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Hau EM, Sláma T, Essig S, Michel G, Wengenroth L, Bergstraesser E, von der Weid NX, Schindera C, Kuehni CE. Validation of self-reported cardiovascular problems in childhood cancer survivors by contacting general practitioners: feasibility and results. BMC PRIMARY CARE 2024; 25:81. [PMID: 38459512 PMCID: PMC10921568 DOI: 10.1186/s12875-024-02322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/23/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Epidemiological studies often rely on self-reported health problems and validation greatly improves study quality. In a study of late effects after childhood cancer, we validated self-reported cardiovascular problems by contacting general practitioners (GPs). This paper describes: (a) the feasibility of this approach; and (b) the agreement between survivor-reports and reports from their GP. METHODS The Swiss Childhood Cancer Survivor Study (SCCSS) contacts all childhood cancer survivors registered in the Swiss Childhood Cancer Registry since 1976 who survived at least 5 years from cancer diagnosis. We validated answers of all survivors who reported a cardiovascular problem in the questionnaire. Reported cardiovascular problems were hypertension, arrhythmia, congestive heart failure, myocardial infarction, angina pectoris, stroke, thrombosis, and valvular problems. In the questionnaire, we further asked survivors to provide a valid address of their GP and a consent for contact. We sent case-report forms to survivors' GPs and requested information on cardiovascular diagnoses of their patients. To determine agreement between information reported by survivors and GPs, we calculated Cohen's kappa (κ) coefficients for each category of cardiovascular problems. RESULTS We used questionnaires from 2172 respondents of the SCCSS. Of 290 survivors (13% of 2172) who reported cardiovascular problems, 166 gave consent to contact their GP and provided a valid address. Of those, 135 GPs (81%) replied, and 128 returned the completed case-report form. Survivor-reports were confirmed by 54/128 GPs (42%). Of the 54 GPs, 36 (28% of 128) confirmed the problems as reported by the survivors; 11 (9% of 128) confirmed the reported problem(s) and gave additional information on more cardiovascular outcomes; and seven GPs (5% of 128) confirmed some, but not all cardiovascular problems. Agreement between GPs and survivors was good for stroke (κ = 0.79), moderate for hypertension (κ = 0.51), arrhythmias (κ = 0.41), valvular problems (κ = 0.41) and thrombosis (κ = 0.56), and poor for coronary heart disease (κ = 0.15) and heart failure (κ = 0.32). CONCLUSIONS Despite excellent GP compliance, it was found unfeasible to validate self-reported cardiovascular problems via GPs because they do not serve as gatekeepers in the Swiss health care system. It is thus necessary to develop other validation methods to improve the quality of patient-reported outcomes.
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Affiliation(s)
- Eva-Maria Hau
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Tomáš Sláma
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Stefan Essig
- Center for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
| | - Gisela Michel
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Laura Wengenroth
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Eva Bergstraesser
- Paediatric Palliative Care and Children's Research Center CRC, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicolas X von der Weid
- Division of Paediatric Oncology/Haematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Christina Schindera
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Paediatric Oncology/Haematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
- Paediatric Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Liu H, Zhao Y, Qiao L, Yang C, Yang Y, Zhang T, Wu Q, Han J. Consistency between self-reported disease diagnosis and clinical assessment and under-reporting for chronic conditions: data from a community-based study in Xi'an, China. Front Public Health 2024; 12:1296939. [PMID: 38292908 PMCID: PMC10825002 DOI: 10.3389/fpubh.2024.1296939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
Aims The current study aims to investigate the consistency between the surveyees' self-reported disease diagnosis and clinical assessment of eight major chronic conditions using community-based survey data collected in Xi'an, China in 2017. With a focus on under-reporting patients, we aim to explore its magnitude and associated factors, to provide an important basis for disease surveillance, health assessment and resource allocation, and public health decision-making and services. Methods Questionnaires were administered to collect self-reported chronic condition prevalence among the study participants, while physical examinations and laboratory tests were conducted for clinical assessment. For each of the eight chronic conditions, the sensitivity, specificity, under-reporting, over-reporting, and agreement were calculated. Log-binomial regression analysis was employed to identify potential factors that may influence the consistency of chronic condition reporting. Results A total of 2,272 participants were included in the analysis. Four out of the eight chronic conditions displayed under-reporting exceeding 50%. The highest under-reporting was observed for goiter [85.93, 95% confidence interval (CI): 85.25-86.62%], hyperuricemia (83.94, 95% CI: 83.22-84.66%), and thyroid nodules (72.89, 95% CI: 72.02-73.76%). Log-binomial regression analysis indicated that senior age and high BMI were potential factors associated with the under-reporting of chronic condition status in the study population. Conclusion The self-reported disease diagnosis by respondents and clinical assessment data exhibit significant inconsistency for all eight chronic conditions. Large proportions of patients with multiple chronic conditions were under-reported in Xi'an, China. Combining relevant potential factors, targeted health screenings for high-risk populations might be an effective method for identifying under-reporting patients.
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Affiliation(s)
- Haobiao Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Yanru Zhao
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lichun Qiao
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Congying Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Ying Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Tianxiao Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
- National Anti-Drug Laboratory Shaanxi Regional Center, Xi'an, Shaanxi, China
| | - Qian Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Jing Han
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China
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Mose J, Jensen KH, Scheel-Hincke LL, Andersen-Ranberg K. Are self-reported medical conditions and medicine use from middle-aged and older adults credible? A validation study comparing Danish SHARE-data with National Health Register data. Ann Epidemiol 2023; 87:100-106. [PMID: 37903678 DOI: 10.1016/j.annepidem.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 09/06/2023] [Accepted: 09/25/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE Self-reported information on medical conditions and medicine use is widely used in epidemiological research. We investigated the validity of self-reported medical conditions and medicine use from Danish participants in the Survey of Health, Ageing and Retirement in Europe. METHODS Self-reported health data were linked at individual level with the National Patient Registry and the Danish National Prescription Registry (n = 5572). Agreement was assessed by kappa value and presented as sensitivity, specificity, predictive values, and odds ratios. RESULTS The agreement of self-reported medical conditions varied by type (κ = 0.23-0.67), lowest for cholesterol-related diseases, highest for diabetes. Self-reported medicine use varied by medication type (κ = 0.33-0.90) lowest for painkillers, highest for diabetes. Women had lower odds for self-reporting medicine use correctly but higher odds for self-reported diseases. Higher age was associated with lower agreement, while higher education with higher agreement. CONCLUSIONS Although Danish data from the Survey of Health, Ageing and Retirement in Europe on medical conditions and medicine vary, the data are valid for epidemiological use for most medicine data, and for diseases associated with hospitalizations or influencing everyday life. Caution is warranted for self-reported data from 70+ year olds and people with lower educational level.
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Affiliation(s)
- Jens Mose
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.
| | | | - Lasse Lybecker Scheel-Hincke
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark; Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Butters A, Blanch B, Kemp-Casey A, Do J, Yeates L, Leslie F, Semsarian C, Nedkoff L, Briffa T, Ingles J, Sweeting J. The Australian Genetic Heart Disease Registry: Protocol for a Data Linkage Study. JMIR Res Protoc 2023; 12:e48636. [PMID: 37728963 PMCID: PMC10551791 DOI: 10.2196/48636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Genetic heart diseases such as hypertrophic cardiomyopathy can cause significant morbidity and mortality, ranging from syncope, chest pain, and palpitations to heart failure and sudden cardiac death. These diseases are inherited in an autosomal dominant fashion, meaning family members of affected individuals have a 1 in 2 chance of also inheriting the disease ("at-risk relatives"). The health care use patterns of individuals with a genetic heart disease, including emergency department presentations and hospital admissions, are poorly understood. By linking genetic heart disease registry data to routinely collected health data, we aim to provide a more comprehensive clinical data set to examine the burden of disease on individuals, families, and health care systems. OBJECTIVE The objective of this study is to link the Australian Genetic Heart Disease (AGHD) Registry with routinely collected whole-population health data sets to investigate the health care use of individuals with a genetic heart disease and their at-risk relatives. This linked data set will allow for the investigation of differences in outcomes and health care use due to disease, sex, socioeconomic status, and other factors. METHODS The AGHD Registry is a nationwide data set that began in 2007 and aims to recruit individuals with a genetic heart disease and their family members. In this study, demographic, clinical, and genetic data (available from 2007 to 2019) for AGHD Registry participants and at-risk relatives residing in New South Wales (NSW), Australia, were linked to routinely collected health data. These data included NSW-based data sets covering hospitalizations (2001-2019), emergency department presentations (2005-2019), and both state-wide and national mortality registries (2007-2019). The linkage was performed by the Centre for Health Record Linkage. Investigations stratifying by diagnosis, age, sex, socioeconomic status, and gene status will be undertaken and reported using descriptive statistics. RESULTS NSW AGHD Registry participants were linked to routinely collected health data sets using probabilistic matching (November 2019). Of 1720 AGHD Registry participants, 1384 had linkages with 11,610 hospital records, 7032 emergency department records, and 60 death records. Data assessment and harmonization were performed, and descriptive data analysis is underway. CONCLUSIONS We intend to provide insights into the health care use patterns of individuals with a genetic heart disease and their at-risk relatives, including frequency of hospital admissions and differences due to factors such as disease, sex, and socioeconomic status. Identifying disparities and potential barriers to care may highlight specific health care needs (eg, between sexes) and factors impacting health care access and use. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48636.
