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Saoud F, AlHenaidi M, AlOtaibi H, AlEnezi A, Mohammed M, AlOtaibi F, AlShammari D, AlKharqawi S, AlMayas H, AlMathkour H, Akhtar S. Prevalence of and factors associated with multimorbidity among adults in Kuwait. BMC Public Health 2024; 24:768. [PMID: 38475726 DOI: 10.1186/s12889-024-18298-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND This cross-sectional study aimed to assess the prevalence of morbidity i.e., one morbidity and multimorbidity (≥ 2 morbid conditions) among adults in Kuwait and to examine the sociodemographic and lifestyle factors associated with morbidity as a multinomial outcome in the study population. METHODS The data were collected from January 26, 2021, to February 3, 2021, using an electronic questionnaire, which was distributed on social media platforms. The consent form was attached with the questionnaire and the participants were requested to sign the consent form before completing the questionnaire. The prevalences (%) of each morbidity and multimorbidity were computed. Multivariable polychotomous logistic regression analysis was used to evaluate the association between the demographic and lifestyle factors with morbidity as a multinomial outcome. RESULTS Of 3572 respondents included, 89% were Kuwaiti, 78.3% females and 66% were 21- 40 years old. The prevalence of multimorbidity and one morbidity respectively was 27.4% and 29.7%. The prevalence of multimorbidity with two, three, four or five ill-health conditions were 14.3%, 7.4%, 3.5%, and 1.2%, respectively. A higher prevalence of multimorbidity was among respondents over 60 years of age (71%) and Kuwaiti nationals (28.9%). The final multivariable polychotomous logistic regression model revealed that age, sex, nativity, sedentary lifestyle, smoking, and alcohol drinking were significantly (p < 0.05) associated with multimorbidity. However, age and alcohol drinking were significant (p < 0.05) predictors of one morbidity. CONCLUSION This study provides evidence that multimorbidity is more prevalent among the elderly, females, and Kuwaiti nationals. Sedentary behaviour, smoking and alcohol consumption were significantly and independently associated with multimorbidity. These findings highlight the burden of multimorbidity and should be considered in the development of future prevention programs.
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Affiliation(s)
- Fajer Saoud
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Maryam AlHenaidi
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Hajer AlOtaibi
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Asayel AlEnezi
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Mariam Mohammed
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Fatemah AlOtaibi
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Danah AlShammari
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Sebakah AlKharqawi
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Hadil AlMayas
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Hatoun AlMathkour
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Saeed Akhtar
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait.
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Russmann S, Martinelli F, Jakobs F, Pannu M, Niedrig DF, Burden AM, Kleber M, Béchir M. Identification of Medication Prescription Errors and Factors of Clinical Relevance in 314 Hospitalized Patients for Improved Multidimensional Clinical Decision Support Algorithms. J Clin Med 2023; 12:4920. [PMID: 37568322 PMCID: PMC10419486 DOI: 10.3390/jcm12154920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Potential medication errors and related adverse drug events (ADE) pose major challenges in clinical medicine. Clinical decision support systems (CDSSs) help identify preventable prescription errors leading to ADEs but are typically characterized by high sensitivity and low specificity, resulting in poor acceptance and alert-overriding. With this cross-sectional study we aimed to analyze CDSS performance, and to identify factors that may increase CDSS specificity. Clinical pharmacology services evaluated current pharmacotherapy of 314 patients during hospitalization across three units of two Swiss tertiary care hospitals. We used two CDSSs (pharmaVISTA and MediQ), primarily for the evaluation of drug-drug interactions (DDI). Additionally, we evaluated potential drug-disease, drug-age, drug-food, and drug-gene interactions. Recommendations for change of therapy were forwarded without delay to treating physicians. Among 314 patients, automated analyses by both CDSSs produced an average of 15.5 alerts per patient. In contrast, additional expert evaluation resulted in only 0.8 recommendations per patient to change pharmacotherapy. For clinical pharmacology experts, co-factors such as comorbidities and laboratory results were decisive for the classification of CDSS alerts as clinically relevant in individual patients in about 70% of all decisions. Such co-factors should therefore be used for the development of multidimensional CDSS alert algorithms with improved specificity. In combination with local expert services, this poses a promising approach to improve drug safety in clinical practice.
