. Prevalence of AD/ADRD was calculated for each calendar year by sex-age strata. Generalized estimating equations were used to assess factors associated with dementia and calculate the adjusted prevalence. RESULTS PWH had a higher prevalence of AD/ADRD, which increased over time compared with PWOH, especially among female beneficiaries and with increasing age. For example, among those aged 80+ years, the prevalence increased from 2007 to 2019 (females with HIV: 31.4%-44.1%; females without HIV: 27.4%-29.9%; males with HIV: 26.2%-33.3%; males without HIV: 21.0%-23.5%). After adjustment for demographics and comorbidities, the differences in dementia burden by HIV status remained, especially among older age groups. CONCLUSIONS Older Medicare enrollees with HIV had an increased dementia burden over time compared with those without HIV, especially women and older subjects. This underscores the need to develop tailored clinical practice guidelines that facilitate the integration of dementia and comorbidity screening, evaluation, and management into the routine primary care of aging PWH.
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Affiliation(s)
- Xiaoying Yu
- Department of Biostatistics & Data Science, University of Texas Medical Branch at Galveston (UTMB), Galveston, TX, USA
- Center for Interdisciplinary Research in Women’s Health, UTMB
| | - Yong-Fang Kuo
- Department of Biostatistics & Data Science, University of Texas Medical Branch at Galveston (UTMB), Galveston, TX, USA
- Center for Interdisciplinary Research in Women’s Health, UTMB
| | | | - Abbey B. Berenson
- Center for Interdisciplinary Research in Women’s Health, UTMB
- Department of Obstetrics & Gynecology, UTMB
| | | | - Thomas P. Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
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Wang LK, Kuo YF, Westra J, Raji MA, Albayyaa M, Allencherril J, Baillargeon J. Association of Cardiovascular Medications With Adverse Outcomes in a Matched Analysis of a National Cohort of Patients With COVID-19. Am J Med Open 2023; 9:100040. [PMID: 37207280 PMCID: PMC10032048 DOI: 10.1016/j.ajmo.2023.100040] [Citation(s) in RCA: 3] [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: 11/30/2022] [Revised: 02/22/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
Background The use of statins, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs), and anticoagulants may be associated with fewer adverse outcomes in COVID-19 patients. Methods Nested within a cohort of 800,913 patients diagnosed with COVID-19 between April 1, 2020 and June 24, 2021 from the Optum COVID-19 database, three case-control studies were conducted. Cases-defined as persons who: (1) were hospitalized within 30 days of COVID-19 diagnosis (n = 88,405); (2) were admitted to the intensive care unit (ICU)/received mechanical ventilation during COVID-19 hospitalization (n = 22,147); and (3) died during COVID-19 hospitalization (n = 2300)-were matched 1:1 using demographic/clinical factors with controls randomly selected from a pool of patients who did not experience the case definition/event. Medication use was based on prescription ≤90 days before COVID-19 diagnosis. Results Statin use was associated with decreased risk of hospitalization (adjusted odds ratio [aOR], 0.72; 95% confidence interval [95% CI], 0.69, 0.75) and ICU admission/mechanical ventilation (aOR, 0.90; 95% CI, 0.84, 0.97). ACEI/ARB use was associated with decreased risk of hospitalization (aOR, 0.67; 95% CI, 0.65, 0.70), ICU admission/mechanical ventilation (aOR, 0.92; 95% CI, 0.86, 0.99), and death (aOR, 0.60; 95% CI, 0.47, 0.78). Anticoagulant use was associated with decreased risk of hospitalization (aOR, 0.94; 95% CI, 0.89, 0.99) and death (aOR, 0.56; 95% CI, 0.41, 0.77). Interaction effects-in the model predicting hospitalization-were statistically significant for statins and ACEI/ARBs (P < .0001), statins and anticoagulants (P = .003), ACEI/ARBs and anticoagulants (P < .0001). An interaction effect-in the model predicting ventilator use/ICU-was statistically significant for statins and ACEI/ARBs (P = .002). Conclusions Statins, ACEI/ARBs, and anticoagulants were associated with decreased risks of the adverse outcomes under study. These findings may provide clinically relevant information regarding potential treatment for patients with COVID-19.
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Affiliation(s)
- Leonard K Wang
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston
- Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - Jordan Westra
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston
| | - Mukaila A Raji
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston
- Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - Mohanad Albayyaa
- Institute for Translational Sciences, University of Texas Medical Branch
| | - Joseph Allencherril
- Texas Heart Institute, Houston
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Jacques Baillargeon
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston
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Sood A, Kuo YF, Westra J, Sharma G, Raji MA. Co-prescribing of Central Nervous System-Active Medications for COPD Patients: Impact on Emergency Room Visits and Hospitalization. Ann Pharmacother 2023; 57:382-396. [PMID: 35942598 PMCID: PMC10508332 DOI: 10.1177/10600280221113299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Anxiety and chronic pain are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), which are frequently managed with benzodiazepines (BZDs) and opioids, respectively. OBJECTIVE The purpose of this study was to determine whether different combinations of opioids, BZD, and their substitutes-gabapentinoids (GABA) and selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors (SSRIs/SNRIs)-are associated with lower risk of acute respiratory events in COPD patients with co-occurring chronic pain and anxiety. METHODS This retrospective cohort study used a nationally representative sample of Medicare beneficiaries with COPD, chronic pain, and anxiety. Patients were grouped based on drug combination (opioid + BZD/Z-hypnotics, opioid + GABA, opioid + SSRI/SNRI, BZD/Z-hypnotics + GABA, BZD/Z-hypnotics + SSRI/SNRI, GABA + SSRI/SNRI, or ≥3 drugs). The primary outcome was emergency room (ER) visit or hospitalization due to acute respiratory events assessed up to 180 days following initiation of drug combination. Overdose secondary to central nervous system (CNS)-related drugs was also assessed up to 180 days following initiation of drug combination. RESULTS The drug combination opioid + GABA was associated with decreased risk for ER visit (hazard ratio [HR] = 0.73; 95% CI = 0.61-0.87) and hospitalization (HR = 0.69; 95% CI = 0.55-0.85). Opioid + SSRI/SNRI also showed decreased risk for ER visit (HR = 0.84; 95% CI = 0.71-0.99). There was no significant difference in risk for CNS-related drug overdose among different drug combinations compared with opioid + BZD/Z-hypnotics. CONCLUSION AND RELEVANCE Opioids in combination with GABA and SSRI/SNRI demonstrate relatively lower risk for acute respiratory events among patients with COPD and comorbid chronic pain and anxiety. The findings emphasize the need for multimodal management in this vulnerable population.
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Affiliation(s)
- Akhil Sood
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Yong-Fang Kuo
- Department of Preventive Medicine & Population Health, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Jordan Westra
- Department of Preventive Medicine & Population Health, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Gulshan Sharma
- Department of Pulmonary, Critical Care, & Sleep Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Mukaila A. Raji
- Department of Geriatric Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
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Armstrong P, Kuo YF, Cram P, Westra J, Raji MA. National trends in osteoporosis medication use among Medicare beneficiaries with and without Alzheimer's disease/related dementias. Osteoporos Int 2023; 34:725-733. [PMID: 36729144 DOI: 10.1007/s00198-023-06680-3] [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: 09/06/2022] [Accepted: 01/19/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Osteoporotic fractures are a leading cause of disability and premature death in the elderly. Patients with Alzheimer's and related dementia (ADRD) have high rates of osteoporosis (OP) and substantial risk of osteoporotic fractures. Yet research is sparse on trends and predictors of OP medication use in ADRD. METHODS Medicare beneficiaries with OP aged ≥ 67 years have Medicare parts A/B/D without HMO from 2016 to 2018. Our outcome was receipt of OP medications in 2018. A multivariable logistic regression assessed association between ADRD and OP drug prescribing, adjusted for age, sex, race, region, Medicare entitlement, dual Medicaid eligibility, chronic conditions, number of provider visits/hospitalizations, and nursing home (NH) resident status. Age/ADRD and NH residency/ADRD interactions were tested. RESULTS Our sample consisted of 47,871 people with OP and ADRD and 201,840 with OP without ADRD. OP drug use was 38.6% in ADRD patients vs. 52.7% in non-ADRD. After adjustment for demographics, chronic conditions, and previous hospitalizations/physician visits, the OR for OP drug in ADRD vs. non-ADRD was 0.85 (95% CI: 0.83-0.87). NH residents had lower odds for OP medication (OR: 0.61, 95% CI: 0.58-0.64). There were significant interactions between ADRD and age, and between ADRD and NH residency. The OR for OP drug use associated with ADRD was 0.88 (95% CI: 0.86-0.90) among community-dwelling elders and 0.66 (95% CI: 0.64-0.69) among NH residents. CONCLUSIONS ADRD patients received OP drugs at a lower rate than their non-ADRD counterparts. More research is needed on when to prescribe or deprescribe OP drugs in the context of different ADRD severity, patient preferences, remaining life expectancy, and time-to-benefit from OP drugs.
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Affiliation(s)
- Peyton Armstrong
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Yong-Fang Kuo
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Peter Cram
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Jordan Westra
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Mukaila A Raji
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
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Yu X, Giordano TP, Baillargeon J, Westra JR, Berenson AB, Raji MA, Kuo YF. Assessing incident depression among older people with and without HIV in U.S. Soc Psychiatry Psychiatr Epidemiol 2023; 58:299-308. [PMID: 36334100 PMCID: PMC10176598 DOI: 10.1007/s00127-022-02375-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Despite substantially higher prevalence of depression among people living with HIV/AIDS (PLWHA), few data exist on the incidence and correlates of depression in this population. This study assessed the effect of HIV infection, age, and cohort period on the risk of developing depression by sex among older U.S. Medicare beneficiaries. METHODS We constructed a retrospective matched cohort using a 5% nationally representative sample of Medicare beneficiaries (1996-2015). People with newly diagnosed (n = 1309) and previously diagnosed (n = 1057) HIV were individually matched with up to three beneficiaries without HIV (n = 6805). Fine-Gray models adjusted for baseline covariates were used to assess the effect of HIV status on developing depression by sex strata. RESULTS PLWHA, especially females, had higher risk of developing depression within five years. The relative subdistribution hazards (sHR) for depression among three HIV exposure groups differed between males and females and indicated a marginally significant interaction (p = 0.08). The sHR (95% CI) for newly and previously diagnosed HIV (vs. people without HIV) were 1.6 (1.3, 1.9) and 1.9 (1.5, 2.4) for males, and 1.5 (1.2, 1.8) and 1.2 (0.9, 1.7) for females. The risk of depression increased with age [sHR 1.3 (1.1, 1.5), 80 + vs. 65-69] and cohort period [sHR 1.3 (1.1, 1.5), 2011-2015 vs. 1995-2000]. CONCLUSIONS HIV infection increased the risk of developing depression within 5 years, especially among people with newly diagnosed HIV and females. This risk increased with older age and in recent HIV epidemic periods, suggesting a need for robust mental health treatment in HIV primary care.