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Affiliation(s)
- Alexandra Butters
- Clinical Genomics Laboratory, Centre for Population Genomics, Garvan Institute of Medical Research, Darlinghurst, Australia
- Clinical Genomics Laboratory, Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Bianca Blanch
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, Australia
| | - Anna Kemp-Casey
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Judy Do
- Clinical Genomics Laboratory, Centre for Population Genomics, Garvan Institute of Medical Research, Darlinghurst, Australia
- Clinical Genomics Laboratory, Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Australia
| | - Laura Yeates
- Clinical Genomics Laboratory, Centre for Population Genomics, Garvan Institute of Medical Research, Darlinghurst, Australia
- Clinical Genomics Laboratory, Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Felicity Leslie
- Clinical Genomics Laboratory, Centre for Population Genomics, Garvan Institute of Medical Research, Darlinghurst, Australia
- Clinical Genomics Laboratory, Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Australia
| | - Christopher Semsarian
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Perth, Australia
- Victor Change Cardiac Research Institute, Sydney, Australia
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Jodie Ingles
- Clinical Genomics Laboratory, Centre for Population Genomics, Garvan Institute of Medical Research, Darlinghurst, Australia
- Clinical Genomics Laboratory, Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Joanna Sweeting
- Clinical Genomics Laboratory, Centre for Population Genomics, Garvan Institute of Medical Research, Darlinghurst, Australia
- Clinical Genomics Laboratory, Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Australia
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Lee AJ, Sanchez D, Reyes-Dumeyer D, Brickman AM, Lantigua RA, Vardarajan BN, Mayeux R. Reliability and Validity of self-reported Vascular Risk Factors in a Multi-Ethnic Community Based Study of Aging and Dementia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.12.23288492. [PMID: 37131736 PMCID: PMC10153321 DOI: 10.1101/2023.04.12.23288492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
INTRODUCTION The reliability and validity of self-reported cardiovascular and cerebrovascular risk factors remains inconsistent in aging research. METHODS We assessed the reliability, validity, sensitivity, specificity, and percent agreement of self-reported hypertension, diabetes, and heart disease, in comparison with direct measures of blood pressure, hemoglobin A1c (HbA1c), and medication use in 1870 participants in a multiethic study of aging and dementia. RESULTS Reliability of self-reported for hypertension, diabetes, and heart disease was excellent. Agreement between self-reports and clinical measures was moderate for hypertension (kappa: 0.58), good for diabetes (kappa: 0.76-0.79), and moderate for heart disease (kappa: 0.45) differing slightly by age, sex, education, and race/ethnic group. Sensitivity and specificity for hypertension was 88.6%-78.1%, for diabetes was 87.7%-92.0% (HbA1c > 6.5%) or 92.7%-92.8% (HbA1c > 7%), and for heart disease was 85.8%-75.5%. DISCUSSION Self-reported history of hypertension, diabetes, and heart disease are reliable and valid compared to direct measurements or medication use.
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Teh R, Kerse N, Pillai A, Lumley T, Rolleston A, Kyaw TA, Connolly M, Broad J, Monteiro E, Clair VWS, Doughty RN. Atrial fibrillation incidence and outcomes in two cohorts of octogenarians: LiLACS NZ. BMC Geriatr 2023; 23:197. [PMID: 36997900 PMCID: PMC10064671 DOI: 10.1186/s12877-023-03902-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/17/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF), the most common cardiac arrhythmia in the general population, has significant healthcare burden. Little is known about AF in octogenarians. OBJECTIVE To describe the prevalence and incidence rate of AF in New Zealand (NZ) octogenarians and the risk of stroke and mortality at 5-year follow-up. DESIGN Longitudinal Cohort Study. SETTING Bay of Plenty and Lakes health regions of New Zealand. SUBJECTS Eight-hundred-seventy-seven (379 indigenous Māori, 498 non-Māori) were included in the analysis. METHODS AF, stroke/TIA events and relevant co-variates were established annually using self-report and hospital records (and ECG for AF). Cox proportional-hazards regression models were used to determine the time dependent AF risk of stroke/TIA. RESULTS AF was present in 21% at baseline (Māori 26%, non-Māori 18%), the prevalence doubled over 5-years (Māori 50%, non-Māori 33%). 5-year AF incidence was 82.6 /1000-person years and at all times AF incidence for Māori was twice that of non-Māori. Five-year stroke/TIA prevalence was 23% (22% in Māori and 24% non- Māori), higher in those with AF than without. AF was not independently associated with 5-year new stroke/TIA; baseline systolic blood pressure was. Mortality was higher for Māori, men, those with AF and CHF and statin use was protective. In summary, AF is more prevalent in indigenous octogenarians and should have an increased focus in health care management. Further research could examine treatment in more detail to facilitate ethnic specific impact and risks and benefits of treating AF in octogenarians.
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Grants
- 06/068B, 09/068B Health Research Council of New Zealand
- 06/068B, 09/068B Health Research Council of New Zealand
- 06/068B, 09/068B Health Research Council of New Zealand
- 06/068B, 09/068B Health Research Council of New Zealand
- 06/068B, 09/068B Health Research Council of New Zealand
- 06/068B, 09/068B Health Research Council of New Zealand
- 06/068B, 09/068B Health Research Council of New Zealand
- 06/068B, 09/068B Health Research Council of New Zealand
- 06/068B, 09/068B Health Research Council of New Zealand
- 06/068B, 09/068B Health Research Council of New Zealand
- 345426/00 Ministry of Health, New Zealand
- 345426/00 Ministry of Health, New Zealand
- 345426/00 Ministry of Health, New Zealand
- 345426/00 Ministry of Health, New Zealand
- 345426/00 Ministry of Health, New Zealand
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Affiliation(s)
- Ruth Teh
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, PO Box 92019, Auckland, New Zealand.
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, PO Box 92019, Auckland, New Zealand
| | - Avinesh Pillai
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Thomas Lumley
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Anna Rolleston
- Manawa Ora, The Centre for Health, Tauranga, New Zealand
| | - Tin Aung Kyaw
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, PO Box 92019, Auckland, New Zealand
| | - Martin Connolly
- Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna Broad
- Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Elaine Monteiro
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, PO Box 92019, Auckland, New Zealand
| | - Valerie Wright-St Clair
- Centre for Active Ageing, Auckland University of Technology New Zealand, Auckland, New Zealand
| | - Robert N Doughty
- Department of Medicine, University of Auckland and Greenlane Cardiovascular Service, Auckland District Health Board, Auckland, New Zealand
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Tan KW, Lew JK, Lee PSS, Ong SK, Koh HL, Young DYL, Lee ES. Concordance of self-reporting of diabetes compared with medical records: A comparative study using polyclinic data in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023. [DOI: 10.47102/annals-acadmedsg.2022246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Introduction: Studies of concordance between patients’ self-report of diseases and a criterion standard (e.g. chart review) are usually conducted in epidemiological studies to evaluate the agreement of self-reported data for use in public health research. To our knowledge, there are no published studies on concordance for highly prevalent chronic diseases such as diabetes and pre-diabetes. The aims of this study were to evaluate the concordance between patients’ self-report and their medical records of diabetes and pre-diabetes diagnoses, and to identify factors associated with diabetes concordance.
Method: A cross-sectional, interviewer-administered survey was conducted on patients with chronic diseases after obtaining written consent to assess their medical notes. Interviewers were blinded to the participants’ profiles. Concordance was evaluated using Cohen’s kappa (κ). A multivariable logistic regression model was used to identify factors associated with diabetes concordance.
Results: There was substantial agreement between self-reported and medical records of diabetes diagnoses (κ=0.76) and fair agreement for pre-diabetes diagnoses (κ=0.36). The logistic regression model suggested that non-Chinese patients had higher odds of diabetes concordance than Chinese patients (odds ratio [OR]=4.10, 95% confidence interval [CI] 1.19–14.13, P=0.03). Patients with 3 or more chronic diseases (i.e. multimorbidity) had lower odds of diabetes concordance than patients without multimorbidity (OR=0.21, 95% CI 0.09–0.48, P<0.001).
Conclusion: Diabetes concordance was substantial, supporting the use of self-report of diabetes by patients with chronic diseases in the primary care setting for future research. Pre-diabetes concordance was fair and may have important clinical implications. Further studies to explore and improve health literacy and patient-physician communication are needed.