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Affiliation(s)
- Stefan Russmann
- Swiss Federal Institute of Technology Zurich (ETHZ), 8093 Zurich, Switzerland; (F.M.); (F.J.); (A.M.B.)
- Faculty of Medicine, University of Nicosia, 2408 Egkomi, Cyprus; (M.P.); (M.B.)
- Drugsafety.ch, Seestrasse 221, 8703 Küsnacht, Switzerland;
- Department of Internal Medicine, Clinic Hirslanden Zurich, 8032 Zurich, Switzerland;
- Center for Internal Medicine, Clinic Hirslanden Aarau, 5001 Aarau, Switzerland
| | - Fabiana Martinelli
- Swiss Federal Institute of Technology Zurich (ETHZ), 8093 Zurich, Switzerland; (F.M.); (F.J.); (A.M.B.)
| | - Franziska Jakobs
- Swiss Federal Institute of Technology Zurich (ETHZ), 8093 Zurich, Switzerland; (F.M.); (F.J.); (A.M.B.)
| | - Manjinder Pannu
- Faculty of Medicine, University of Nicosia, 2408 Egkomi, Cyprus; (M.P.); (M.B.)
| | - David F. Niedrig
- Drugsafety.ch, Seestrasse 221, 8703 Küsnacht, Switzerland;
- Hospital Pharmacy, Clinic Hirslanden Zurich, 8032 Zurich, Switzerland
| | - Andrea Michelle Burden
- Swiss Federal Institute of Technology Zurich (ETHZ), 8093 Zurich, Switzerland; (F.M.); (F.J.); (A.M.B.)
| | - Martina Kleber
- Department of Internal Medicine, Clinic Hirslanden Zurich, 8032 Zurich, Switzerland;
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Markus Béchir
- Faculty of Medicine, University of Nicosia, 2408 Egkomi, Cyprus; (M.P.); (M.B.)
- Center for Internal Medicine, Clinic Hirslanden Aarau, 5001 Aarau, Switzerland
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Somi M, Ostadrahimi A, Gilani N, Haji Kamanaj A, Hassannezhad S, Faramarzi E. Patterns and Predictors of Multimorbidity in the Azar Cohort. ARCHIVES OF IRANIAN MEDICINE 2023; 26:8-15. [PMID: 37543916 PMCID: PMC10685807 DOI: 10.34172/aim.2023.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 02/27/2022] [Indexed: 08/08/2023]
Abstract
BACKGROUND The co-existence of chronic diseases (CDs), a condition defined as multimorbidity (MM), is becoming a major public health issue. Therefore, we aimed to determine the patterns and predictors of MM in the Azar Cohort. METHODS We evaluated the prevalence of MM in 15,006 (35-70-year old) subjects of the Azar Cohort Study. MM was defined as the co-existence of two or more CDs. Data on the subjects' socioeconomic status, demographics, sleeping habits, and physical activity were collected using questionnaires. RESULTS The overall prevalence of MM was 28.1%. The most prevalent CDs, in decreasing order, were obesity, hypertension, depression, and diabetes. Obesity, depression, and diabetes were the most co-occurring CDs. The MM risk increased significantly with age, illiteracy, and in females. Also, the subjects within the lowest tertile of physical activity level (OR=1.89; 95% CI: 1.75-2.05) showed higher MM risk than those with the highest level of physical activity. Findings regarding current smoking status indicated that being an ex-smoker or smoker of other types of tobacco significantly increased the risk of MM. CONCLUSION The reduction of MM is possible by promoting public health from an early age among people of various socioeconomic conditions. It is vital to offer the necessary health support to the aging population of Iran.