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Affiliation(s)
- Xiaoying Yu
- Department of Biostatistics & Data Science, The University of Texas Medical Branch at Galveston, 700 Harborside Drive, Ewing Hall, 1.134, Galveston, TX, USA.
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
| | - Thomas P Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Jacques Baillargeon
- Department of Epidemiology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Jordan R Westra
- Department of Biostatistics & Data Science, The University of Texas Medical Branch at Galveston, 700 Harborside Drive, Ewing Hall, 1.134, Galveston, TX, USA
| | - Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Mukaila A Raji
- Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Yong-Fang Kuo
- Department of Biostatistics & Data Science, The University of Texas Medical Branch at Galveston, 700 Harborside Drive, Ewing Hall, 1.134, Galveston, TX, USA
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
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Mehta HB, An H, Ardeshirrouhanifard S, Raji MA, Alexander GC, Segal JB. Comparative Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin Among Adults With Cancer and Atrial Fibrillation. Circ Cardiovasc Qual Outcomes 2022; 15:e008951. [PMID: 36453260 PMCID: PMC9772095 DOI: 10.1161/circoutcomes.122.008951] [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: 01/21/2022] [Accepted: 10/27/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND While clinical guidelines recommend direct-acting oral anticoagulants (DOAC) over warfarin to treat isolated nonvalvular atrial fibrillation, guidelines are silent regarding nonvalvular atrial fibrillation treatment among individuals with cancer, reflecting the paucity of evidence in this setting. We quantified relative risk of ischemic stroke or systemic embolism and major bleeding (primary outcomes), and all-cause and cardiovascular death (secondary outcomes) among older individuals with cancer and nonvalvular atrial fibrillation comparing DOACs and warfarin. METHODS This retrospective cohort study used Surveillance, Epidemiology, and End Results cancer registry and linked US Medicare data from 2010 through 2016, and included individuals diagnosed with cancer and nonvalvular atrial fibrillation who newly initiated DOAC or warfarin. We used inverse probability of treatment weighting to control confounding. We used competing risk regression for primary outcomes and cardiovascular death, and Cox proportional hazard regression for all-cause death. RESULTS Among 7675 individuals included in the cohort, 4244 (55.3%) received DOACs and 3431 (44.7%) warfarin. In the inverse probability of treatment weighting analysis, there was no statistically significant difference among DOAC and warfarin users in the risk of ischemic stroke or systemic embolism (1.24 versus 1.19 events per 100 person-years, adjusted hazard ratio 1.41 [95% CI, 0.92-2.14]), major bleeding (3.08 versus 4.49 events per 100 person-years, adjusted hazard ratio 0.90 [95% CI, 0.70-1.17]), and cardiovascular death (1.88 versus 3.14 per 100 person-years, adjusted hazard ratio 0.82 [95% CI, 0.59-0.1.13]). DOAC users had significantly lower risk of all-cause death (7.09 versus 13.3 per 100 person-years, adjusted hazard ratio 0.81 [95% CI, 0.69-0.94]) compared to warfarin users. CONCLUSIONS Older adults with cancer and atrial fibrillation exposed to DOACs had similar risks of stroke and systemic embolism and major bleeding as those exposed to warfarin. Relative to warfarin, DOAC use was associated with a similar risk of cardiovascular death and a lower risk of all-cause death.
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Affiliation(s)
- Hemalkumar B. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Huijun An
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shirin Ardeshirrouhanifard
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mukaila A. Raji
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - G. Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD
| | - Jodi B. Segal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD
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22
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Abstract
IMPORTANCE Chronic pain prevalence among US adults increased between 2010 and 2019. Yet little is known about trends in the use of prescription opioids and nonpharmacologic alternatives in treating pain. OBJECTIVES To compare annual trends in the use of prescription opioids, nonpharmacologic alternatives, both treatments, and neither treatment; compare estimates for the annual use of acupuncture, chiropractic care, massage therapy, occupational therapy, and physical therapy; and estimate the association between calendar year and pain treatment based on the severity of pain interference. DESIGN, SETTING, AND PARTICIPANTS A serial cross-sectional analysis was conducted using the nationally representative Medical Expenditure Panel Survey to estimate the use of outpatient services by cancer-free adults with chronic or surgical pain between calendar years 2011 and 2019. Data analysis was performed from December 29, 2021, to August 5, 2022. EXPOSURES Calendar year (2011-2019) was the primary exposure. MAIN OUTCOMES AND MEASURES The association between calendar year and mutually exclusive pain treatments (opioid vs nonpharmacologic vs both vs neither treatment) was examined. A secondary outcome was the prevalence of nonpharmacologic treatments (acupuncture, chiropractic care, massage therapy, occupational therapy, and physical therapy). All analyses were stratified by pain type. RESULTS Among the unweighted 46 420 respondents, 9643 (20.4% weighted) received surgery and 36 777 (79.6% weighted) did not. Weighted percentages indicated that 41.7% of the respondents were aged 45 to 64 years and 55.0% were women. There were significant trends in the use of pain treatments after adjusting for demographic factors, socioeconomic status, health conditions, and pain severity. For example, exclusive use of nonpharmacologic treatments increased in 2019 for both cohorts (chronic pain: adjusted odds ratio [aOR], 2.72; 95% CI, 2.30-3.21; surgical pain: aOR, 1.53; 95% CI, 1.13-2.08) compared with 2011. The use of neither treatment decreased in 2019 for both cohorts (chronic pain: aOR, 0.43; 95% CI, 0.37-0.49; surgical pain: aOR, 0.59; 95% CI, 0.46-0.75) compared with 2011. Among nonpharmacologic treatments, chiropractors and physical therapists were the most common licensed healthcare professionals. CONCLUSIONS AND RELEVANCE Among cancer-free adults with pain, the annual prevalence of nonpharmacologic pain treatments increased and the prevalent use of neither opioids nor nonpharmacologic therapy decreased for both chronic and surgical pain cohorts. These findings suggest that, although access to outpatient nonpharmacologic treatments is increasing, more severe pain interference may inhibit this access.
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Affiliation(s)
- Kevin T. Pritchard
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, School of Public and Population Health, University of Texas Medical Branch, Galveston
| | - Jacques Baillargeon
- Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch, Galveston
| | - Wei-Chen Lee
- Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - Mukaila A. Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - Yong-Fang Kuo
- Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston
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23
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Tzeng HM, Raji MA, Tahashilder MI, Kuo YF. Association between medicare annual wellness visits and prevention of falls and fractures in older adults in Texas, USA. Prev Med 2022; 164:107331. [PMID: 36334680 PMCID: PMC9691561 DOI: 10.1016/j.ypmed.2022.107331] [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: 04/26/2022] [Revised: 09/17/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022]
Abstract
Fall-related injuries contribute to increased frailty, disability, and premature death in older adults (≥65 years). The US Centers for Medicare and Medicaid Services began reimbursing annual wellness visits (AWVs) in 2011. In the present study, we assessed the effect of AWV receipt in 2017 on fall and fracture prevention through December 31, 2018. Using Texas Medicare data for 2014-2018, we identified cohorts of Medicare beneficiaries ≥68 years, matched for the presence/absence of an AWV in 2017 by propensity score, and observed two outcomes: fracture as a primary diagnosis, and fall occurrences. Rates of each outcome were estimated using the Kaplan-Meier method. Of the 2017 beneficiaries, 32.2% received an AWV. For the 742,494 beneficiaries in the matched cohort, conditional Cox proportional hazards models revealed that receiving an AWV in 2017 was associated with reduced risks for future falls (3.9%) and fractures (4%). The effect of the AWV was stronger on fall reduction in rural residents (HR: 0.799; 95% CI: 0.679 to 0.941) and on fracture reduction in beneficiaries with ≥4 morbidities (HR: 0.918; 95% CI: 0.867 to 0.972). Receipt of an AWV in three consecutive years (2015-2017) further lowered the risk of future falls. We conclude that the risks for future falls/fractures are lower in older adults receiving AWVs. Our study underscores the need for expanded public education programs that raise awareness about AWVs and the potential for AWV data to inform fall prevention interventions and other health promotion practices.
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Affiliation(s)
- Huey-Ming Tzeng
- School of Nursing, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.
| | - Mukaila A Raji
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Department of Internal Medicine-Geriatrics and Palliative Medicine Division, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Department of Internal Medicine-Geriatrics and Palliative Medicine Division, University of Texas Medical Branch, Galveston, TX, USA; Office of Biostatics, University of Texas Medical Branch, Galveston, TX, USA; Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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24
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Sultana R, Sissoho F, Kaushik VP, Raji MA. The Case for Early Use of Glucagon-like Peptide-1 Receptor Agonists in Obstructive Sleep Apnea Patients with Comorbid Diabetes and Metabolic Syndrome. Life (Basel) 2022; 12:1222. [PMID: 36013401 PMCID: PMC9410036 DOI: 10.3390/life12081222] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/22/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023] Open
Abstract
Patients with obstructive sleep apnea (OSA) have high rates of co-occurring type 2 diabetes, hypertension, obesity, stroke, congestive heart failure, and accelerated atherosclerotic cardiovascular diseases. These conditions frequently require multiple medications, raising the risk of polypharmacy, adverse drug-drug and drug-disease interactions, decreased quality of life, and increased healthcare cost in these patients. The current review of extant literature presents evidence supporting glucagon-like peptide-1 receptor agonists (GLP-1RA) as one pharmacologic intervention that provides a "one-stop shop" for OSA patients because of the multiple effects GLP-1RA has on comorbidities (e.g., hypertension, diabetes, obesity, metabolic syndrome, and atherosclerotic cardiovascular diseases) that commonly co-occur with OSA. Examples of glucagon-like peptide-1 receptor agonists approved by the FDA for diabetes (some of which are also approved for obesity) are liraglutide, exenatide, lixisenatide, dulaglutide, semaglutide, and albiglutide. Prescribing of GLP-1RAs to address these multiple co-occurring conditions has enormous potential to reduce polypharmacy, cost, and adverse drug events, and to improve quality of life for patients living with OSA and diabetes. We thus strongly advocate for increased and early use of GLP-1RA in OSA patients with co-occurring diabetes and other cardiometabolic conditions common in OSA.