Keywords: Concordance, diabetes, multimorbidity, primary care, self-reported data
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Affiliation(s)
- Khai Wei Tan
- National Healthcare Group Polyclinics, Singapore
| | | | | | - Sin Kee Ong
- National Healthcare Group Polyclinics, Singapore
| | - Hui Li Koh
- National Healthcare Group Polyclinics, Singapore
| | | | - Eng Sing Lee
- National Healthcare Group Polyclinics, Singapore
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Lee AJ, Sanchez D, Reyes-Dumeyer D, Brickman AM, Lantigua RA, Vardarajan BN, Mayeux R. Reliability and Validity of Self-Reported Vascular Risk Factors: Hypertension, Diabetes, and Heart Disease, in a Multi-Ethnic Community Based Study of Aging and Dementia. J Alzheimers Dis 2023; 95:275-285. [PMID: 37483004 PMCID: PMC10578288 DOI: 10.3233/jad-230374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Queries for the presence of cardiovascular and cerebrovascular risk factors are typically assessed through self-report. However, the reliability and validity of self-reported cardiovascular and cerebrovascular risk factors remain inconsistent in aging research. OBJECTIVE To determine the reliability and validity of the most frequently self-reported vascular risk factors: hypertension, diabetes, and heart disease. METHODS 1,870 individuals aged 65 years or older among African Americans, Caribbean Hispanics, and white non-Hispanic individuals were recruited as part of a community study of aging and dementia. We assessed the reliability, validity, sensitivity, specificity, and percent agreement of self-reported hypertension, diabetes, and heart disease, in comparison with direct measures of blood pressure, hemoglobin A1c (HbA1c), and medication use. The analyses were subsequently stratified by age, sex, education, and ethnic group. RESULTS Reliability of self-reported hypertension, diabetes, and heart disease was excellent. Agreement between self-reports and clinical measures was moderate for hypertension (kappa: 0.58), good for diabetes (kappa: 0.76-0.79), and moderate for heart disease (kappa: 0.45) differing slightly by age, sex, education, and ethnic group. Sensitivity and specificity for hypertension was 88.6% -78.1%, for diabetes was 87.7% -92.0% (HbA1c ≥6.5%) or 92.7% -92.8% (HbA1c ≥7%), and for heart disease was 85.8% -75.5%. Percent agreement of self-reported was 87.0% for hypertension, 91.6% -92.6% for diabetes, and 77.4% for heart disease. CONCLUSION Ascertainment of self-reported histories of hypertension, diabetes, and heart disease are reliable and valid compared to direct measurements or medication use.
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Affiliation(s)
- Annie J. Lee
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University and the New York Presbyterian Hospital, New York, NY, USA
| | - Didi Sanchez
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University and the New York Presbyterian Hospital, New York, NY, USA
| | - Dolly Reyes-Dumeyer
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University and the New York Presbyterian Hospital, New York, NY, USA
| | - Adam M. Brickman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University and the New York Presbyterian Hospital, New York, NY, USA
| | - Rafael A. Lantigua
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University and the New York Presbyterian Hospital, New York, NY, USA
| | - Badri N. Vardarajan
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University and the New York Presbyterian Hospital, New York, NY, USA
| | - Richard Mayeux
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University and the New York Presbyterian Hospital, New York, NY, USA
- Department of Medicine, College of Physicians and Surgeons, Columbia University and the New York Presbyterian Hospital, New York, NY, USA
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Steinkirchner AB, Zimmermann ME, Donhauser FJ, Dietl A, Brandl C, Koller M, Loss J, Heid IM, Stark KJ. Self-report of chronic diseases in old-aged individuals: extent of agreement with general practitioner medical records in the German AugUR study. J Epidemiol Community Health 2022; 76:jech-2022-219096. [PMID: 36028306 PMCID: PMC9554083 DOI: 10.1136/jech-2022-219096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND To estimate prevalence and incidence of diseases through self-reports in observational studies, it is important to understand the accuracy of participant reports. We aimed to quantify the agreement of self-reported and general practitioner-reported diseases in an old-aged population and to identify socio-demographic determinants of agreement. METHODS This analysis was conducted as part of the AugUR study (n=2449), a prospective population-based cohort study in individuals aged 70-95 years, including 2321 participants with consent to contact physicians. Self-reported chronic diseases of participants were compared with medical data provided by their respective general practitioners (n=589, response rate=25.4%). We derived overall agreement, over-reporting/under-reporting, and Cohen's kappa and used logistic regression to evaluate the dependency of agreement on participants' sociodemographic characteristics. RESULTS Among the 589 participants (53.1% women), 96.9% reported at least one of the evaluated chronic diseases. Overall agreement was >80% for hypertension, diabetes, myocardial infarction, stroke, cancer, asthma, bronchitis/chronic obstructive pulmonary disease and rheumatoid arthritis, but lower for heart failure, kidney disease and arthrosis. Cohen's kappa was highest for diabetes and cancer and lowest for heart failure, musculoskeletal, kidney and lung diseases. Sex was the primary determinant of agreement on stroke, kidney disease, cancer and rheumatoid arthritis. Agreement for myocardial infarction and stroke was most compromised by older age and for cancer by lower educational level. CONCLUSION Self-reports may be an effective tool to assess diabetes and cancer in observational studies in the old and very old aged. In contrast, self-reports on heart failure, musculoskeletal, kidney or lung diseases may be substantially imprecise.
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Affiliation(s)
- Anna B Steinkirchner
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Martina E Zimmermann
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | | | - Alexander Dietl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Caroline Brandl
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
- Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Julika Loss
- Department for Epidemiology and Preventive Medicine, Medical Sociology, University of Regensburg, Regensburg, Germany
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Iris M Heid
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Klaus J Stark
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
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10
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Hu Z, Zheng B, Kaminga AC, Zhou F, Xu H. Association Between Functional Limitations and Incident Cardiovascular Diseases and All-Cause Mortality Among the Middle-Aged and Older Adults in China: A Population-Based Prospective Cohort Study. Front Public Health 2022; 10:751985. [PMID: 35223720 PMCID: PMC8873112 DOI: 10.3389/fpubh.2022.751985] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background The prevalence of functional limitations is relatively high among the middle-aged and older adults. However, the contribution of functional limitations to subsequent incident cardiovascular diseases (CVD) and death is unclear. This study aims to examine the association between functional limitations and incident CVD and all-cause mortality among the middle-aged and older adults. Methods This is a nationally representative prospective cohort study. Participants were middle-aged and older Chinese adults from The China Health and Retirement Longitudinal Study. Functional limitations were measured using activities of daily living (ADL) scale and instrumental activities of daily living (IADL) scale. Incident CVD and death were recorded at followed-up from June 1, 2011, up until August 31, 2018. Cox proportional hazards model was used to assess the association between functional limitations and incident CVD and all-cause mortality. Results A total of 11,013 participants were included in this study. During the 7 years of follow-up, 1,914 incident CVD and 1,182 incident deaths were identified. Participants with functional limitations were associated with a 23% increased risk of incident CVD (HR, 1.23, 95% CI:1.08,1.39) after adjusting for age, gender, residential area, marital status, education, smoking, alcohol drinking, sleep duration, nap duration, depression symptoms, social participation, history of hypertension, diabetes, dyslipidemia, use of hypertension medications, diabetes medications, and lipid-lowering therapy. Moreover, participants with functional limitations were associated with a 63% increased risk of all-cause mortality (HR,1.63, 95%CI: 1.41,1.89) after adjusting for potential confounders. Conclusions Functional limitations were significantly associated with subsequent incident CVD and death among the middle-aged and older Chinese adults.
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Affiliation(s)
- Zhao Hu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Baohua Zheng
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Atipatsa Chiwanda Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- Department of Mathematics and Statistics, Mzuzu University, Luwinga, Mzuzu, Malawi
| | - Feixiang Zhou
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
- *Correspondence: Huilan Xu
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11
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Maeda D, Matsue Y, Kagiyama N, Jujo K, Saito K, Kamiya K, Saito H, Ogasahara Y, Maekawa E, Konishi M, Kitai T, Iwata K, Wada H, Hiki M, Dotare T, Sunayama T, Kasai T, Nagamatsu H, Ozawa T, Izawa K, Yamamoto S, Aizawa N, Yonezawa R, Oka K, Momomura SI, Minamino T. Inaccurate recognition of own comorbidities is associated with poor prognosis in elderly patients with heart failure. ESC Heart Fail 2022; 9:1351-1359. [PMID: 35088546 PMCID: PMC8934983 DOI: 10.1002/ehf2.13824] [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: 06/29/2021] [Revised: 11/30/2021] [Accepted: 01/14/2022] [Indexed: 12/29/2022] Open
Abstract
Aims A patient's understanding of his or her own comorbidities is part of the recommended patient education for those with heart failure. The accuracy of patients' understanding of their comorbidities and its prognostic impact have not been reported. Methods and results Patients hospitalized for heart failure (n = 1234) aged ≥65 years (mean age: 80.1 ± 7.7 years; 531 females) completed a questionnaire regarding their diagnoses of diabetes, malignancy, stroke, hypertension, chronic obstructive pulmonary disease (COPD), and coronary artery disease (CAD). The patients were categorized into three groups based on the number of agreements between self‐reported comorbidities and provider‐reported comorbidities: low (1–2, n = 19); fair (3–4, n = 376); and high (5–6, n = 839) agreement groups. The primary outcome was a composite of all‐cause mortality or heart failure rehospitalization at 1 year. The low agreement group had more comorbidities and a higher prevalence of a history of heart failure. The agreement was good for diabetes (κ = 0.73), moderate for malignancy (κ = 0.56) and stroke (κ = 0.50), and poor‐to‐fair for hypertension (κ = 0.33), COPD (κ = 0.25), and CAD (κ = 0.30). The fair and low agreement groups had poorer outcomes than the good agreement group [fair agreement group: hazard ratio (HR): 1.25; 95% confidence interval (CI): 1.01–1.56; P = 0.041; low agreement group: HR: 2.74: 95% CI: 1.40–5.35; P = 0.003]. Conclusions The ability to recognize their own comorbidities among older patients with heart failure was low. Patients with less accurate recognition of their comorbidities may be at higher risk for a composite of all‐cause mortality or heart failure rehospitalization.