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Affiliation(s)
- Mohammdhossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Gilani
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arash Haji Kamanaj
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Hassannezhad
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Faramarzi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Singh K, Alomari A, Lenjawi B. Prevalence of Multimorbidity in the Middle East: A Systematic Review of Observational Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16502. [PMID: 36554382 PMCID: PMC9778740 DOI: 10.3390/ijerph192416502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/24/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND There has not been a review that evaluated the prevalence of multimorbidity in the Middle East. This review aims to measure the prevalence, demographic factors, and consequences of multimorbidity in the Middle East region. STUDY DESIGN A quantitative systematic review includes cross-sectional and longitudinal cohort studies. METHODS The prevalence systematic review approach from the Joanna Briggs Institute was applied. We searched PsychINFO, MEDLINE, EMCARE, CINAHL, Scopus, Science Direct, and the Cochrane Central Register of Controlled Trials. Data were extracted methodically in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Studies written in English and released between 2012 and March 2022 were included. For the meta-analysis, a random-effects model was applied. PROSPERO registration number: CRD42022335534. RESULTS The final sample consisted of eight cohort and observational studies. The number of participants varied from 354 to 796,427. Multimorbidity was present in all populations with a prevalence of 21.8% (95% confidence interval (CI): 21.7-21.8%). CONCLUSION Multimorbidity affects a significant section of the world's population. A uniform operationalization of multimorbidity is required in the Middle East in order to enable reliable estimates of illness burden, effective disease management, and resource distribution.
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Gharekhani A, Somi M, Ostadrahimi A, Hatefi A, Haji Kamanaj A, Hassannezhad S, Faramarzi E. Prevalence and Predicting Risk Factors of Polypharmacy in Azar Cohort Population. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH 2022; 21:e126922. [PMID: 36060920 PMCID: PMC9420226 DOI: 10.5812/ijpr-126922] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/12/2022] [Accepted: 04/03/2022] [Indexed: 11/16/2022]
Abstract
Background As polypharmacy has some medically negative impacts, it has become a challenging issue for public health and affected people. Therefore, we decided to investigate the prevalence of polypharmacy and its predicting risk factors in the Azar cohort population. Methods In this cross-sectional population-based cohort study, the prevalence of polypharmacy was evaluated in 15,001 subjects who participated in the Azar cohort study. We measured demographic characteristics (age, gender, socioeconomic status, smoking status, marital status, and education level), physical activity level, body mass index (BMI), blood pressure, multimorbidity (coexistence of two or more chronic diseases (CDs)), and polypharmacy status (a daily intake of five or more medicines for a minimum of 90 days). Results Based on our results, 9.51% of the population had polypharmacy. The five most prescribed medications were drugs acting on the cardiovascular system (19.9%), central nervous system (16.7%), endocrine system (13.3%), NSAIDs (11.5%), and drugs used for musculoskeletal and joint diseases (11.4%). Being female, illiterate, and having the lowest tertile of physical activity level significantly increased the risk of polypharmacy. The risk of polypharmacy was 49.36 times higher in patients with four or more CDs than in those without. Conclusions Our study emphasized the importance of routine monitoring to evaluate polypharmacy among those aged 35 to 59 and the elderly. Physicians should carefully assess drug suitability, especially in multimorbid and obese patients, to prevent excessive polypharmacy and its potentially negative impacts.
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Affiliation(s)
- Afshin Gharekhani
- Department of Clinical Pharmacy (Pharmacotherapy), Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammadhossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ayda Hatefi
- Student Research Committee, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arash Haji Kamanaj
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Hassannezhad
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Faramarzi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding Author: Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Golgahsht st., Tabriz, Iran.