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Affiliation(s)
- Rizwana Sultana
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
| | - Fatoumatta Sissoho
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
| | - Vinod P. Kaushik
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
| | - Mukaila A. Raji
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
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25
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Kuo YF, Liaw V, Yu X, Raji MA. Opioid and Benzodiazepine Substitutes: Impact on Drug Overdose Mortality in Medicare Population. Am J Med 2022; 135:e194-e206. [PMID: 35341773 PMCID: PMC9232943 DOI: 10.1016/j.amjmed.2022.02.039] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Gabapentinoids (GABAs) and serotonergic drugs (selective serotonin reuptake inhibitors [SSRIs]/serotonin and norepinephrine reuptake inhibitors [SNRIs]) are increasingly being prescribed as potential substitutes to opioids and benzodiazepines (benzos), respectively, to treat co-occurring pain and anxiety disorders. The toxicities of these drug classes and their combinations are not well understood. METHODS We conducted a matched case-control study using 2013-2016 Medicare files linked to the National Death Index. Cases were enrollees who died from drug overdose. Controls were enrollees who died from other causes. Cases and controls were matched on patient characteristics and prior chronic conditions. Possession of any opioids, GABAs, benzos, and SSRIs/SNRIs in the month prior to death was defined as drug use. Combination drug use was defined as possessing at least 2 types of these prescriptions for an overlapping period of at least 7 days in the month prior to death. RESULTS Among 4323 matches, benzo possession was associated with twice the risk for drug overdose death in cases vs controls. Compared with opioid-benzo co-prescribing, combinations involving SSRIs/SNRIs and opioids (or GABAs) were associated with decreased risk (adjusted odds ratio 0.55; 95% confidence interval, 0.44-0.69 for opioids and SSRIs/SNRIs; adjusted odds ratio 0.59; 95% confidence interval, 0.44-0.79 for GABAs and SSRIs/SNRIs). Fatal drug overdose risk was similar in users of GABA-opioid, GABA-benzo, and opioid-benzo combinations. CONCLUSIONS Benzodiazepines, prescribed alone or in combination, were associated with an increased risk of drug overdose death. SSRIs/SNRIs were associated with lower risk of overdose death vs benzodiazepines. GABAs were not associated with decreased risk compared with opioids, raising concerns for GABAs' perceived relative safety.
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Affiliation(s)
- Yong-Fang Kuo
- Department of Internal Medicine and Sealy Center on Aging; Department of Preventive Medicine and Population Health; Institute for Translational Science; Office of Biostatistics, University of Texas Medical Branch, Galveston.
| | - Victor Liaw
- School of Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Xiaoying Yu
- Department of Preventive Medicine and Population Health; Office of Biostatistics, University of Texas Medical Branch, Galveston
| | - Mukaila A Raji
- Department of Internal Medicine and Sealy Center on Aging; Department of Preventive Medicine and Population Health
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26
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Pritchard KT, Downer B, Raji MA, Baillargeon J, Kuo YF. Incident Functional Limitations Among Community-Dwelling Adults Using Opioids: A Retrospective Cohort Study Using a Propensity Analysis with the Health and Retirement Study. Drugs Aging 2022; 39:559-571. [PMID: 35713791 DOI: 10.1007/s40266-022-00953-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Opioid analgesics are commonly used to manage pain; however, it is unclear how they affect patient function. This study examines the association between opioid analgesics and incident limitations in activities of daily living (ADL), instrumental activities of daily living (IADL), and cognitive functioning among community-dwelling older adults. METHODS Data included 10,003 participants of the 2016 and 2018 waves of the Health and Retirement Study, which sampled US adults aged 51-98 years. The primary exposure was self-reported opioid pain medication use in 2016. Outcomes included incident limitations in ADL, IADL, and cognitive functioning in 2018. Statistical methods adjusted for confounding using multivariable logistic regressions, inverse probability of treatment weighting, and propensity scores. RESULTS Opioid use (adjusted odds ratio [aOR]: 1.34, 95% confidence interval [CI] 1.07-1.68) was associated with a statistically significant higher odds of incident ADL limitation in multivariable regression and in propensity score adjustment (aOR: 1.41, 95% CI 1.13-1.76). The association between opioid use and ADL and IADL limitations was modified by age. Adults aged < 65 years had a higher odds of incident ADL (aOR: 1.83, 95% CI 1.38-2.42) and IADL (aOR: 1.42, 95% CI 1.06-1.90) limitations compared with those aged ≥ 65 years. CONCLUSIONS Community-dwelling adults using opioid analgesics to manage pain may be at risk for incident ADL limitations. Middle-aged adults, compared with those older than 65 years of age, experienced the greatest odds for incident ADL and IADL limitations following opioid use. According to sensitivity analyses, our findings were robust to unmeasured confounding.
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Affiliation(s)
- Kevin T Pritchard
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1137, USA.
| | - Brian Downer
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1137, USA
| | - Mukaila A Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Jacques Baillargeon
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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27
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Ardeshirrouhanifard S, An H, Goyal RK, Raji MA, Segal JB, Alexander GC, Mehta HB. Use of oral anticoagulants among individuals with cancer and atrial fibrillation in the United States, 2010-2016. Pharmacotherapy 2022; 42:375-386. [PMID: 35364622 PMCID: PMC9302858 DOI: 10.1002/phar.2679] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 11/22/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 01/12/2023]
Abstract
Background Anticoagulation among patients with cancer and atrial fibrillation is challenging due to elevated risk of bleeding and stroke. We characterized use of oral anticoagulants among patients with cancer and non‐valvular atrial fibrillation (NVAF). Methods We used Surveillance, Epidemiology, and End Results (SEER)‐Medicare data and included patients with cancer aged ≥66 years with an incident diagnosis of NVAF from 2010 to 2016. We used a Cox proportional hazard model and multivariable logistic regression to identify factors associated with anticoagulant use versus no use and direct oral anticoagulants (DOACs) versus warfarin use, respectively. Results Of 27,702 patients with cancer and NVAF, 4469 (16.1%) used DOACs and 3577 (12.9%) used warfarin. Among 8046 anticoagulant users, DOACs use increased from 21.8% in 2011 to 76.2% in 2016, with a corresponding decline in warfarin use from 78.2% to 23.8%. Nearly 7 out of 10 patients with cancer and NVAF did not initiate anticoagulation in 2016. Anticoagulant use was more likely among those with higher CHA₂DS₂‐VASc scores (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.27–1.90 for score ≥6 vs. 1) or with lower HAS‐BLED scores (HR 1.96, 95% CI 1.67–2.30 for score 1 vs. ≥6). Among anticoagulant users, DOAC use was less likely than warfarin in those with higher CHA₂DS₂‐VASc scores (odds ratio [OR] 0.53, 95% CI 0.33–0.84 for score ≥6 vs. 1). Conclusions Nearly 7 out of 10 patients with cancer and NVAF did not receive anticoagulation. Use of DOACs increased from 2010 to 2016, with a corresponding decline in warfarin use. DOACs are used less than warfarin among those at higher risk of stroke.
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Affiliation(s)
- Shirin Ardeshirrouhanifard
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Huijun An
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ravi K Goyal
- College of Pharmacy, University of Houston, Houston, Texas, USA.,RTI Health Solutions, Durham, North Carolina, USA
| | - Mukaila A Raji
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Jodi B Segal
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hemalkumar B Mehta
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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28
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Baillargeon J, Kuo YF, Westra J, Lopez DS, Urban RJ, Williams SB, Raji MA. Association of testosterone therapy with disease progression in older males with COVID-19. Andrology 2022; 10:1057-1066. [PMID: 35486968 PMCID: PMC9347854 DOI: 10.1111/andr.13193] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/11/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022]
Abstract
Importance Low testosterone levels in males have been linked with increase in proinflammatory cytokines—a primary culprit in COVID‐19 disease progression—and with adverse COVID‐19 outcomes. To date, however, no published studies have assessed the effect of testosterone therapy on COVID‐19 outcomes in older men. Objective To examine whether testosterone therapy reduced disease progression in older men diagnosed with COVID‐19. Design, setting, and participants Nested within a national cohort of older (aged ≥50 years) male patients diagnosed with COVID‐19 between January 1, 2020 and July 1, 2021 from the Optum electronic health record COVID‐19 database, two matched case–control studies of COVID‐19 outcomes were conducted. Cases—defined, respectively, as persons who (a) were hospitalized ≤30 days after COVID‐19 diagnosis (n = 33,380), and (b) were admitted to the intensive care unit or received mechanical ventilation during their COVID‐19 hospitalization (n = 10,273)—were matched 1:1 with controls based on demographic and clinical factors. Exposures Testosterone therapy was defined based on receipt of prescription at ≤60, ≤90, or ≤120 days before COVID‐19 diagnosis. Main outcomes and measures Adjusted odds ratios (ORs) for the risk of hospitalization within 30 days of COVID‐19 diagnosis and intensive care unit admission/mechanical ventilation during COVID‐19 hospitalization. Results The use of testosterone therapy was not associated with decreased odds of hospitalization (≤60 days: OR = 0.92, 95% confidence interval [CI] = 0.70–1.20; ≤90 days: OR = 0.87, 95% CI = 0.68–1.13; ≤120 days: OR = 0.97, 95% CI = 0.72–1.32) or intensive care unit admission/mechanical ventilation (≤60 days: OR = 0.67, 95% CI = 0.37–1.23; ≤90 days: OR = 0.63, 95% CI = 0.36–0.11; ≤120 days: OR = 0.58, 95% CI = 0.29–1.19). Conclusions and relevance This study showed that testosterone therapy was not associated with decreased risks of COVID‐19 adverse outcomes. These findings may provide clinically relevant information regarding testosterone treatment in older men with COVID‐19 and other respiratory viral infections with similar pathogenesis.