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Affiliation(s)
- Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Cardiology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.,Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan.,Department of Cardiovascular Biology and Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kentaro Jujo
- Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan
| | - Kazuya Saito
- Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Hiroshi Saito
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Rehabilitation, Kameda Medical Center, Kamogawa, Japan
| | - Yuki Ogasahara
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masaaki Konishi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Wada
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaru Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirofumi Nagamatsu
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Tetsuya Ozawa
- Department of Rehabilitation, Odawara Municipal Hospital, Odawara, Japan
| | - Katsuya Izawa
- Department of Rehabilitation, Kasukabe Chuo General Hospital, Kasukabe, Japan
| | - Shuhei Yamamoto
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Naoki Aizawa
- Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus, Okinawa, Japan
| | - Ryusuke Yonezawa
- Rehabilitation Center, Kitasato University Medical Center, Kitamoto, Japan
| | - Kazuhiro Oka
- Department of Rehabilitation, Saitama Citizens Medical Center, Saitama, Japan
| | | | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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12
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Lin CMA, Ng N, Orman A, Clement ND, Deehan DJ. Reliability of patient-reported comorbidities: a systematic review and meta-analysis. Postgrad Med J 2021; 99:postgradmedj-2021-140857. [PMID: 34645695 DOI: 10.1136/postgradmedj-2021-140857] [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: 07/17/2021] [Accepted: 09/18/2021] [Indexed: 11/04/2022]
Abstract
Self-reported questionnaires have become a widely adopted method of reviewing patients in clinical practice. This systematic review aimed to determine the reliability of patient-reported comorbidities and to identify which patient factors influence the reliability. Included studies assessed the reliability of at least one patient-reported comorbidity against their medical record or clinical assessment as gold standard. Twenty-four eligible studies were included in the meta-analysis. Only endocrine diseases (Cohen's Kappa Coefficient (CKC) 0.81 (95% CI 0.76 to 0.85)), consisting of diabetes mellitus (CKC 0.83 (95% CI 0.80 to 0.86)) and thyroid disease (CKC 0.68 (95% CI 0.50 to 0.86)), showed good-to-excellent reliability. Factors most frequently reported to influence concordance included age, sex and educational level.This systematic review demonstrated poor-to-moderate reliability for most systems, except for endocrine which showed good-to-excellent reliability. Although patient self-reporting can be a useful guide to clinical management, several patient factors were demonstrated to affect reliability therefore it should be avoided as a standalone measure.
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Affiliation(s)
| | - Nathan Ng
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alexander Orman
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nicholas D Clement
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Musculoskeletal Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - David J Deehan
- Musculoskeletal Department, Freeman Hospital, Newcastle upon Tyne, UK
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13
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Scott OW, Gott M, Edlin R, Moyes SA, Muru-Lanning M, Kerse N. Costs of inpatient hospitalisations in the last year of life in older New Zealanders: a cohort study. BMC Geriatr 2021; 21:514. [PMID: 34579669 PMCID: PMC8477539 DOI: 10.1186/s12877-021-02458-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Rapidly ageing populations means that many people now die in advanced age. This paper investigated public hospital and long-term care home costs in the 12 months before death in Māori and non-Māori of advanced age in New Zealand. Methods Data from an existing longitudinal study (LiLACS NZ) was used, in which 937 older New Zealanders were enrolled in 2010. At the time of this study, 213 Māori and 241 non-Māori in the cohort had died. National Health Index numbers were linked to the hospitalisation National Minimum Dataset to ascertain public hospitalisation and care home costs in the last year of life. Results The average total publicly funded hospital and long-term care home costs in the 12 months prior to death were $16,211 and $17,351 for Māori and non-Māori respectively. Non-Māori tended to have long lengths of stay in their last year of life, and non-Māori men had the highest proportion with high costs and long lengths of stay in care homes. Costs in the last year of life were 8.1 times higher in comparison to costs for individuals who did not die in the same time period. Conclusion Despite New Zealand’s commitment to providing an equitable level of healthcare, this study illustrated that ethnic and gender disparities are still apparent at the end of life. This raises questions as to whether money at the end of life is being spent appropriately, and how it could potentially be more equitably targeted to meet the diverse needs of older people and their families. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02458-6.
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Affiliation(s)
- Oliver W Scott
- School of Population Health, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - Merryn Gott
- School of Nursing, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Richard Edlin
- School of Population Health, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Simon A Moyes
- School of Population Health, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Marama Muru-Lanning
- James Henare Research Centre, University of Auckland, 18 Wynyard Street, Auckland Central, Auckland, 1010, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
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14
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Dietary Protein Intake and Transition between Frailty States in Octogenarians Living in New Zealand. Nutrients 2021; 13:nu13082843. [PMID: 34445004 PMCID: PMC8401514 DOI: 10.3390/nu13082843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/04/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022] Open
Abstract
Adequate nutritional status may influence progression to frailty. The purpose of this study is to determine the prevalence of frailty and examine the relationship between dietary protein intake and the transition between frailty states and mortality in advanced age. We used data from a longitudinal cohort study of Māori (80–90 years) and non-Māori (85 years). Dietary assessments (24-h multiple pass dietary recalls) were completed at the second year of follow-up (wave 2 and forms the baseline in this study). Frailty was defined using the Fried Frailty criteria. Multi-state modelling examined the association of protein intake and transitions between frailty states and death over four years. Over three quarters of participants were pre-frail or frail at baseline (62% and 16%, respectively). Those who were frail had a higher co-morbidity (p < 0.05), where frailty state changed, 44% showed a worsening of frailty status (robust → pre-frail or pre-frail → frail). Those with higher protein intake (g/kg body weight/day) were less likely to transition from robust to pre-frail [Hazard Ratio (95% Confidence Interval): 0.28 (0.08–0.91)] but also from pre-frail to robust [0.24 (0.06–0.93)]. Increased protein intake was associated with lower risk of transitioning from pre-frailty to death [0.19 (0.04–0.80)], and this association was moderated by energy intake [0.22 (0.03–1.71)]. Higher protein intake in this sample of octogenarians was associated with both better and worse outcomes.
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15
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Wham C, Moyes SA, Rolleston A, Adamson A, Kerse N, Teh R. Association between dietary protein intake and change in grip strength over time among adults of advanced age: Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ). Australas J Ageing 2021; 40:430-437. [PMID: 34124824 DOI: 10.1111/ajag.12968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine the association between dietary protein intake and change in grip strength (GS) over time among Māori and non-Māori of advanced age. METHODS Protein intake was estimated from 2×24h multiple pass recall (MPR) in 554 participants, and GS was measured yearly over five years. Anthropometric, physical activity and health data were collected. RESULTS The median weight-adjusted protein intake was low (for Māori and non-Māori men 1.05 and 0.98g/kg/day; for Māori and non-Māori women 0.87 and 0.91g/kg/day, respectively). There was a general decrease in GS over five years (mean % change of -2.38 ± 15.32 and -4.49 ± 21.92 for Māori and non-Māori women and -5.47 ± 16.09 and -1.81 ± 13.16 for Māori and non-Māori men yearly). Intake of protein was not related to GS at any of the five-year assessment points nor was it related to change over time. CONCLUSION Protein intake was low in this cohort of octogenarians and was not protective against loss of GS over five years.
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Affiliation(s)
- Carol Wham
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Simon A Moyes
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anna Rolleston
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ashley Adamson
- Institute of Health and Society and Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ruth Teh
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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16
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Atlas A, Muru-Lanning M, Moyes S, Kerse N, Jatrana S. Cell phone and technology use by octogenarians. J Prim Health Care 2021; 12:35-40. [PMID: 32223848 DOI: 10.1071/hc19042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/13/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Many countries, including New Zealand, have an aging population and new technologies such as cell phones may be useful for older people. AIM To examine cell phone and technology use by octogenarians. METHODS Te Puawaitanga O Nga Tapuwae Kia Ora Tonu- Life and Living in Advanced Age: A Cohort Study In New Zealand (LILACs NZ) cohort study data of Māori (aged 80-90 years, 11-year age band) and non-Māori (aged 85 years, 1-year age band) followed for 3 years was used to describe the prevalence among study participants of the use of the internet, cell phones and watching pay-per-view television. Association of these activities with living arrangement, congestive heart failure, chronic obstructive respiratory disease and participants' cognition were examined. RESULTS Technology use was relatively low among study octogenarians. Fewer Māori used cell phones and the internet (16% and 6%) than non-Māori (30% and 19%). Māori participants supported only by a pension were less likely to use cell phones than Māori with more income. More men watched pay-per-view television (e.g. SKY) than women. Living alone and having chronic lung disease were associated with not watching pay-per-view television. Participants who used the internet had higher cognition scores than others. Non-Māori women were less likely to watch pay-per-view television and non-Māori on a pension only were less likely to watch pay-per-view television than people on a higher income. Participants who lived alone were less likely to watch pay-per-view. CONCLUSION Relatively low use of technology may limit potential for health technology innovation for people of advanced age. Socioeconomic and ethnic disparities will amplify this.