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Odland ML, Ismail S, Sepanlou SG, Poustchi H, Sadjadi A, Pourshams A, Marshall T, Witham MD, Malekzadeh R, Davies JI. Multimorbidity and associations with clinical outcomes in a middle-aged population in Iran: a longitudinal cohort study. BMJ Glob Health 2022; 7:bmjgh-2021-007278. [PMID: 35550337 PMCID: PMC9109019 DOI: 10.1136/bmjgh-2021-007278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 04/19/2022] [Indexed: 12/05/2022] Open
Abstract
Background As the populations of lower-income and middle-income countries age, multimorbidity is increasing, but there is little information on its long-term consequences. We aimed to show associations between multimorbidity and outcomes of mortality and hospitalisation in Iran, a middle-income country undergoing rapid economic transition. Methods We conducted a secondary analysis of longitudinal data collected in the Golestan Cohort Study. Data on demographics, morbidities and lifestyle factors were collected at baseline, and information on hospitalisations or deaths was captured annually. Logistic regression was used to analyse the association between baseline multimorbidity and 10-year mortality, Cox-proportional hazard models to measure lifetime risk of mortality and zero-inflation models to investigate the association between hospitalisation and multimorbidity. Multimorbidity was classified as ≥2 conditions or number of conditions. Demographic, lifestyle and socioeconomic variables were included as covariables. Results The study recruited 50 045 participants aged 40–75 years between 2004 and 2008, 47 883 were available for analysis, 416 (57.3%) were female and 12 736 (27.94%) were multimorbid. The odds of dying at 10 years for multimorbidity defined as ≥2 conditions was 1.99 (95% CI 1.86 to 2.12, p<0.001), and it increased with increasing number of conditions (OR of 3.57; 95% CI 3.12 to 4.08, p<0.001 for ≥4 conditions). The survival analysis showed the hazard of death for those with ≥4 conditions was 3.06 (95% CI 2.74 to 3.43, p<0.001). The number of hospital admissions increased with number of conditions (OR of not being hospitalised of 0.36; 95% CI 0.31 to 0.52, p<0.001, for ≥4 conditions). Conclusion The long-terms effects of multimorbidity on mortality and hospitalisation are similar in this population to those seen in high-income countries.
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Affiliation(s)
- Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK .,Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.,Malawi-Liverpool-Wellcome Trust Research Institute, Blantyre, Malawi
| | - Samiha Ismail
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sadaf G Sepanlou
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Sadjadi
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Pourshams
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Reza Malekzadeh
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
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Li P, Sun Z, Xu J. Unplanned extubation among critically ill adults: A systematic review and meta-analysis. Intensive Crit Care Nurs 2022; 70:103219. [DOI: 10.1016/j.iccn.2022.103219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 01/10/2023]
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Asogwa OA, Boateng D, Marzà-Florensa A, Peters S, Levitt N, van Olmen J, Klipstein-Grobusch K. Multimorbidity of non-communicable diseases in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open 2022; 12:e049133. [PMID: 35063955 PMCID: PMC8785179 DOI: 10.1136/bmjopen-2021-049133] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Multimorbidity is a major public health challenge, with a rising prevalence in low/middle-income countries (LMICs). This review aims to systematically synthesise evidence on the prevalence, patterns and factors associated with multimorbidity of non-communicable diseases (NCDs) among adults residing in LMICs. METHODS We conducted a systematic review and meta-analysis of articles reporting prevalence, determinants, patterns of multimorbidity of NCDs among adults aged >18 years in LMICs. For the PROSPERO registered review, we searched PubMed, EMBASE and Cochrane libraries for articles published from 2009 till 30 May 2020. Studies were included if they reported original research on multimorbidity of NCDs among adults in LMICs. RESULTS The systematic search yielded 3272 articles; 39 articles were included, with a total of 1 220 309 participants. Most studies used self-reported data from health surveys. There was a large variation in the prevalence of multimorbidity; 0.7%-81.3% with a pooled prevalence of 36.4% (95% CI 32.2% to 40.6%). Prevalence of multimorbidity increased with age, and random effect meta-analyses showed that female sex, OR (95% CI): 1.48, 1.33 to 1.64, being well-off, 1.35 (1.02 to 1.80), and urban residence, 1.10 (1.01 to 1.20), respectively were associated with higher odds of NCD multimorbidity. The most common multimorbidity patterns included cardiometabolic and cardiorespiratory conditions. CONCLUSION Multimorbidity of NCDs is an important problem in LMICs with higher prevalence among the aged, women, people who are well-off and urban dwellers. There is the need for longitudinal data to access the true direction of multimorbidity and its determinants, establish causation and identify how trends and patterns change over time. PROSPERO REGISTRATION NUMBER CRD42019133453.