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Affiliation(s)
- Jacques Baillargeon
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, 77555
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, 77555.,Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555
| | - Jordan Westra
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, 77555
| | - David S Lopez
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, 77555
| | - Randall J Urban
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555
| | - Stephen B Williams
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555
| | - Mukaila A Raji
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, 77555.,Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555
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29
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Milani SA, Raji MA, Kuo YF, Lopez DS, Markides KS, Al Snih S. Multimorbidity Is Associated With Pain Over 6 Years Among Community-Dwelling Mexican Americans Aged 80 and Older. Front Pain Res (Lausanne) 2022; 3:830308. [PMID: 35399155 PMCID: PMC8983931 DOI: 10.3389/fpain.2022.830308] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Multimorbidity, the co-occurrence of two or more chronic conditions, is common among older adults and is associated with decreased quality of life, greater disability, and increased mortality. Yet, the association of multimorbidity with pain, another significant contributor to decreased quality of life, has not been widely studied. This is especially understudied among very old (aged ≥ 80) Mexican Americans, a fast-growing segment of the United States (US) population. Objective To assess the association of multimorbidity with pain in very old Mexican Americans, over six years of follow-up. Methods We used data from Waves 7 (2010/2011) to 9 (2015/2016) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly, a longitudinal study of older Mexican Americans residing in the Southwestern US. Multimorbidity was defined as reporting two or more chronic health conditions. Pain was defined as (1) pain on weight-bearing, (2) pain in back, hips, knees, ankles/feet, legs, entire body, or two or more locations, and (3) pain that limits daily activities. We use generalized estimation equations to estimate the odds ratio of pain as a function of multimorbidity over 6 years. Results At baseline (n = 841), 77.3% of participants had multimorbidity. Those with multimorbidity had greater odds [2.27, 95% confidence interval (CI): 1.74, 2.95] of reporting pain on weight-bearing over time, compared to those without multimorbidity. Also, those with multimorbidity had 2.12 times the odds of reporting pain that limited their daily activities (95% CI: 1.61, 2.78) compared to those without multimorbidity. Lastly, those with multimorbidity had higher odds of reporting pain in their back, knee, ankles/feet, legs, hips, entire body, or two or more locations, compared to those without multimorbidity. Conclusions Those with multimorbidity consistently had higher odds of all types of pain, highlighting the need for early management of pain among those with multiple chronic conditions and complex health needs. This is especially important among very old Mexican Americans, who have a high burden of chronic health conditions.
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Affiliation(s)
- Sadaf Arefi Milani
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, United States
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX, United States
| | - Mukaila A. Raji
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, United States
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, United States
| | - Yong-Fang Kuo
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, United States
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX, United States
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, United States
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, United States
| | - David S. Lopez
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, United States
| | - Kyriakos S. Markides
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, United States
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, United States
| | - Soham Al Snih
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, United States
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
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Polychronopoulou E, Kuo YF, Wilkes D, Raji MA. Prescribing of Gabapentinoids with or without opioids after burn injury in the US, 2012-2018. Burns 2022; 48:293-302. [PMID: 34991930 PMCID: PMC9007844 DOI: 10.1016/j.burns.2021.12.006] [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] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 12/14/2022]
Abstract
Burn injury pain manifests as a combination of inflammatory, nociceptive, and neuropathic features. While opioids are the mainstay of burn pain management, non-opioid medications, such as gabapentinoids, have also been considered as they target the central nervous system. Increased opioid adverse events and overdose deaths in the United States led to the 2014 and 2016 guidelines to reduce opioid prescribing and consider alternatives, such as gabapentinoids. In the context of burn, the rate of gabapentinoid prescribing at the national level is unknown and it is unclear whether any shift has occurred in prescribing practices over time. We conducted a population level cohort study of adult burn patients from 2012 to 2018 to evaluate the rates and determinants of gabapentinoid prescribing, with and without opioids. Of 98,001 patients with burn, 22,521 (22.98%) received opioids and/or gabapentinoids (GABA). GABA represented 2.4% of prescriptions in 2012, but increased to 7.2% by 2018, while GABA-opioid co-prescriptions increased from 2.3% to 5.1%. The rate of increase in GABA prescriptions was higher for those aged 50-65 years or residing in the South. After adjustment, GABA was 44% more likely to be prescribed in 2017 and 2018 compared to 2012 and 2013, opioids were 38% less likely, while co-prescribing did not show a statistically significant change. Our study showed a modest increase in gabapentinoids' outpatient prescribing for burn patients after the 2014 and 2016 guidelines, indicating more opportunities for prescribers to expand non-opioid pain management in this population.
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Affiliation(s)
- Efstathia Polychronopoulou
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch,Division of Rehabilitation Sciences, University of Texas Medical Branch
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch,Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Texas Medical Branch,Sealy Center on Aging, University of Texas Medical Branch,Institute for Translational Sciences, University of Texas Medical Branch
| | - Denise Wilkes
- Department of Anesthesiology, The University of Texas Medical Branch
| | - Mukaila A. Raji
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch,Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Texas Medical Branch,Sealy Center on Aging, University of Texas Medical Branch
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Gibson DC, Raji MA, Holmes HM, Baillargeon JG, Kuo YF. Risk of an Opioid-Related Emergency Department Visit or Hospitalization Among Older Breast, Colorectal, Lung, and Prostate Cancer Survivors. Mayo Clin Proc 2022; 97:560-570. [PMID: 35135691 PMCID: PMC8898260 DOI: 10.1016/j.mayocp.2021.08.030] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/20/2021] [Accepted: 08/26/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess whether long-term cancer survivors (≥5 years after diagnosis) are at an increased risk of experiencing an opioid-related emergency department (ED) visit or hospitalization compared with persons without cancer. METHODS A 1:1 matched retrospective cohort study was performed using the Surveillance, Epidemiology, and End Results-Medicare linked data sets. The analysis was conducted from October 2020 to December 2020 in persons who lived 5 years or more after a breast, colorectal, lung, or prostate cancer diagnosis matched to noncancer controls on the basis of age, sex, race, pain conditions, and previous opioid use. Fine-Gray regression models were used to assess the relationship between cancer survivorship status and opioid-related ED visit or hospitalization. RESULTS The incidence of opioid-related ED visits and hospitalizations was 51.2 (95% CI, 43.5 to 59.8) and 62.2 (95% CI, 53.4 to 72.1) per 100,000 person-years among cancer survivors and matched noncancer controls, respectively. No significant association was observed between survivorship and opioid-related adverse event among opioid naive (hazard ratio, 0.79; 95% CI, 0.61 to 1.02) and non-naive (hazard ratio, 1.26; 95% CI, 0.84 to 1.89) cohorts. CONCLUSION Cancer survivors and noncancer controls had a similar risk of an ED visit or inpatient admission. Guidelines and policies should promote nonopioid pain management approaches especially to opioid non-naive older adults, a population at high risk for an opioid-related ED visit or hospitalization.
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Affiliation(s)
- Derrick C Gibson
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston.
| | - Mukaila A Raji
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - Holly M Holmes
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Health Science Center, Houston
| | - Jacques G Baillargeon
- Department of Preventive Medicine and Population Health, Office of Biostatistics, University of Texas Medical Branch, Galveston
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, Office of Biostatistics, University of Texas Medical Branch, Galveston
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Tzeng HM, Raji MA, Chou LN, Kuo YF. Impact of State Nurse Practitioner Regulations on Potentially Inappropriate Medication Prescribing Between Physicians and Nurse Practitioners: A National Study in the United States. J Nurs Care Qual 2022; 37:6-13. [PMID: 34483310 PMCID: PMC8608008 DOI: 10.1097/ncq.0000000000000595] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The American Geriatrics Society regularly updates the Beers Criteria for Potentially Inappropriate Medication (PIM) to improve prescribing safety. PURPOSE This study assessed the impact of nurse practitioner (NP) practices on PIM prescribing across states in the United States and compared the change in PIM prescribing rates between 2016 and 2018. METHODS We used data from a random selection of 20% of Medicare beneficiaries (66 years or older) from 2015 to 2018 to perform multilevel logistic regression. A PIM prescription was classified as initial or refill on the basis of medication history 1 year before a visit. PIM use after an outpatient visit was the primary study outcome. RESULTS We included 9 000 224 visits in 2016 and 9 310 261 in 2018. The PIM prescription rate was lower in states with full NP practice and lower among NPs than among physicians; these rates for both physicians and NPs decreased from 2016 to 2018. CONCLUSIONS Changes could be due to individual state practices.
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Affiliation(s)
- Huey-Ming Tzeng
- School of Nursing (Dr Tzeng), Department of Internal Medicine (Drs Raji and Kuo), Sealy Center on Aging (Drs Tzeng, Raji, and Kuo), Department of Preventive Medicine and Population Health (Dr Kuo), and Office of Biostatistics (Ms Chou and Dr Kuo), University of Texas Medical Branch, Galveston
| | - Mukaila A. Raji
- School of Nursing (Dr Tzeng), Department of Internal Medicine (Drs Raji and Kuo), Sealy Center on Aging (Drs Tzeng, Raji, and Kuo), Department of Preventive Medicine and Population Health (Dr Kuo), and Office of Biostatistics (Ms Chou and Dr Kuo), University of Texas Medical Branch, Galveston
| | - Lin-Na Chou
- School of Nursing (Dr Tzeng), Department of Internal Medicine (Drs Raji and Kuo), Sealy Center on Aging (Drs Tzeng, Raji, and Kuo), Department of Preventive Medicine and Population Health (Dr Kuo), and Office of Biostatistics (Ms Chou and Dr Kuo), University of Texas Medical Branch, Galveston
| | - Yong-Fang Kuo
- School of Nursing (Dr Tzeng), Department of Internal Medicine (Drs Raji and Kuo), Sealy Center on Aging (Drs Tzeng, Raji, and Kuo), Department of Preventive Medicine and Population Health (Dr Kuo), and Office of Biostatistics (Ms Chou and Dr Kuo), University of Texas Medical Branch, Galveston
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Shah R, Raji MA, Westra J, Kuo YF. Association of co-prescribing of opioid and benzodiazepine substitutes with incident falls and fractures among older adults: a cohort study. BMJ Open 2021; 11:e052057. [PMID: 35476819 PMCID: PMC8719209 DOI: 10.1136/bmjopen-2021-052057] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/13/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Examine the association between the co-prescribing of opioids, benzodiazepines, gabapentinoids (pregabalin and gabapentin) and selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors (SSRI/SNRIs) in different combinations and the risk of falls and fractures. DESIGN Retrospective cohort study from 2015 to 2018. SETTING Medicare enrolment and claims data. PARTICIPANTS Medicare beneficiaries with both chronic pain and anxiety disorders in 2016 with continuous enrolments in Parts A and B from 2015 to 2016 who were prescribed any combination of opioid, benzodiazepine, gabapentinoid and SSRI/SNRI in 2017 for ≥7 days, as documented in their Medicare Part D coverage. INTERVENTIONS Any combination of use of seven drug regimens (benzodiazepine +opioid; benzodiazepine +gabapentinoid; benzodiazepine +SSRI/SNRI; opioid +gabapentinoid; opioid +SSRI/SNRI; gabapentinoid +SSRI/SNRI; ≥3 drug classes). MAIN OUTCOMES First event of fall and the first event of fracture after the index date, which was the first day of combination drug use that lasted ≥7 days in 2017. RESULTS A total of 47 964 patients (mean [SD] age, 75.9 [7.1]; 78.0% woman) with diagnoses of both chronic pain and anxiety were studied. The median (Q1-Q3) duration of drug combination use was 26 (14-30) days. After adjusting for demographic characteristics, chronic conditions and history of hospitalisation and fall or fracture, the co-prescribing of ≥3 drugs (adjusted HR [aHR], 1.38; 95% CI 1.14 to 1.67) and opioid plus gabapentinoid (aHR, 1.18; 95% CI 1.02 to 1.37) were associated with a high fall risk, compared with benzodiazepineplus opioid co-prescribing, findings consistent with the secondary analysis using inverse probability of treatment weighting with propensity scores. The co-prescribing of benzodiazepine plus gabapentinoid (aHR, 0.76; 95% CI 0.59 to 0.98) was associated with lower fracture risk compared with the co-prescribing of benzodiazepine plus opioid, though this finding was not robust. CONCLUSIONS Our findings add to comparative toxicity research on different combinations of gabapentinoids and serotonergic agents commonly prescribed with or as substitutes for opioids and benzodiazepines in patients with co-occurring chronic pain and anxiety.