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Affiliation(s)
- Astrid Atlas
- University of Auckland School of Population Health, General Practice and Primary Health Care, Auckland, New Zealand; and Corresponding author.
| | | | - Simon Moyes
- The University of Auckland, School of Population Health, Auckland, New Zealand
| | - Ngaire Kerse
- The University of Auckland, School of Population Health, Auckland, New Zealand
| | - Santosh Jatrana
- Swinburne University of Technology, Centre for Social Impact, Auckland, New Zealand
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17
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Delhey L, Shoults C, Johnson K, Orloff M, Faramawi MF, Delongchamp R. The difference between hypertension determined by self-report versus examination in the adult population of the USA: Continuous NHANES 1999-2016. J Public Health (Oxf) 2021; 43:316-324. [PMID: 31781770 DOI: 10.1093/pubmed/fdz132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/08/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Studies have considered the validity of self-reported hypertension relative to hypertension detected by examination; no study has explored trends in the difference between these two measures. Our objective was to calculate these differences overtime within subpopulations of the USA. METHODS We included non-Hispanic white, non-Hispanic black and Hispanic adults who participated in the National Health and Nutrition Examination Surveys from 1999 to 2016, in the analysis (N = 44 333). We subtracted self-reported hypertension from hypertension detected by examination to calculate blood pressure difference (BPD). We fit weighted linear regression models that included important covariates along with all combination of two- and three-way interactions to predict the BPD. We used the fitted lines of the models to depict the patterns of differences in the different subpopulations. RESULTS Age ≥ 45 years, lack of annual clinical visit, body mass index (BMI) < 25 and time were important factors associated with increased BPD. CONCLUSIONS People who are ≥ 45 years, have normal BMI, or do not have annual medical visits are more likely to have a bigger BPD. We can use the calculated BPD, to adjust estimates of the prevalence of self-reported hypertension.
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Affiliation(s)
- Leanna Delhey
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Catherine Shoults
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Kemmian Johnson
- Department of Internal Medicine, School of Medicine, Louisiana State University, New Orleans, LA 70112, USA
| | - Mohammed Orloff
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Mohammed F Faramawi
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.,Department of Internal Medicine, School of Medicine, Louisiana State University, New Orleans, LA 70112, USA
| | - Robert Delongchamp
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.,Department of Bioinformatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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18
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Cardwell K, Kerse N, Ryan C, Teh R, Moyes SA, Menzies O, Rolleston A, Broad J, Hughes CM. The Association Between Drug Burden Index (DBI) and Health-Related Outcomes: A Longitudinal Study of the 'Oldest Old' (LiLACS NZ). Drugs Aging 2020; 37:205-213. [PMID: 31919805 DOI: 10.1007/s40266-019-00735-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The prescribing of medications with anticholinergic and/or sedative properties is considered potentially inappropriate in older people (due to their side-effect profile), and the Drug Burden Index (DBI) is an evidence-based tool which measures exposure to these medications. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) is an ongoing longitudinal study investigating the determinants of healthy ageing. Using data from LiLACS NZ, this study aimed to determine whether a higher DBI was associated with poorer outcomes (hospitalisation, falls, mortality and cognitive function and functional status) over 36 months follow-up. METHODS LiLACS NZ consists of two cohorts: Māori (the indigenous population of New Zealand) aged ≥ 80 years and non-Māori aged 85 years at the time of enrolment. Data relating to regularly prescribed medications at baseline, 12 months and 24 months were used in this study. Medications with anticholinergic and/or sedative properties (i.e. medications with a DBI > 0) were identified using the Monthly Index of Medical Specialities (MIMS) medication formulary, New Zealand. DBI was calculated for everyone enrolled at each time point. The association between DBI at baseline and outcomes was evaluated throughout a series of 12-month follow-ups using negative binomial (hospitalisations and falls), Cox (mortality) and linear (cognitive function and functional status) regression analyses (significance p < 0.05). Regression models were adjusted for age, gender, general practitioner (GP) visits, socioeconomic deprivation, number of medicines prescribed and one of the following: prior hospitalisation, history of falls, baseline cognitive function [Modified Mini-Mental State Examination (3MS)] or baseline functional status [Nottingham Extended Activities of Daily Living (NEADL)]. RESULTS Full demographic data were obtained for 671, 510 and 403 individuals at baseline, 12 months and 24 months, respectively. Overall, 31%, 30% and 34% of individuals were prescribed a medication with a DBI > 0 at baseline, 12 months and 24 months, respectively. At baseline and 12 months, non-Māori had a greater mean DBI (0.28 ± 0.5 and 0.27 ± 0.5, respectively) compared to Māori (0.16 ± 0.3 and 0.18 ± 0.5, respectively). At baseline, the most commonly prescribed medicines with a DBI > 0 were zopiclone, doxazosin, amitriptyline and codeine. In Māori, a higher DBI was significantly associated with a greater risk of mortality: at 36 months follow-up, adjusted hazard ratio [95% confidence interval (CI)] 1.89 (1.11-3.20), p = 0.02. In non-Māori, a higher DBI was significantly associated with a greater risk of mortality [at 12 months follow-up, adjusted hazard ratio (95% CIs) 2.26 (1.09-4.70), p = 0.03] and impaired cognitive function [at 24 months follow-up, adjusted mean difference in 3MS score (95% CIs) 0.89 (- 3.89 to - 0.41), p = 0.02). CONCLUSIONS Using data from LiLACS NZ, a higher DBI was significantly associated with a greater risk of mortality (in Māori and non-Māori) and impaired cognitive function (in non-Māori). This highlights the importance of employing strategies to manage the prescribing of medications with a DBI > 0 in older adults.
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Affiliation(s)
- Karen Cardwell
- Northern Ireland Centre for Pharmacy Learning and Development, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK.
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Cristín Ryan
- School of Pharmacy and Pharmaceutical Science, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | - Ruth Teh
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Simon A Moyes
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Oliver Menzies
- Older People's Health, Auckland District Health Board, Auckland, New Zealand
| | | | - Joanna Broad
- Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Carmel M Hughes
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK
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Griffith LE, Gruneir A, Fisher KA, Upshur R, Patterson C, Perez R, Favotto L, Markle-Reid M, Ploeg J. Measuring multimorbidity series-an overlooked complexity comparison of self-report vs. administrative data in community-living adults: paper 2. Prevalence estimates depend on the data source. J Clin Epidemiol 2020; 124:163-172. [PMID: 32353403 DOI: 10.1016/j.jclinepi.2020.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 02/01/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of the study was to compare multimorbidity prevalence using self-reported and administrative data and identify factors associated with agreement between data sources. STUDY DESIGN AND SETTING Self-reported cross-sectional data from four Canadian Community Health Survey waves were linked to administrative data in Ontario, Canada. Multimorbidity prevalence was examined using two definitions, 2+ and 3+ chronic conditions (CCs). Agreement between data sources was assessed using Kappa and Phi statistics. Logistic regression was used to estimate associations between agreement and sociodemographic, health behavior, and health status variables for each multimorbidity definition. RESULTS Regardless of multimorbidity definition, prevalence was higher using administrative data (2+ CCs: 55.5% vs. 47.1%; 3+ CCs: 30.0% vs. 24.2%). Agreement between data sources was moderate (2+ CCs K = 0.482; 3+ CCs K = 0.442), and while associated with sociodemographic, health behavior, and health status factors, the magnitude and sometimes direction of association differed by multimorbidity definition. CONCLUSION A better understanding is needed of what factors influence individuals' reporting of CCs and how they align with what is in administrative data as policy makers need a solid evidence base on which to make decisions for health planning. Our results suggest that data sources may need to be triangulated to provide accurate estimates of multimorbidity for health services planning and policy.
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Affiliation(s)
- Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Andrea Gruneir
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada; ICES, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Kathryn A Fisher
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Bridgepoint Collaboratory for Research and Innovation, Sinai Health System, Toronto, Ontario, Canada
| | | | - Richard Perez
- ICES, McMaster University, Hamilton, Ontario, Canada
| | - Lindsay Favotto
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, McMaster University, Hamilton, Ontario, Canada
| | - Maureen Markle-Reid
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
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Cardwell K, Kerse N, Hughes CM, Teh R, Moyes SA, Menzies O, Rolleston A, Broad JB, Ryan C. Does potentially inappropriate prescribing predict an increased risk of admission to hospital and mortality? A longitudinal study of the 'oldest old'. BMC Geriatr 2020; 20:28. [PMID: 31992215 PMCID: PMC6986145 DOI: 10.1186/s12877-020-1432-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Potentially inappropriate prescribing (PIP) is associated with negative health outcomes, including hospitalisation and mortality. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) is a longitudinal study of Māori (the indigenous population of New Zealand) and non-Māori octogenarians. Health disparities between indigenous and non-indigenous populations are prevalent internationally and engagement of indigenous populations in health research is necessary to understand and address these disparities. Using LiLACS NZ data, this study reports the association of PIP with hospitalisations and mortality prospectively over 36-months follow-up. Methods PIP, from pharmacist applied criteria, was reported as potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs). The association between PIP and hospitalisations (all-cause, cardiovascular disease-specific and ambulatory-sensitive) and mortality was determined throughout a series of 12-month follow-ups using binary logistic (hospitalisations) and Cox (mortality) regression analysis, reported as odds ratios (ORs) and hazard ratios (HRs), respectively, and the corresponding confidence intervals (CIs). Results Full demographic data were obtained for 267 Māori and 404 non-Māori at baseline, 178 Māori and 332 non-Māori at 12-months, and 122 Māori and 281 non-Māori at 24-months. The prevalence of any PIP (i.e. ≥1 PIM and/or PPO) was 66, 75 and 72% for Māori at baseline, 12-months and 24-months, respectively. In non-Māori, the prevalence of any PIP was 62, 71 and 73% at baseline, 12-months and 24-months, respectively. At each time-point, there were more PPOs than PIMs; at baseline Māori were exposed to a significantly greater proportion of PPOs compared to non-Māori (p = 0.02). In Māori: PPOs were associated with a 1.5-fold increase in hospitalisations and mortality. In non-Māori, PIMs were associated with a double risk of mortality. Conclusions PIP was associated with an increased risk of hospitalisation and mortality in this cohort. Omissions appear more important for Māori in predicting hospitalisations, and PIMs were more important in non-Māori in predicting mortality. These results suggest understanding prescribing outcomes across and between population groups is needed and emphasises prescribing quality assessment is useful.