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Affiliation(s)
- Ogechukwu Augustina Asogwa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
- Department of Epidemiology & Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anna Marzà-Florensa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
| | - Sanne Peters
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
- The George Institute for Global Health, Imperial College London, London, UK
| | - Naomi Levitt
- Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Josefien van Olmen
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Ebrahimoghli R, Janati A, Sadeghi-Bazargani H, Hamishehkar H, Khalili-Azimi A. Incremental Healthcare Resource Utilization and Expenditures Associated with Cardiovascular Diseases in Patients with Diabetes: A Cross-Sectional Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:53-62. [PMID: 35017778 PMCID: PMC8743375 DOI: 10.30476/ijms.2020.87284.1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/16/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the most prevalent comorbid condition among patients with diabetes. The objective of this study is to determine the incremental healthcare resource utilization and expenditures (HRUE) associated with CVD comorbidity in diabetic patients. METHODS In a cross-sectional study, patients receiving antidiabetic drugs were identified using the 2014 database of the Iran Health Insurance Organization of East Azerbaijan province (Iran). The frequency of HRUE was the main outcome. Outcome measures were compared between diabetic patients with and without CVD comorbidity during 2014-2016. The generalized regression model was used to adjust for cofounders because of a highly skewed distribution of data. Negative binomial regression and gamma distribution model were applied for the count and expenditure data, respectively. RESULTS A total of 34,716 diabetic patients were identified, of which 21,659 (63%) had CVD comorbidity. The incremental healthcare resource utilization associated with CVD compared to non-CVD diabetic patients for physician services, prescription drugs, laboratory tests, and medical imaging was 5.9±0.34 (28% increase), 46±1.9 (46%), 12.9±0.66 (27%), and 0.16±0.40 (7%), respectively (all P<0.001). Similarly, extra health care costs associated with CVD comorbidity for physician services, prescription drugs, laboratory tests, and medical imaging were 10.6±0.67 million IRR (294.4±18.6 USD) (50% increase), 1.44±0.06 million IRR (40±1.6 USD) (32%), 8.36±0.57 million IRR (232.2±15.8 USD) (58%), 0.51±0.02 million IRR (14.1±0.5 USD) (24%), and 0.29±0.02 million IRR (8±0.5 USD) (22%), respectively (all P<0.001). CONCLUSION CVD comorbidity substantially increases HRUE in patients with diabetes. Our findings draw the attention of healthcare decision-makers to proactively prevent CVD comorbidity in diabetic patients.
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Affiliation(s)
- Reza Ebrahimoghli
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Janati
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hadi Hamishehkar
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atefeh Khalili-Azimi
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Interpersonal Continuity of Care and Its Effect on Health Care Utilizations and Expenditures for Diabetes: An Experience From a Fragmented Health System. J Ambul Care Manage 2021; 44:237-248. [PMID: 34009834 DOI: 10.1097/jac.0000000000000376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We aimed to quantify continuity of care (COC) and investigate its association with health care utilizations and expenditure among patients with diabetes. This was an observational retrospective cohort study using administrative claims database of Iranian Health Insurance Organization for East Azerbaijan Province, Iran. Standard indices of COC were calculated for each patient, and their associations with utilization outcomes were determined by applying general linear regression models. A total of 32 263 patients were included (mean age: 60.9 ± 14.5 years; 64% females). Higher levels of COC were associated with a reduced number and spending of all health care service categories.
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