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Affiliation(s)
- Rahul Shah
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mukaila A Raji
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Jordan Westra
- Office of Biostatistics, Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Yong-Fang Kuo
- Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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Esechie A, Kuo YF, Goodwin JS, Westra J, Raji MA. Trends in prescribing pattern of opioid and benzodiazepine substitutes among Medicare part D beneficiaries from 2013 to 2018: a retrospective study. BMJ Open 2021; 11:e053487. [PMID: 34794996 PMCID: PMC8603279 DOI: 10.1136/bmjopen-2021-053487] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Opioid and benzodiazepine co-prescribing is associated with a substantial increase in opioid overdose deaths. In this study, we examine the prescribing trends of substitutes of opioids and benzodiazepines alone or in combination, compared with opioids and benzodiazepines. DESIGN Retrospective cohort study. SETTING Data were collected using a 20% national sample of Medicare beneficiaries from 2013 to 2018. PARTICIPANTS 4.1-4.3 million enrollees each year from 2013 to 2018. INTERVENTION None. PRIMARY OUTCOME We employ a generalised linear mixed models to calculate ORs for opioid use, benzodiazepine or Z-drug (benzos/Z-drugs) use, opioid/benzos/Z-drugs 30-day use, gabapentinoid use and (selective serotonin reuptake inhibitors (SSRI) and serotonin norepinephrine reuptake inhibitors (SNRIs)) use, adjusted for the repeated measure of patient. We then created two models to calculate the ORs for each year and comparing to 2013. RESULTS Opioid and benzos/Z-drugs use decreased by 2018 (aOR 0.626; 95% CI 0.622 to 0.630) comparing to 2013. We demonstrate a 36.3% and 9.9% increase rate of gabapentinoid and SSRI/SNRI use, respectively. Furthermore, combined gabapentinoid and SSRI/SNRI use increased in 2018 (aOR 1.422; 95% CI 1.412 to 1.431). CONCLUSION Little is known about the prescribing pattern and trend of opioid and benzodiazepine alternatives as analgesics. There is a modest shift from prescribing opioid and benzos/Z-drugs (alone or in combination) towards prescribing non-opioid analgesics-gabapentinoids with and without non-benzos/Z-drugs that are indicated for anxiety. It is unclear if this trend towards opioid/benzos/Z-drugs alternatives is associated with fewer drug overdose death, better control of pain and comorbid anxiety, and improved quality of life.
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Affiliation(s)
- Aimalohi Esechie
- Neurology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Yong-Fang Kuo
- Division of Geriatrics and Palliative Medicine & Sealy Center on Aging, Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - James S Goodwin
- Division of Geriatrics and Palliative Medicine & Sealy Center on Aging, Department of Internal Medicine, Department of Preventive Medicine and Population Health, Institute for Translational Science, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Jordan Westra
- Office of Biostatistics, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Mukaila A Raji
- Department of Neurology, Division of Geriatrics and Palliative Medicine & Sealy Center on Aging, Department of Internal Medicine, Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, Texas, USA
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Milani SA, Raji MA, Chen L, Kuo YF. Trends in the Use of Benzodiazepines, Z-Hypnotics, and Serotonergic Drugs Among US Women and Men Before and During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2131012. [PMID: 34694388 PMCID: PMC8546497 DOI: 10.1001/jamanetworkopen.2021.31012] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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] [Received: 05/25/2021] [Accepted: 08/21/2021] [Indexed: 01/06/2023] Open
Abstract
Importance The ongoing COVID-19 pandemic and associated mitigation measures have disrupted access to psychiatric medications, particularly for women. Objective To assess the sex differences in trends in the prescribing of benzodiazepines, Z-hypnotics and serotonergic (selective serotonin reuptake inhibitors [SSRIs] and serotonin and norepinephrine reuptake inhibitors [SNRIs]), which are commonly prescribed for anxiety, insomnia, and depression. Design, Setting, and Participants This cohort study used data from Clinformatics Data Mart, one of the largest commercial health insurance databases in the US. Enrollees 18 years or older were required to have complete enrollment in a given month during our study period, January 1, 2018, to March 31, 2021, to be included for that month. Main Outcomes and Measures Prescription of a benzodiazepine, Z-hypnotic, or SSRI or SNRI. For each month, the percentage of patients with benzodiazepine, Z-hypnotic, or SSRI or SNRI prescriptions by sex was calculated. Results The records of 17 255 033 adults (mean [SD] age, 51.7 [19.5] years; 51.3% female) were examined in 2018, 17 340 731 adults (mean [SD] age, 52.5 [19.7] years; 51.6% female) in 2019, 16 916 910 adults (mean [SD] age, 53.7 [19.8] years; 51.9% female) in 2020, and 15 135 998 adults (mean [SD] age, 56.2 [19.8] years; 52.5% female) in 2021. Compared with men, women had a higher rate of prescriptions for all 3 drugs classes and had larger changes in prescription rates over time. Benzodiazepine prescribing decreased from January 2018 (women: 5.61%; 95% CI, 5.60%-5.63%; men: 3.03%; 95% CI, 3.02%-3.04%) to March 2021 (women: 4.91%; 95% CI, 4.90%-4.93%; men: 2.66%; 95% CI, 2.65%-2.67%), except for a slight increase in April 2020 among women. Z-hypnotic prescribing increased from January 2020 for women (1.39%; 95% CI, 1.38%-1.40%) and February 2020 for men (0.97%; 95% CI, 0.96%-0.98%) to October 2020 (women: 1.46%; 95% CI, 1.46%-1.47%; men: 1.00%; 95% CI, 0.99%-1.01%). Prescribing of SSRIs and SNRIs increased from January 2018 (women: 12.77%; 95% CI; 12.75%-12.80%; men: 5.56%; 95% CI, 5.44%-5.58%) to April 2020 for men (6.73%; 95% CI, 6.71%-6.75%) and October 2020 for women (15.18%; 95% CI, 15.16%-15.21%). Conclusions and Relevance In this cohort study, coinciding with the COVID-19 pandemic onset was an increase in Z-hypnotic as well as SSRI and SNRI prescriptions in both men and women along with an increase in benzodiazepine prescriptions in women, findings that suggest a substantial mental health impact of COVID-19-associated mitigation measures.
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Affiliation(s)
- Sadaf Arefi Milani
- Department of Internal Medicine–Geriatrics and Palliative Medicine, University of Texas Medical Branch, Galveston
- Sealy Center on Aging, University of Texas Medical Branch, Galveston
- Center for Interdisciplinary Research in Women’s Health, University of Texas Medical Branch, Galveston
| | - Mukaila A. Raji
- Department of Internal Medicine–Geriatrics and Palliative Medicine, University of Texas Medical Branch, Galveston
- Sealy Center on Aging, University of Texas Medical Branch, Galveston
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston
| | - Lu Chen
- Office of Biostatistics, University of Texas Medical Branch, Galveston
| | - Yong-Fang Kuo
- Department of Internal Medicine–Geriatrics and Palliative Medicine, University of Texas Medical Branch, Galveston
- Sealy Center on Aging, University of Texas Medical Branch, Galveston
- Center for Interdisciplinary Research in Women’s Health, University of Texas Medical Branch, Galveston
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston
- Office of Biostatistics, University of Texas Medical Branch, Galveston
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Milani SA, Cantu PA, Berenson AB, Kuo YF, Markides KS, Raji MA. Gender Differences in Neuropsychiatric Symptoms Among Community-Dwelling Mexican Americans Aged 80 and Older. Am J Alzheimers Dis Other Demen 2021; 36:15333175211042958. [PMID: 34565200 DOI: 10.1177/15333175211042958] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background and ObjectivesTo assess gender differences in prevalence of neuropsychiatric symptoms (NPS) among community-dwelling Mexican Americans ≥80 years. Research Design and Methods: Using data from Wave 7 (2010-2011) of the Hispanic Established Population for the Epidemiological Study of the Elderly, we analyzed the NPS of 914 participants as determined by the Neuropsychiatric Inventory (NPI) with assessments conducted by their caregivers. Multivariate logistic regression models were used to test the association of individual NPS with gender, adjusting for relevant characteristics. Results: The average age of our sample was 86.1 years, and 65.3% were women. Over 60% of participants had at least one informant/caregiver reported NPS. After adjustment, women had lower odds than men of agitation/aggression but higher odds of dysphoria/depression and anxiety. Discussion: Recognizing gender differences in NPS phenotype could help guide development of culturally appropriate NPS screening and treatment programs.