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Affiliation(s)
- Karen Cardwell
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
| | - Carmel M Hughes
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland
| | - Ruth Teh
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
| | - Simon A Moyes
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
| | - Oliver Menzies
- Older People's Health, Auckland District Health Board, Auckland, New Zealand
| | | | - Joanna B Broad
- Department of Geriatric Medicine, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
| | - Cristín Ryan
- School of Pharmacy & Pharmaceutical Science, Trinity College Dublin, The University of Dublin, College Green, Dublin, Dublin 2, Ireland
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Assari S, Wisseh C, Saqib M, Bazargan M. Polypharmacy Is Associated with Lower Memory Function in African American Older Adults. Brain Sci 2020; 10:brainsci10010049. [PMID: 31963177 PMCID: PMC7017256 DOI: 10.3390/brainsci10010049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/08/2020] [Accepted: 01/14/2020] [Indexed: 12/15/2022] Open
Abstract
Although previous research has linked polypharmacy to lower cognitive function in the general population, we know little about this association among economically challenged African American (AA) older adults. This study explored the link between polypharmacy and memory function among AA older adults. This community-based study recruited 399 AA older adults who were 65+ years old and living in economically disadvantaged areas of South Los Angeles. Polypharmacy (taking 5+ medications) was the independent variable, memory function was the outcome variable (continuous variable), and gender, age, living arrangement, socioeconomic status (educational attainment and financial strain), health behaviors (current smoking and any binge drinking), and multimorbidity (number of chronic diseases) were the covariates. Linear regression was used for data analyses. Polypharmacy was associated with lower scores on memory function, above and beyond covariates. Among AA older adults, polypharmacy may be linked to worse cognitive function. Future research should test the mechanisms by which polypharmacy is associated with lower levels of cognitive decline. There is a need for screening for memory problems in AA older adults who are exposed to polypharmacy.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90095, USA;
- Correspondence: ; Tel.: +1-734-858-8333
| | - Cheryl Wisseh
- Department of Pharmacy Practice, West Coast University School of Pharmacy, Los Angeles, CA 91606, USA;
| | - Mohammed Saqib
- Health Behavior & Health Education, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90095, USA;
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
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Ryan C, Teh R, Moyes S, Wilkinson T, Connolly M, Rolleston A, Kepa M, Kerse N. Quality of prescribing predicts hospitalisation in octogenarians: life and living in advanced age: a cohort study in New Zealand (LiLACS NZ). BMC Geriatr 2019; 19:357. [PMID: 31856733 PMCID: PMC6921419 DOI: 10.1186/s12877-019-1305-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 10/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prescribing for older people is complex, and many studies have highlighted that appropriate prescribing in this cohort is not always achieved. However, the long-term effect of inappropriate prescribing on outcomes such as hospitalisation and mortality has not been demonstrated. The aim of this study was to determine the level of potentially inappropriate prescribing (PIP) for participants of the Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ) study at baseline and examine the association between PIP and hospitalisation and mortality at 12-months follow-up. METHODS PIP was determined using STOPP/START. STOPP identified potentially inappropriate medicines (PIMs) prescribed, START identified potential prescribing omissions (PPOs). STOPP/START were applied to all LiLACS NZ study participants, a longitudinal study of ageing, which includes 421 Māori aged 80-90 years and 516 non-Māori aged 85 years. Participants' details (e.g. age, sex, living arrangements, socioeconomic status, physical functioning, medical conditions) were gathered by trained interviewers. Some participants completed a core questionnaire only, which did not include medications details. Medical conditions were established from a combination of self-report, review of hospital discharge and general practitioner records. Binary logistic regression, controlled for multiple potential confounders, was conducted to determine if either PIMs or PPOs were associated with hospital admissions and mortality (p < 0.05 was considered significant). RESULTS Full data were obtained for 267 Māori and 404 non-Māori. The mean age for Māori was 82.3(±2.6) years, and 84.6(±0.53) years for non-Māori. 247 potentially inappropriate medicines were identified, affecting 24.3% Māori and 28.0% non-Māori. PIMs were not associated with 12-month mortality or hospitalisation for either cohort (p > 0.05; adjusted models). 590 potential prescribing omissions were identified, affecting 58.1% Māori and 49.0% non-Māori. PPOs were associated with hospitalisation (p = 0.001 for Māori), but were not associated with risk of mortality (p > 0.05) for either cohort within the 12-month follow-up (adjusted models). CONCLUSION PPOs were more common than PIMs and were associated with an increased risk of hospitalisation for Māori. This study highlights the importance of carefully considering all indicated medicines when deciding what to prescribe. Further follow-up is necessary to determine the long-term effects of PIP on mortality and hospitalisation.
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Affiliation(s)
- Cristín Ryan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.
| | - Ruth Teh
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
| | - Simon Moyes
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
| | - Tim Wilkinson
- Older People's Health, University of Otago, Dunedin, New Zealand
| | - Martin Connolly
- Freemasons Department of Geriatric Medicine, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
| | - Anna Rolleston
- Te Kupenga Haoura Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mere Kepa
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
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Hale MD, Santorelli G, Brundle C, Clegg A. A cross-sectional study assessing agreement between self-reported and general practice-recorded health conditions among community dwelling older adults. Age Ageing 2019; 49:135-140. [PMID: 31665206 DOI: 10.1093/ageing/afz124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/24/2019] [Accepted: 08/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND self-reported data regarding health conditions are utilised in both clinical practice and research, but their agreement with general practice records is variable. The extent of this variability is poorly studied amongst older adults, particularly amongst those with multiple health conditions, cognitive impairment or frailty. This study investigates the agreement between self-reported and general practice-recorded data amongst such patients and the impact of participant factors on this agreement. METHODS data on health conditions was collected from participants in the Community Ageing Research 75+ (CARE75+) study (n = 964) by self-report during face-to-face assessment and interrogation of the participants' general practice electronic health records. Agreement between self-report and practice records was assessed using Kappa statistics and the effect of participant demographics using logistic regression. RESULTS agreement ranged from K = 0.25 to 1.00. The presence of ≥2 health conditions modified agreement for cancer (odds ratio, OR:0.62, 95%confidence interval, CI:0.42-0.94), diabetes (OR:0.55, 95%CI:0.38-0.80), dementia (OR:2.82, 95%CI:1.31-6.13) and visual impairment (OR:3.85, 95%CI:1.71-8.62). Frailty reduced agreement for cerebrovascular disease (OR:0.45, 95%CI:0.23-0.89), heart failure (OR:0.40, 95%CI:0.19-0.84) and rheumatoid arthritis (OR:0.41, 95%CI:0.23-0.75). Cognitive impairment reduced agreement for dementia (OR:0.36, 95%CI:0.21-0.62), diabetes (OR:0.47, 95%CI:0.33-0.67), heart failure (OR:0.53, 95%CI:0.35-0.80), visual impairment (OR:0.42, 95%CI:0.25-0.69) and rheumatoid arthritis (OR:0.53, 95%CI:0.37-0.76). CONCLUSIONS significant variability exists for agreement between self-reported and general practice-recorded comorbidities. This is further affected by an individual's health conditions. This study is the first to assess frailty as a factor modifying agreement and highlights the importance of utilising the general practice records as the gold standard for data collection from older adults.
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Affiliation(s)
- Matthew D Hale
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Gillian Santorelli
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Caroline Brundle
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Andrew Clegg
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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24
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Rydén L, Sigström R, Nilsson J, Sundh V, Falk Erhag H, Kern S, Waern M, Östling S, Wilhelmson K, Skoog I. Agreement between self-reports, proxy-reports and the National Patient Register regarding diagnoses of cardiovascular disorders and diabetes mellitus in a population-based sample of 80-year-olds. Age Ageing 2019; 48:513-518. [PMID: 31220207 PMCID: PMC6775759 DOI: 10.1093/ageing/afz033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 01/19/2019] [Accepted: 03/18/2019] [Indexed: 11/27/2022] Open
Abstract
Background cognitive impairment is common among older adults, necessitating the use of collateral sources in epidemiological studies involving this age group. The objective of this study was to evaluate agreement between self- and proxy-reports of cardiovascular disorders and diabetes mellitus in a population-based sample of 80-year-olds. Further, both self- and proxy-reports were compared with hospital register data. Methods data were obtained from the Gothenburg H70 Birth Cohort Studies in Sweden. The study had a cross-sectional design and information was collected through semi-structured interviews in 2009–2012 from participants born in 1930 (N = 419) and their proxy informants. The National Patient Register provided diagnoses registered during hospital stays. Agreement was measured with Kappa values (K). Results agreement between self- and proxy-reports was substantial for diabetes mellitus (K = 0.79), atrial fibrillation (K = 0.61), myocardial infarction (K = 0.75), angina pectoris (K = 0.73) and hypertension (K = 0.62), and fair for intermittent claudication (K = 0.38) and heart failure (K = 0.40). Compared to the National Patient Register, a large proportion of those with a hospital discharge diagnosis were also self- and proxy-reported. Conclusions proxy informants can be an important source of information, at least for well-defined conditions such as myocardial infarction, angina pectoris and diabetes mellitus.
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Affiliation(s)
- Lina Rydén
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden
| | - Robert Sigström
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden
| | - Johan Nilsson
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden
| | - Valter Sundh
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden
| | - Hanna Falk Erhag
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden
| | - Silke Kern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden
| | - Margda Waern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden
| | - Svante Östling
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden
| | - Katarina Wilhelmson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden
- Department of Geriatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden
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Sanuade OA, Dodoo FNA, Koram K, de-Graft Aikins A. Prevalence and correlates of stroke among older adults in Ghana: Evidence from the Study on Global AGEing and adult health (SAGE). PLoS One 2019; 14:e0212623. [PMID: 30865654 PMCID: PMC6415815 DOI: 10.1371/journal.pone.0212623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/06/2019] [Indexed: 01/19/2023] Open
Abstract
This study examines the prevalence and correlates of stroke among older adults in Ghana. This cross-sectional study retrieved data from Wave 1 of the World Health Organization (WHO) Survey on Global Ageing and Adult Health (SAGE) conducted between 2007 and 2008. The sample, comprising 4,279 respondents aged 50 years and above, was analysed using descriptive statistics, cross tabulations and Chi-Square tests, and a multivariable binary logistic regression. Respondents ranged in age from 50 to 114 years, with a median age of 62 years. Stroke prevalence was 2.6%, with the correlates being marital status, level of education, employment status, and living with hypertension or diabetes. The results showed that being separated/divorced, having primary and secondary education, being unemployed and living with hypertension and diabetes, significantly increased the odds of stroke prevalence in this population. The results suggest that interventions to reduce stroke prevalence and impact must be developed alongside interventions for hypertension, diabetes and sociodemographic/economic factors such as marital status, level of education, and employment status.
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Affiliation(s)
| | | | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana., Accra, Ghana
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
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Chiu CJ, Huang HM, Lu TH, Wang YW. National health data linkage and the agreement between self-reports and medical records for middle-aged and older adults in Taiwan. BMC Health Serv Res 2018; 18:917. [PMID: 30509280 PMCID: PMC6276180 DOI: 10.1186/s12913-018-3738-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/19/2018] [Indexed: 11/30/2022] Open
Abstract
Background Characteristics associated with acceptance of dataset linkages and health data linkage data quality were analyzed. Methods Participants from the 2011 Taiwan Longitudinal Study on Aging were asked to link their epidemiological data with concurrent and future medical claim datasets. Characteristics associated with acceptance of data linkage, data consistency, under-reporting, and over-reporting of disease conditions were identified. Results Among the 3727 respondents, 3601 (96.6%) accepted data linkage. Middle-aged adults with worse functional health accepted data linkage. Older adults (65+) with better health behavior and social support were more likely to accept data linkage. Consistency between self-reports and medical data was very good to satisfactory (Kappa = 0.80 and 0.67, respectively, for diabetes and hypertension). Comorbidities were common risk factors resulting in inconsistency between self-reports and medical data (OR = 1.58 and 1.27, respectively, for diabetes and hypertension). Living alone was another risk factor resulting in inconsistency for diabetes. Male, older, and not living alone were other risk factors resulting in inconsistencies for hypertension. Under-reporting of illness was associated with poor health and older age. Over-reporting of illness was associated with better health and younger age. Discussion The findings suggest different adjustment methods for middle-aged versus older respondents when considering self-report data validity.
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Affiliation(s)
- Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, Taiwan, 70101.
| | - Hsiang-Min Huang
- Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Wei Wang
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Physical Activity, Function, and Mortality in Advanced Age: A Longitudinal Follow-Up (LiLACS NZ). J Aging Phys Act 2018; 26:583-588. [DOI: 10.1123/japa.2017-0178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The relationship between physical activity, function, and mortality is not established in advanced age. Physical activity, function, and mortality were followed in a cohort of Māori and non-Māori adults living in advanced age for a period of 6 years. Generalized linear regression models were used to analyze the association between physical activity and Nottingham Extended Activities of Daily Living scale, whereas Kaplan–Meier survival analysis and Cox proportional hazard models were used to assess the association between the physical activity and mortality. The hazard ratio for mortality for those in the least active physical activity quartile was 4.1 for Māori and 1.8 for non-Māori compared with the most active physical activity quartile. There was an inverse relationship between physical activity and mortality, with lower hazard ratios for mortality at all levels of physical activity. Higher levels of physical activity were associated with lower mortality and higher functional status in advanced-aged adults.
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Teh RO, Menzies OH, Connolly MJ, Doughty RN, Wilkinson TJ, Pillai A, Lumley T, Ryan C, Rolleston A, Broad JB, Kerse N. Patterns of multi-morbidity and prediction of hospitalisation and all-cause mortality in advanced age. Age Ageing 2018; 47:261-268. [PMID: 29281041 DOI: 10.1093/ageing/afx184] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Indexed: 11/14/2022] Open
Abstract
Background multi-morbidity is associated with poor outcomes and increased healthcare utilisation. We aim to identify multi-morbidity patterns and associations with potentially inappropriate prescribing (PIP), subsequent hospitalisation and mortality in octogenarians. Methods life and Living in Advanced Age; a Cohort Study in New Zealand (LiLACS NZ) examined health outcomes of 421 Māori (indigenous to New Zealand), aged 80-90 and 516 non-Māori, aged 85 years in 2010. Presence of 14 chronic conditions was ascertained from self-report, general practice and hospitalisation records and physical assessments. Agglomerative hierarchical cluster analysis identified clusters of participants with co-existing conditions. Multivariate regression models examined the associations between clusters and PIP, 48-month hospitalisations and mortality. Results six clusters were identified for Māori and non-Māori, respectively. The associations between clusters and outcomes differed between Māori and non-Māori. In Māori, those in the complex multi-morbidity cluster had the highest prevalence of inappropriately prescribed medications and in cluster 'diabetes' (20% of sample) had higher risk of hospitalisation and mortality at 48-month follow-up. In non-Māori, those in the 'depression-arthritis' (17% of the sample) cluster had both highest prevalence of inappropriate medications and risk of hospitalisation and mortality. Conclusions in octogenarians, hospitalisation and mortality are better predicted by profiles of clusters of conditions rather than the presence or absence of a specific condition. Further research is required to determine if the cluster approach can be used to target patients to optimise resource allocation and improve outcomes.
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Affiliation(s)
- Ruth O Teh
- Department of General Practice and Primary Health Care, University of Auckland
| | | | - Martin J Connolly
- Freemasons’ Department of Geriatric Medicine, University of Auckland
| | - Rob N Doughty
- Auckland Hospital, University of Auckland and Heart Foundation Professor
| | | | | | | | - Cristin Ryan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin
| | | | - Joanna B Broad
- Freemasons’ Department of Geriatric Medicine, University of Auckland
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, University of Auckland
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Kilbourne AM, Schumacher K, Frayne SM, Cypel Y, Barbaresso MM, Nord KM, Perzhinsky J, Lai Z, Prenovost K, Spiro A, Gleason TC, Kimerling R, Huang GD, Serpi TB, Magruder KM. Physical Health Conditions Among a Population-Based Cohort of Vietnam-Era Women Veterans: Agreement Between Self-Report and Medical Records. J Womens Health (Larchmt) 2017; 26:1244-1251. [DOI: 10.1089/jwh.2016.6069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amy M. Kilbourne
- VA Ann Arbor Healthcare System and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Karen Schumacher
- VA Ann Arbor Healthcare System and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Susan M. Frayne
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System and Stanford University School of Medicine, Menlo Park, California
| | - Yasmin Cypel
- Post Deployment Health Services (10P4Q), Epidemiology Program, Office of Patient Care Services, Department of Veterans Affairs, Washington, District of Columbia
| | - Michelle M. Barbaresso
- VA Ann Arbor Healthcare System and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kristina M. Nord
- Office of Research and Development, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, District of Columbia
| | - Juliette Perzhinsky
- Aleda E. Lutz VAMC and Central Michigan University College of Medicine, Saginaw, Michigan
| | - Zongshan Lai
- Department of Pathology, Beaumont Health System, Troy, Michigan
| | - Katherine Prenovost
- VA Ann Arbor Healthcare System and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System and Departments of Epidemiology and Psychiatry, Boston University Schools of Public Health and Medicine, Boston, Massachusetts
| | - Theresa C. Gleason
- Patient-Centered Outcomes Research Institute, Clinical Effectiveness & Decision Science, Washington DC
| | - Rachel Kimerling
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System and Stanford University School of Medicine, Menlo Park, California
| | - Grant D. Huang
- Cooperative Studies Program Central Office, VHA Office of Research and Development, Washington, DC
| | - Tracey B. Serpi
- VA Cooperative Studies Program, Veterans Health Administration, Perry Point, Maryland
| | - Kathryn M. Magruder
- Medical University of South Carolina, Charleston, South Carolina, Charleston, South Carolina
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Camplain R, Kucharska-Newton A, Loehr L, Keyserling TC, Layton JB, Wruck L, Folsom AR, Bertoni AG, Heiss G. Accuracy of Self-Reported Heart Failure. The Atherosclerosis Risk in Communities (ARIC) Study. J Card Fail 2017; 23:802-808. [PMID: 28893677 DOI: 10.1016/j.cardfail.2017.09.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/19/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this work was to estimate agreement of self-reported heart failure (HF) with physician-diagnosed HF and compare the prevalence of HF according to method of ascertainment. METHODS AND RESULTS ARIC cohort members (60-83 years of age) were asked annually whether a physician indicated that they have HF. For those self-reporting HF, physicians were asked to confirm their patients' HF status. Physician-diagnosed HF included surveillance of hospitalized HF and hospitalized and outpatient HF identified in administrative claims databases. We estimated sensitivity, specificity, positive predicted value, kappa, prevalence and bias-adjusted kappa (PABAK), and prevalence. Compared with physician-diagnosed HF, sensitivity of self-report was low (28%-38%) and specificity was high (96%-97%). Agreement was poor (kappa 0.32-0.39) and increased when adjusted for prevalence and bias (PABAK 0.73-0.83). Prevalence of HF measured by self-report (9.0%), ARIC-classified hospitalizations (11.2%), and administrative hospitalization claims (12.7%) were similar. When outpatient HF claims were included, prevalence of HF increased to 18.6%. CONCLUSIONS For accurate estimates HF burden, self-reports of HF are best confirmed by means of appropriate diagnostic tests or medical records. Our results highlight the need for improved awareness and understanding of HF by patients, because accurate patient awareness of the diagnosis may enhance management of this common condition.