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Affiliation(s)
- Sadaf Arefi Milani
- Department of Internal Medicine-Geriatrics, 12338University of Texas Medical Branch, Galveston, TX, USA.,Sealy Center on Aging, 12338University of Texas Medical Branch, Galveston, TX, USA.,Center for Interdisciplinary Research in Women's Health, 12338University of Texas Medical Branch, Galveston, TX, USA
| | - Phillip A Cantu
- Sealy Center on Aging, 12338University of Texas Medical Branch, Galveston, TX, USA
| | - Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, 12338University of Texas Medical Branch, Galveston, TX, USA.,Department of Obstetrics/Gynecology, 12338University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Department of Internal Medicine-Geriatrics, 12338University of Texas Medical Branch, Galveston, TX, USA.,Sealy Center on Aging, 12338University of Texas Medical Branch, Galveston, TX, USA.,Center for Interdisciplinary Research in Women's Health, 12338University of Texas Medical Branch, Galveston, TX, USA.,Office of Biostatistics, 12338University of Texas Medical Branch, Galveston, TX, USA.,Department of Preventive Medicine and Population Health, 12338University of Texas Medical Branch, Galveston, TX, USA
| | - Kyriakos S Markides
- Sealy Center on Aging, 12338University of Texas Medical Branch, Galveston, TX, USA.,Department of Preventive Medicine and Population Health, 12338University of Texas Medical Branch, Galveston, TX, USA
| | - Mukaila A Raji
- Department of Internal Medicine-Geriatrics, 12338University of Texas Medical Branch, Galveston, TX, USA.,Sealy Center on Aging, 12338University of Texas Medical Branch, Galveston, TX, USA.,Department of Preventive Medicine and Population Health, 12338University of Texas Medical Branch, Galveston, TX, USA
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Polychronopoulou E, Raji MA, Wolf SE, Kuo YF. US national trends in prescription opioid use after burn injury, 2007 to 2017. Surgery 2021; 170:952-961. [PMID: 33472746 PMCID: PMC8285464 DOI: 10.1016/j.surg.2020.12.011] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Opioid misuse and overdose in the United States remain a public health emergency. Overprescribing has been recognized as a significant contributor to the epidemic. Opioids are the mainstay for pain management after burn; however, to date, no large-scale nationally representative study has evaluated outpatient opioid prescribing practices in this population. METHODS A retrospective study was conducted of patients up to 65 years old with burn injuries between 2007 and 2017 using national commercial insurance data. The primary outcome was initial opioid prescribing after burn injury. Secondary outcomes were total days' supply, oral daily morphine milligram equivalents, and number of refills. RESULTS Of the 140,753 patients with burns, 34,685 (24.6%) received an opioid prescription. The odds of prescription opioid use were lower in 2015, 2016, and 2017 compared with 2007. Interactions with age, severity (P < .0001), and region (P = .003) showed significant variation in rates of decline from 2007 to 2017, with the steepest decline in those aged <20 and in residents of Northeast United States. Prescribing rates remained stable over time among those with more severe burn injuries. The significant decline in daily opioid morphine milligram equivalents after 2013 was paralleled by an increase in days of supply (P values <.005). The odds of refill declined in 2016 and 2017. CONCLUSION While opioid prescribing after burn has declined in the past decade, significant variation remains among regions and age groups, suggesting a need to develop uniform guidelines to improve the quality of opioid prescribing and pain management protocols in burn patients.
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Affiliation(s)
- Efstathia Polychronopoulou
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - Mukaila A Raji
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX; Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Texas Medical Branch, Galveston, TX; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
| | - Steven E Wolf
- Division of Burn and Trauma Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX; Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Texas Medical Branch, Galveston, TX; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX; Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX.
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Mehta HB, Kuo YF, Raji MA, Westra J, Boyd C, Alexander GC, Goodwin JS. State Variation in Chronic Opioid Use in Long-Term Care Nursing Home Residents. J Am Med Dir Assoc 2021; 22:2593-2599.e4. [PMID: 34022153 DOI: 10.1016/j.jamda.2021.04.016] [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] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Policies and regulations on opioid use have evolved from being primarily state-to federally based. We examined the trends and variation in chronic opioid use among states and nursing homes. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS We used the nursing home Minimum Data Set and Medicare claims from 2014 to 2018 and included long-term care nursing home residents from each year who had at least 120 days of consecutive stay. MEASUREMENTS Chronic opioid use was defined as use for ≥90 days. Three-level hierarchical logistic regression models (resident, nursing home, state) were constructed to estimate intraclass correlation coefficient (ICC) at the state level and at the nursing home level. The ICC shows the proportion of variation in chronic opioid use that is attributable to states or nursing homes. All models were constructed separately for each calendar year and controlled for resident, nursing home, and state characteristics. RESULTS We included 3,245,714 nursing home stays from 2014 to 2018, representing 1,502,131 unique residents. The stays ranged from 676,413 in 2014 to 594,874 in 2018, with residents contributing a maximum of 1 stay per year. Chronic opioid use among nursing home residents declined from 14.1% in 2014 to 11.4% in 2018. The variation (ICC) in chronic opioid use among states declined from 2.5% in 2014 to 1.7% in 2018. In contrast, the variation (ICC) among nursing homes increased from 5.6% in 2014 to 6.5% in 2018. CONCLUSIONS AND IMPLICATIONS Variation in chronic opioid use declined by one-third at the state level but not at the nursing home level. National guidelines on opioid use and federal policies on opioid use may have contributed to reducing state-level variation in chronic opioid use.
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Affiliation(s)
- Hemalkumar B Mehta
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch at Galveston, TX, USA
| | - Mukaila A Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Jordan Westra
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch at Galveston, TX, USA
| | - Cynthia Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - James S Goodwin
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
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Abstract
OBJECTIVE The goal of this study was to examine the impact of substance use disorder on the risk of hospitalization, complications, and mortality among adult patients diagnosed as having COVID-19. METHODS The authors conducted a propensity score (PS)-matched double-cohort study (N=5,562 in each cohort) with data from the TriNetX Research Network database to identify 54,529 adult patients (≥18 years) diagnosed as having COVID-19 between February 20 and June 30, 2020. RESULTS Primary analysis (PS matched on demographic characteristics and presence of diabetes and obesity) showed that substance use disorder was associated with an increased risk of hospitalization (odds ratio [OR]=1.84, 95% confidence interval [CI]=1.69-2.01), ventilator use (OR=1.45, 95% CI=1.22-1.72), and mortality (OR=1.30, 95% CI=1.08-1.56). CONCLUSIONS The findings suggest that COVID-19 patients with substance use disorders are at increased risk for adverse outcomes. The attenuation of ORs in the model that matched for chronic respiratory and cardiovascular diseases associated with substance abuse suggests that the observed risks may be partially mediated by these conditions.
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Affiliation(s)
- Jacques Baillargeon
- Department of Preventive Medicine and Population Health (all authors), and Department of Internal Medicine (Kuo, Raji), University of Texas Medical Branch, Galveston
| | - Efstathaia Polychronopoulou
- Department of Preventive Medicine and Population Health (all authors), and Department of Internal Medicine (Kuo, Raji), University of Texas Medical Branch, Galveston
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health (all authors), and Department of Internal Medicine (Kuo, Raji), University of Texas Medical Branch, Galveston
| | - Mukaila A Raji
- Department of Preventive Medicine and Population Health (all authors), and Department of Internal Medicine (Kuo, Raji), University of Texas Medical Branch, Galveston
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Daodu OB, Jokotola PT, Omowon AA, Olorunshola ID, Ahmed OA, Raufu IA, Raji MA, Daodu OC. Cross-species surveillance and risk factors associated with Avian Coronavirus in North-Central and South West Regions of Nigeria. Trop Biomed 2021; 38:28-32. [PMID: 33797520 DOI: 10.47665/tb.38.1.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Infectious bronchitis viral (IBV) (Avian coronavirus) diseases is among the major reproductive diseases affecting the avian production in Africa. There is scanty information on its current status and vaccination compliance among captive wild birds (CWB) and indigenous chickens (LC) in Nigeria. This study aimed to assess the exposure and the risk factors associated with IBV in CWB and LC from North-central and South west regions of Nigeria. Sera samples from 218 LC and 43 CWB were examined for IBV IgG using enzyme linked immunosorbent assay. Also, owners of LC and managers of CWB were interviewed using a pre-tested structured checklist. An overall IBV prevalence of 42.9% (112/261) was obtained. Captive wild birds and indigenous chickens had 11.6% (5/43) and 49.1% (107/218) prevalence respectively with a significant difference (p< 0.0001, OR= 7.3, 95% CI= 2.8-19.3). Also, geo-location indicated significant difference in IBV exposure among birds (p<=0.034). Furthermore, the study showed that there had never been laboratory screening on all acquired wild birds for exposure to infectious agents in the study location while none of these birds (LB/CWB) had history of vaccination. Since IBV is endemic in Nigeria, the use of vaccine for prophylactic measure should be advocated among LC and CWB owners in order to avoid unnecessary losses. Also, the essence of screening for infectious agents in newly acquired wild birds should be considered crucial for health sustenance and public safety.