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Affiliation(s)
- Ricky Camplain
- Center for Health Equity, Northern Arizona University, Flagstaff, Arizona; Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America.
| | - Anna Kucharska-Newton
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Laura Loehr
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Thomas C Keyserling
- Department of Medicine, The University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - J Bradley Layton
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Lisa Wruck
- Center for Predictive Medicine, Duke Clinical Research Institute, Durham, North Carolina, United States of America
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America
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Caceres BA, Brody A, Chyun D. Recommendations for cardiovascular disease research with lesbian, gay and bisexual adults. J Clin Nurs 2016; 25:3728-3742. [PMID: 27239792 PMCID: PMC5121075 DOI: 10.1111/jocn.13415] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2016] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this paper is to provide recommendations to strengthen cardiovascular disease research with lesbian, gay and bisexual adults, and highlight implications for practice. BACKGROUND Lesbian, gay and bisexual individuals face significant discrimination that negatively impacts their health. Health disparities research in lesbian, gay and bisexual adults have focused on mental health, sexually transmitted infections and substance use. Although cardiovascular disease is the leading cause of death and many lesbian, gay and bisexual adults report increased risk factors for cardiovascular disease, there has been limited research in this area. DESIGN This paper is a critical review. METHODS A literature search was conducted that compared cardiovascular disease risk and/or prevalence between lesbian, gay and bisexual and heterosexual adults. RESULTS Measures to assess cardiovascular disease risk factors and diagnoses varied widely across the 31 included studies. There was a lack of standardisation in definitions used for alcohol consumption, illicit drug use, mental health and self-rated physical health. Most studies that reported body mass index relied on participant self-report. Few studies included measures of physical activity and diet and those that did lacked standardisation. Only seven studies used laboratory data to establish diagnosis of cardiovascular disease. CONCLUSIONS This study is the first comprehensive review on this topic. In cardiovascular disease research with lesbian, gay and bisexual adults, there is a need for: (1) inclusion of stress as a risk factor for cardiovascular disease, (2) standardised measures, (3) objective measures for determining the presence of cardiovascular disease, (4) data from electronic health records to strengthen the study of cardiovascular disease in this population. RELEVANCE TO CLINICAL PRACTICE Strengthening cardiovascular disease research in lesbian, gay and bisexual adults is an important step in addressing health disparities in this population. Nurses and other healthcare professionals should assess sexual orientation in routine health assessments.
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Affiliation(s)
- Billy A Caceres
- New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Abraham Brody
- New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Deborah Chyun
- New York University Rory Meyers College of Nursing, New York, NY, USA
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What do we know about the nutritional status of the very old? Insights from three cohorts of advanced age from the UK and New Zealand. Proc Nutr Soc 2016; 75:420-30. [PMID: 27165559 DOI: 10.1017/s0029665116000203] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Very old people (referred to as those aged 85 years and over) are the fastest growing age segment of many Western societies owing to the steady rise of life expectancy and decrease in later life mortality. In the UK, there are now more than 1·5 million very old people (2·5 % of total population) and the number is projected to rise to 3·3 million or 5 % over the next 20 years. Reduced mobility and independence, financial constraints, higher rates of hospitalisation, chronic diseases and disabilities, changes in body composition, taste perception, digestion and absorption of food all potentially influence either nutrient intake or needs at this stage of life. The nutritional needs of the very old have been identified as a research priority by the British Nutrition Foundation's Task Force report, Healthy Ageing: The Role of Nutrition and Lifestyle. However, very little is known about the dietary habits and nutritional status of the very old. The Newcastle 85+ study, a cohort of more than 1000 85-year olds from the North East of England and the Life and Living in Advanced Age study (New Zealand), a bicultural cohort study of advanced ageing of more than 900 participants from the Bay of Plenty and Rotorua regions of New Zealand are two unique cohort studies of ageing, which aim to assess the spectrum of health in the very old as well as examine the associations of health trajectories and outcomes with biological, clinical and social factors as each cohort ages. The nutrition domain included in both studies will help to fill the evidence gap by identifying eating patterns, and measures of nutritional status associated with better, or worse, health and wellbeing. This review will explore some of this ongoing work.
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Woodfield R, Sudlow CLM. Accuracy of Patient Self-Report of Stroke: A Systematic Review from the UK Biobank Stroke Outcomes Group. PLoS One 2015; 10:e0137538. [PMID: 26355837 PMCID: PMC4565695 DOI: 10.1371/journal.pone.0137538] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 08/18/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We performed a systematic review of the accuracy of patient self-report of stroke to inform approaches to ascertaining and confirming stroke cases in large prospective studies. METHODS We sought studies comparing patient self-report against a reference standard for stroke. We extracted data on survey method(s), response rates, participant characteristics, the reference standard used, and the positive predictive value (PPV) of self-report. Where possible we also calculated sensitivity, specificity, negative predictive value (NPV), and stroke prevalence. Study-level risk of bias was assessed using the Quality Assessment of Diagnostic Studies tool (QUADAS-2). RESULTS From >1500 identified articles, we included 17 studies. Most asked patients to report a lifetime history of stroke but a few limited recall time to ≤5 years. Some included questions for transient ischaemic attack (TIA) or stroke synonyms. No study was free of risk of bias in the QUADAS-2 assessment, the most frequent causes of bias being incomplete reference standard data, absence of blinding of adjudicators to self-report status, and participant response rates (<80%). PPV of self-report ranged from 22-87% (17 studies), sensitivity from 36-98% (10 studies), specificity from 96-99.6% (10 studies), and NPV from 88.2-99.9% (10 studies). PPV increased with stroke prevalence as expected. Among six studies with available relevant data, if confirmed TIAs were considered to be true rather than false positive strokes, PPV of self-report was >75% in all but one study. It was not possible to assess the influence of recall time or of the question(s) asked on PPV or sensitivity. CONCLUSIONS Characteristics of the study population strongly influence self-report accuracy. In population-based studies with low stroke prevalence, a large proportion of self-reported strokes may be false positives. Self-report is therefore unlikely to be helpful for identifying cases without subsequent confirmation, but may be useful for case ascertainment in combination with other data sources.
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Affiliation(s)
- Rebecca Woodfield
- Clinical Centre for Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Cathie L M Sudlow
- Clinical Centre for Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; UK Biobank, Adswood, Stockport, United Kingdom
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Wham C, Baggett F, Teh R, Moyes S, Kēpa M, Connolly M, Jatrana S, Kerse N. Dietary protein intake may reduce hospitalisation due to infection in Māori of advanced age: LiLACS NZ. Aust N Z J Public Health 2015; 39:390-5. [DOI: 10.1111/1753-6405.12406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/01/2015] [Accepted: 02/01/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Carol Wham
- School of Food and Nutrition; Massey University; New Zealand
| | - Fiona Baggett
- School of Food and Nutrition; Massey University; New Zealand
| | - Ruth Teh
- Department of General Practice and Primary Health Care; University of Auckland; New Zealand
| | - Simon Moyes
- Department of General Practice and Primary Health Care; University of Auckland; New Zealand
| | - Mere Kēpa
- Department of General Practice and Primary Health Care; University of Auckland; New Zealand
| | - Martin Connolly
- Freemason's Department of Geriatric Medicine; North Shore, University of Auckland; New Zealand
| | - Santosh Jatrana
- Alfred Deakin Research Institute, Deakin University; Victoria
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care; University of Auckland; New Zealand
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35
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Kerse N, Teh R, Moyes SA, Broad J, Rolleston A, Gott M, Kepa M, Wham C, Hayman K, Jatrana S, Adamson A, Lumley T. Cohort Profile: Te Puawaitanga o Nga Tapuwae Kia Ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ). Int J Epidemiol 2015; 44:1823-32. [DOI: 10.1093/ije/dyv103] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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