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Affiliation(s)
- O B Daodu
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, University of Ilorin, PMB 1515, Ilorin, Kwara State, Nigeria
| | - P T Jokotola
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, University of Ilorin, PMB 1515, Ilorin, Kwara State, Nigeria
| | - A A Omowon
- Department of Animal Health Technology, School of Animal and Fisheries Technology, Oyo State College of Agriculture and Technology, Igboora, Oyo State, Nigeria
| | - I D Olorunshola
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, University of Ilorin, PMB 1515, Ilorin, Kwara State, Nigeria
| | - O A Ahmed
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, University of Ilorin, PMB 1515, Ilorin, Kwara State, Nigeria
| | - I A Raufu
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, University of Ilorin, PMB 1515, Ilorin, Kwara State, Nigeria
| | - M A Raji
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, University of Ilorin, PMB 1515, Ilorin, Kwara State, Nigeria
| | - O C Daodu
- Department of Wildlife and Ecotourism, Faculty of Agriculture, University of Ibadan, Ibadan, Oyo State, Nigeria
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Taha SA, Westra JR, Raji MA, Kuo YF. Trends in Urine Drug Testing Among Long-term Opioid Users, 2012-2018. Am J Prev Med 2021; 60:546-551. [PMID: 33288392 PMCID: PMC8017600 DOI: 10.1016/j.amepre.2020.10.011] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Long-term opioid therapy increases the risk of opioid overdose death. Government agencies and medical societies, including the Center for Disease Control and Prevention and the American Society for Clinical Oncology, emphasized risk mitigation strategies, including urine drug testing, in published guidelines. Urine drug testing rates, time trends, and covariates among long-term opioid therapy users were examined to gauge guideline adherence. METHODS Using Optum's De-identified Clinformatics DataMart, an incidence cohort (n=28,790) and prevalence cohort (n=621,449) were created to measure baseline and annual urine drug testing, respectively, from 2012 to 2018. Urine drug testing time trends were evaluated by demographics, pain conditions, and Elixhauser comorbidity index. A multivariable generalized estimating model was developed in 2020 to examine the factors associated with urine drug testing. RESULTS Annual urine drug testing rates doubled from 25.6% in 2012 to 52.2% in 2018, whereas baseline urine drug testing also increased from 3.75% to 11.1%. Annual urine drug testing increased within each age group over time; however, older patients (OR=0.21, 95% CI=0.21, 0.22, aged >79 years) and patients with cancer (OR=0.82, 95% CI=0.80, 0.84) were less likely to receive urine drug testing. Patients residing in the South (OR=1.99, 95% CI=1.96, 2.01) and those with back pain (OR=2.04, 95% CI=2.02, 2.06) or with other chronic pain (OR=1.64, 95% CI=1.62, 1.66) were significantly more likely to be tested. Independent predictors of baseline urine drug testing were similar to predictors of annual urine drug testing. CONCLUSIONS Despite increasing urine drug testing trends from 2012 to 2018, annual and baseline urine drug testing remained low in 2018, relative to numerous guideline recommendations. Findings suggest a need for research on better guideline implementation strategies and the effectiveness of urine drug testing on patient outcomes.
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Affiliation(s)
- Shaden A Taha
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas; Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas.
| | - Jordan R Westra
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas; Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas
| | - Mukaila A Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
| | - Yong F Kuo
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas; Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas; Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
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Chou LN, Kuo YF, Raji MA, Goodwin JS. Potentially inappropriate medication prescribing by nurse practitioners and physicians. J Am Geriatr Soc 2021; 69:1916-1924. [PMID: 33749843 DOI: 10.1111/jgs.17120] [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] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/06/2021] [Accepted: 03/03/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Potentially inappropriate medication (PIM) use is a risk factor for hospitalization and mortality. However, there were few studies focusing on the impact of provider type on PIM use. OBJECTIVE We aimed to estimate the initial and refill PIM prescribing rate for physician visits and nurse practitioner (NP) visits and the impact of provider type on PIM prescribing. RESEARCH DESIGN We used 100% Texas Medicare data to define physician visits and NP visits in 2016. The rate of visits with a PIM prescription from the same provider was measured, distinguishing between initial and refill prescription to estimate the PIM rate and adjusted odds ratio (OR) by provider type. RESULTS There were 24.1 per 1000 visits with a prescription for a PIM: 9.0 per 1000 visits for an initial PIM and 15.1 per 1000 visits for a refill PIM. A visit to an NP was less likely to result in an initial (OR = 0.74, 95% confidence interval [CI] = 0.70-0.79) or refill (OR = 0.54, 95% CI = 0.51-0.57) PIM. The association of lower odds of receiving a prescription for an initial PIM from an NP was substantially stronger among black enrollees than white enrollees (OR = 0.44, 95%CI = 0.30-0.65 for blacks and OR = 0.73, 95%CI = 0.68-0.78 for white enrollees). The association of an NP provider with lower odds of receiving a PIM refill was more pronounced in older patients and in those with more comorbidities. CONCLUSIONS NPs prescribed fewer initial PIMs and were less likely to refill a PIM after an outpatient visit than physicians. The lower odds of receiving PIMs during an NP visit varied by age, race/ethnicity, rurality, and number of comorbidities.
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Affiliation(s)
- Lin-Na Chou
- Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas, USA.,Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Yong-Fang Kuo
- Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas, USA.,Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas, USA.,Department in Internal Medicine, Division of Geriatrics and Palliative Care, University of Texas Medical Branch, Galveston, Texas, USA.,Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA
| | - Mukaila A Raji
- Department in Internal Medicine, Division of Geriatrics and Palliative Care, University of Texas Medical Branch, Galveston, Texas, USA.,Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA
| | - James S Goodwin
- Department in Internal Medicine, Division of Geriatrics and Palliative Care, University of Texas Medical Branch, Galveston, Texas, USA.,Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA
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Abstract
Based on evidence of the immunosuppressive effects of chronic opioids, long-term users of prescription and illicit opioids comprise an unrecognized but growing population of Americans with compromised immune function and respiratory depression who may be at high risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)-related hospitalization, prolonged ICU stay, adverse events, and death. This perspective is of broad clinical and public health importance because the US has the highest population of long-term users of prescription opioids, a sequel of a decade-long practice of opioid overprescribing in the US. For long-term opioid users who are hospitalized for COVID-19, clinicians face clinical challenges arising from the suppressive effects of opioids on the respiratory and immune functions, as well as the potential for adverse drug-drug interaction when opioids have to be continued in long-term users. More research is needed to further understand the association of long-term opioid use and susceptibility to COVID-19 and other emerging infections.
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Affiliation(s)
- Rahul Shah
- Department of Internal Medicine and Sealy Center on Aging, University of Texas Medical Branch (UTMB), Galves-ton, Texas
| | - Yong-Fang Kuo
- Department of Internal Medicine and Sealy Center on Aging; Department of Preventive Medicine and Commu-nity Health; and Institute for Translational Science, University of Texas Medical Branch (UTMB), Galveston, Texas
| | - Jacques Baillargeon
- Department of Internal Medicine and Sealy Center on Aging; Department of Preventive Medicine and Community Health; Institute for Translational Science, University of Texas Medical Branch (UTMB), Galveston, Texas. ORCID: https://orcid.org/0000-0002-3297-653X
| | - Mukaila A Raji
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine and Sealy Center on Aging; De-partment of Preventive Medicine and Community Health, University of Texas Medical Branch (UTMB), Galveston, Texas
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Gibson DC, Raji MA, Baillargeon JG, Kuo YF. Regional and temporal variation in receipt of long-term opioid therapy among older breast, colorectal, lung, and prostate cancer survivors in the United States. Cancer Med 2021; 10:1550-1561. [PMID: 33423372 PMCID: PMC7940244 DOI: 10.1002/cam4.3709] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/04/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Older cancer survivors have high rates of long-term opioid therapy (≥90 days/year). However, the geographical and temporal variation in long-term opioid therapy rates for older cancer survivors is not known. METHODS A retrospective cohort study was conducted using SEER-Medicare data. Persons aged ≥66 years, diagnosed with breast, colorectal, lung, or prostate cancer from 1991 to 2011, and alive ≥5 years after diagnosis were included. Persons were followed from 1/1/2008 until 12/31/2016. Persons were assigned to a census region in their state of residence each year. Individuals who were covered by an opioid prescription for at least 90 days in a calendar year were classified as having received long-term opioid therapy. Multivariable analysis was conducted using generalized estimating equations. RESULTS Temporal trends significantly varied by region (p < 0.0001) and opioid-naïve status (p < 0.0001). Compared to 2013, opioid-naïve cancer survivors in the south and non-naïve survivors in the south and west experienced significant declines in long-term opioid therapy in 2015 and 2016. Significant declines were observed in 2016 for opioid-naïve and non-naïve cancer survivors residing in the northeast and among opioid-naïve cancer survivors living in the Midwest. CONCLUSION The annual trends in the receipt of long-term opioid therapy significantly varied by region among older cancer survivors. Variation in a clinical practice suggests the need for more research and interventions to improve efficiency, process, cost, and quality of care.
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Affiliation(s)
- Derrick C Gibson
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch - Galveston, Galveston, TX, USA
| | - Mukaila A Raji
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch - Galveston, Galveston, TX, USA
| | - Jacques G Baillargeon
- Department of Preventive Medicine and Population Health, Office of Biostatistics, University of Texas Medical Branch - Galveston, Galveston, TX, USA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, Office of Biostatistics, University of Texas Medical Branch - Galveston, Galveston, TX, USA
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Kuo YF, Baillargeon J, Raji MA. Overdose deaths from nonprescribed prescription opioids, heroin, and other synthetic opioids in Medicare beneficiaries. J Subst Abuse Treat 2021; 124:108282. [PMID: 33771281 DOI: 10.1016/j.jsat.2021.108282] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 06/04/2020] [Revised: 12/06/2020] [Accepted: 01/01/2021] [Indexed: 11/30/2022]
Abstract
IMPORTANCE Opioid use disorder in the United States' Medicare population increased from 10 to 24 per 1000 from 2012 to 2018. Understanding the changes in the patterns of opioid overdose mortality over time holds broad clinical and public health relevance. OBJECTIVE To examine trends and correlates of opioid overdose deaths from nonprescribed prescription opioids, heroin, and other synthetic opioids. DESIGN, SETTING AND PARTICIPANTS The study used Medicare-National Death Index linked data from a 20% national sample to identify a retrospective cohort who died from opioid overdose in 2012-2016. The study analyzed data from December 2019 to March 2020. MAIN OUTCOME AND MEASURES We examined type of opioid overdose deaths; percentage of opioid deaths without documented opioid prescriptions in the prior 6 months; and percentage of deaths from heroin or synthetic opioids among people on long-term prescription opioids whose prescribers reduced or subsequently discontinued their opioids. The study also calculated the proportion receiving medication for addiction treatment. The study included demographic characteristics and 15 chronic or potentially disabling conditions associated with overall opioid overdose deaths. RESULTS Among 6932 Medicare enrollees who died from opioid overdose in 2012-2016, the mean (SD) age was 52.9 (12.1) years, 45.4% were women, and 82.4% were white. The number of opioid overdose deaths increased from 1159 in 2012 to 1697 in 2016. In the adjusted analyses, opioid deaths occurring in 2016 were 2.6 times more likely to be due to heroin or other synthetic opioids than opioid deaths occurring in 2012. The prescription opioid deaths occurring without a documented opioid prescription in the 6 months before death increased from 6.8% in 2012 to 11.7% in 2016. Factors associated with such deaths, assessed in a stepwise logistic regression model, included metropolitan or rural residence and diagnosis of opioid use disorder. Among people with long-term opioid use whose prescription opioids were reduced in the 6 months before death, the percentage of deaths attributable to heroin and other synthetic opioids increased from 17% in 2012 to 47% in 2016. Factors associated with such deaths, assessed in a stepwise logistic regression model, included diagnosis of hepatitis and opioid use disorder. Less than 10% of these enrollees received medication for addiction treatment. CONCLUSION There were substantial increases in patients' obtaining opioid analgesics from unlicensed sources and in overdose deaths from nonprescribed opioids during the study period (2012-2016). Increased access to pain management and opioid use disorder treatments is critical to reducing the opioid overdose deaths in the United States.
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Affiliation(s)
- Yong-Fang Kuo
- Department of Internal Medicine and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555-0177, United States of America; Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX 77555-1148, United States of America; Institute for Translational Science, University of Texas Medical Branch, Galveston, TX 77555-0342, United States of America.
| | - Jacques Baillargeon
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX 77555-1148, United States of America; Institute for Translational Science, University of Texas Medical Branch, Galveston, TX 77555-0342, United States of America
| | - Mukaila A Raji
- Department of Internal Medicine and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555-0177, United States of America; Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX 77555-1148, United States of America
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Kuo YF, Agrawal P, Chou LN, Jupiter D, Raji MA. Assessing Association Between Team Structure and Health Outcome and Cost by Social Network Analysis. J Am Geriatr Soc 2020; 69:10.1111/jgs.16962. [PMID: 33289067 PMCID: PMC8166955 DOI: 10.1111/jgs.16962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/03/2020] [Revised: 10/01/2020] [Accepted: 11/05/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND/OBJECTIVE To assess the impact of team structure composition and degree of collaboration among various providers on process and outcomes of primary care. DESIGN Cross-sectional study. SETTING Data from 20% randomly selected primary care service areas in the 2015 Medicare claims were used to identify primary care practices. PARTICIPANTS 449,460 patients with diabetes, heart failure, or chronic obstructive pulmonary disease cared for by the identified primary care practices. MEASUREMENTS Social network analysis measures, including edge density, degree centralization, and betweenness centralization for each practice. RESULTS When compared with practices with MDs and nurse practitioners (NPs) or/and physicians assistants (PAs), the practices with MDs had only lower degree of centralization and higher MD-to-MD connectedness. Within the primary care practices comprising MDs, NPs, or/and PAs, the nonphysician providers were more connected (measured as edge density) to all providers in the practice but with higher degree of centralization compared with the MDs in the practice. After adjusting for patient characteristics and type of practice, higher edge density was associated with lower odds of hospitalization (odds ratio (OR) = 0.89, 95% confidence interval (CI) = 0.79-0.99), emergency department (ER) admission (OR = 0.80, 95% CI = 0.70-0.92), and total spending (cost ratio (CR) = 0.86, standard error of the mean (SE) = 0.038). Conversely, higher degree centralization was associated with higher rates of hospitalization (OR = 1.15, 95% CI = 1.03-1.28), ER admission (OR = 1.23, 95% CI = 1.08-1.40), and total spending (CR = 1.14, SE = 0.037). However, higher degree centralization was associated with lower rates of potentially inappropriate medications (OR = 0.90, 95% CI = 0.81-0.99). Team leadership by an NP versus an MD was similar in the rate of ER admissions, hospitalizations, or total spending. CONCLUSION Our findings showed that highly connected primary care practices with high collaborative care and less top-down MD-centered authority have lower odds of hospitalization, fewer ER admissions, and less total spending; findings likely reflecting better communication and more coordinated care of older patients.
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Affiliation(s)
- Yong-Fang Kuo
- Department of Internal Medicine and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, 77555-0177
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, 77555-1148
| | - Pooja Agrawal
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555
| | - Lin-Na Chou
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, 77555-1148
| | - Daniel Jupiter
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, 77555-1148
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, 77555-0165
| | - Mukaila A. Raji
- Department of Internal Medicine and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, 77555-0177
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Anjorin AA, Abioye AI, Asowata OE, Soipe A, Kazeem MI, Adesanya IO, Raji MA, Adesanya M, Oke FA, Lawal FJ, Kasali BA, Omotayo MO. Comorbidities and the COVID-19 pandemic dynamics in Africa. Trop Med Int Health 2020; 26:2-13. [PMID: 33012053 PMCID: PMC7675305 DOI: 10.1111/tmi.13504] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The debate around the COVID‐19 response in Africa has mostly focused on effects and implications of public health measures, in light of the socio‐economic peculiarities of the continent. However, there has been limited exploration of the impact of differences in epidemiology of key comorbidities, and related healthcare factors, on the course and parameters of the pandemic. We summarise what is known about (a) the pathophysiological processes underlying the interaction of coinfections and comorbidities in shaping prognosis of COVID‐19 patients, (b) the epidemiology of key coinfections and comorbidities, and the state of related healthcare infrastructure that might shape the course of the pandemic, and (c) implications of (a) and (b) for pandemic management and post‐pandemic priorities. There is a critical need to generate empirical data on clinical profiles and the predictors of morbidity and mortality from COVID‐19. Improved protocols for acute febrile illness and access to diagnostic facilities, not just for SARS‐CoV‐2 but also other viral infections, are of urgent importance. The role of malaria, HIV/TB and chronic malnutrition on pandemic dynamics should be further investigated. Although chronic non‐communicable diseases account for a relatively lighter burden, they have a significant effect on COVID‐19 prognosis, and the fragility of care delivery systems implies that adjustments to clinical procedures and re‐organisation of care delivery that have been useful in other regions are unlikely to be feasible. Africa is a large region with local variations in factors that can shape pandemic dynamics. A one‐size‐fits‐all response is not optimal, but there are broad lessons relating to differences in epidemiology and healthcare delivery factors, that should be considered as part of a regional COVID‐19 response framework.
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Affiliation(s)
- A A Anjorin
- Department of Microbiology (Virology Research), Lagos State University, Ojo, Lagos, Nigeria
| | - A I Abioye
- Population Health Science Program & Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - O E Asowata
- Africa Health Research Institute, Durban, South Africa.,School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - A Soipe
- Department of Medicine, Division of Nephrology, Upstate Medical University, Syracuse, NY, USA
| | - M I Kazeem
- Department of Biochemistry, Lagos State University, Ojo, Lagos, Nigeria
| | | | - M A Raji
- Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - M Adesanya
- Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,CPT US Army Reserve, Houston, TX, USA.,Nursing Department, University of Texas at Arlington, Arlington, TX, USA
| | - F A Oke
- Department of Internal Medicine, Brookdale University Hospital Medical Centre, New York City, NY, USA
| | - F J Lawal
- Department of Infectious Diseases, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - B A Kasali
- Independent Researcher, Seattle, WA, USA
| | - M O Omotayo
- Centre for Global Health and Division of Pediatric Global Health, Massachusetts General Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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48
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Affiliation(s)
- Rahul Shah
- School of Medicine, University of Texas Medical Branch, Galveston, TX
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX
| | - Jordan Westra
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX
| | - Yu-Li Lin
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX
| | - Mukaila A. Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
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Baillargeon J, Urban RJ, Raji MA, Westra JR, Williams SB, Lopez DS, Kuo YF. Testosterone Prescribing Among Women in the USA, 2002-2017. J Gen Intern Med 2020; 35:1891-1893. [PMID: 31637649 PMCID: PMC7280376 DOI: 10.1007/s11606-019-05365-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/13/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Jacques Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA.
| | - Randall J Urban
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, USA
| | - Mukaila A Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, USA
| | - Jordan R Westra
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Stephen B Williams
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, USA.,Division of Urology, University of Texas Medical Branch, Galveston, TX, USA
| | - David S Lopez
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
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50
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Jazzar U, Shan Y, Klaassen Z, Freedland SJ, Kamat AM, Raji MA, Masel T, Tyler DS, Baillargeon J, Kuo YF, Mehta HB, Bergerot CD, Williams SB. Impact of Alzheimer's disease and related dementia diagnosis following treatment for bladder cancer. J Geriatr Oncol 2020; 11:1118-1124. [PMID: 32354675 DOI: 10.1016/j.jgo.2020.04.009] [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] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Our objective was to assess the incidence of Alzheimer's Disease and related dementia diagnosis following treatment for muscle-invasive bladder cancer and impact on survival outcomes. MATERIALS AND METHODS A total of 4814 patients diagnosed with clinical stage T2-T4a, N0, M0 bladder cancer between January 1, 2002 to December 31, 2011 using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database were identified. Alzheimer's disease and related dementia diagnosis was identified using International Statistical Classification of Disease-Ninth Edition outpatient and inpatient codes. Incidence of dementia following treatment were calculated and reported as dementia cases per 10,000 person-years. Cox proportional hazards models were used to assess the impact of dementia on survival outcomes. RESULTS Of the 4814 patients, 2403 (49.9%) underwent radical cystectomy (RC) and 2411 (50.1%) underwent radiotherapy (RTX) and/or chemotherapy (CTX). Overall, 837 (17.4%) patients developed Alzheimer's disease and related dementia following bladder cancer treatment. There was no significant difference in the incidence of Alzheimer's disease and related dementia following either treatment. Patients diagnosed with Alzheimer's disease and related dementia had worse overall (Hazard Ratio (HR), 2.64; 95% Confidence Interval (CI), 2.41-2.89) and cancer-specific (HR, 2.45; 95% CI, 2.18-2.76) survival than those without a dementia diagnosis following treatment. CONCLUSION While we observed no difference in new-onset Alzheimer's disease and related dementia diagnosis following RC or RTX and/or CTX, patients with a Alzheimer's and related dementia diagnosis was associated with worse overall and cancer-specific survival. These findings have important implications for screening and the development of targeted interventions for improving outcomes in older adults following complex cancer treatments, as observed in this bladder cancer population.
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Affiliation(s)
- Usama Jazzar
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America
| | - Yong Shan
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America
| | - Stephen J Freedland
- Department of Urology, Cedars Sinai Medical Center, Los Angeles, CA, United States of America
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Mukaila A Raji
- Department of Preventive Medicine and Community Health, Sealy Center of Aging, The University of Texas Medical Branch, Galveston, TX, United States of America
| | - Todd Masel
- Department of Neurology, The University of Texas Medical Branch, Galveston, TX, United States of America
| | - Douglas S Tyler
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America
| | - Jacques Baillargeon
- Department of Preventive Medicine and Community Health, Sealy Center of Aging, The University of Texas Medical Branch, Galveston, TX, United States of America
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, Sealy Center of Aging, The University of Texas Medical Branch, Galveston, TX, United States of America
| | - Hemalkumar B Mehta
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America
| | - Cristiane D Bergerot
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Stephen B Williams
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America.
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