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Shi Y, Fong MWM, Metts CL, LaVela SL, Bombardier C, Hu L, Wong AWK. Dynamics of Perceived Social Isolation, Secondary Conditions, and Daily Activity Patterns Among Individuals With Stroke: A Network Analysis of Ecological Momentary Assessment Data. Arch Phys Med Rehabil 2024; 105:1314-1321. [PMID: 38458373 PMCID: PMC11227394 DOI: 10.1016/j.apmr.2024.02.733] [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: 07/21/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To assess contemporaneous and temporal dynamics of perceived social isolation (PSI), secondary conditions, and daily activity patterns in individuals post-stroke. DESIGN Longitudinal observational study using ecological momentary assessment (EMA) as a real-time assessment of an individual's lived experiences. We conducted dynamic network analyses to examine longitudinal associations among EMA variables. SETTINGS Home and Community. PARTICIPANTS 202 individuals with mild-to-moderate chronic stroke (median age=60 years; 45% women; 44% black; 90% ischemic stroke; median NIHSS score=2; N=202). INTERVENTION Not applicable. MAIN OUTCOME MEASURES EMA questions measured PSI, secondary conditions (pain, tiredness, stress, anxiety, worthlessness, difficulty concentrating, and cheerfulness), and daily activity patterns (being at home, being alone, and participating in productive activities). RESULTS The median EMA response rate was 84%. The contemporaneous model showed that PSI was associated with being home, alone, and all symptoms except pain. The temporal model revealed a pathway indicating that feelings of worthlessness predicted PSI (regression coefficient=0.06, P=.019), followed by stress (regression coefficient=0.06, P=.024), and then by being not at home (regression coefficient=-0.04, P=.013). CONCLUSION Implementing dynamic network analyses on EMA data can uncover dynamic connections among PSI, secondary conditions, and daily activity patterns after stroke. This study found a significant temporal association between PSI and negative emotions. Feeling isolated was followed by feeling stressed, which was followed by a tendency to be out of home, indicating adaptive behaviors in individuals with stroke. These findings highlight the importance of engaging in out-of-home or outdoor activities to mitigate PSI and negative emotions.
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Affiliation(s)
- Yun Shi
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Mandy W M Fong
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Michigan Avenue Neuropsychologists, Chicago, IL
| | - Christopher L Metts
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC
| | - Sherri L LaVela
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Center of Innovation for Complex Chronic Healthcare, Department of Veterans Affairs, Edwards Hines Jr VA Hospital, Hines, IL
| | - Charles Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Lu Hu
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Alex W K Wong
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Yang TC, Kim S, Matthews SA, Shoff C. Social Vulnerability and the Prevalence of Opioid Use Disorder Among Older Medicare Beneficiaries in U.S. Counties. J Gerontol B Psychol Sci Soc Sci 2023; 78:2111-2121. [PMID: 37788567 PMCID: PMC10699735 DOI: 10.1093/geronb/gbad146] [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: 04/18/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVES Recent research has investigated the factors associated with the prevalence of opioid use disorder (OUD) among older adults (65+), which has rapidly increased in the past decade. However, little is known about the relationship between social vulnerability and the prevalence of OUD, and even less is about whether the correlates of the prevalence of OUD vary across the social vulnerability spectrum. This study aims to fill these gaps. METHODS We assemble a county-level data set in the contiguous United States (U.S.) by merging 2021 Medicare claims with the CDC's social vulnerability index and other covariates. Using the total number of older beneficiaries with OUD as the dependent variable and the total number of older beneficiaries as the offset, we implement a series of nested negative binomial regression models and then analyze by social vulnerability quartiles. RESULTS Higher social vulnerability is associated with higher prevalence of OUD in U.S. counties. This association cannot be fully explained by the differences in the characteristics of older Medicare beneficiaries (e.g., average age) and/or other social conditions (e.g., social capital) across counties. Moreover, the group comparison tests indicate correlates of the prevalence of OUD vary across social vulnerability quartiles in that the average number of mental disorders is positively related to OUD prevalence in the least and the most vulnerable counties and social capital benefits the less vulnerable counties. DISCUSSION A perspective drawing upon contextual factors, especially social vulnerability, may be more effective in reducing OUD among older adults in U.S. counties than a one-size-fits-all approach.
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Affiliation(s)
- Tse-Chuan Yang
- Department of Sociology, University at Albany, State University of New York, Albany, New York, USA
| | - Seulki Kim
- Department of Sociology, University of Nebraska—Lincoln, Lincoln, Nebraska, USA
| | - Stephen A Matthews
- Departments of Sociology and Criminology, and Anthropology, The Pennsylvania State University, University Park, Pennsylvania, USA
- Population Research Institute, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Carla Shoff
- Independent Consultant, Baltimore, Maryland, USA
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Furo H, Podichetty A, Whitted M, Zhou YY, Torres F, Brimhall BB. Association Between Opioid Use Disorder and Seizure Incidents Among Alcohol Use Disorder Patients. Subst Abuse 2023; 17:11782218231181563. [PMID: 37426877 PMCID: PMC10326460 DOI: 10.1177/11782218231181563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/25/2023] [Indexed: 07/11/2023]
Abstract
Many previous studies have discussed an association between alcohol use disorder (AUD) and seizure incidents. There are also case reports of seizures during opioid withdrawals. Therefore, it is possible that AUD patients may have a higher risk of seizures if they also have opioid use disorder (OUD). However, it remains unproven whether AUD patients with a dual diagnosis of OUD have higher seizure incidents, to our knowledge. This study explored seizure incidents among the patients with a dual diagnosis of AUD and OUD as well as seizures among AUD only or OUD only patients. This study utilized de-identified data from 30 777 928 hospital inpatient encounters at 948 healthcare systems over 4 years (9/1/2018-8/31/2022) from the Vizient® Clinical Database for this study. Applying the International Classification of Diseases 10th Revision (ICD-10) diagnostic codes, AUD (1 953 575), OUD (768 982), and seizure (1 209 471) encounters were retrieved from the database to examine the effects of OUD on seizure incidence among AUD patients. This study also stratified patient encounters for demographic factors such as gender, age, and race, as well as the Vizient-categorized primary payer. Greatest gender differences were identified among AUD followed by OUD, and seizure patient groups. The mean age for seizure incidents was 57.6 years, while that of AUD was 54.7 years, and OUD 48.9 years. The greatest proportion of patients in all 3 groups were White, followed by Black, with Medicare being the most common primary payer in all 3 categories. Seizure incidents were statistically more common (P < .001, chi-square) in patients with a dual diagnosis of AUD and OUD (8.07%) compared to those with AUD only (7.55%). The patients with the dual diagnosis had a higher odd ratio than those with AUD only or OUD only. These findings across more than 900 health systems provide a greater understanding of seizure risks. Consequently, this information may help in triaging AUD and OUD patients in certain higher-risk demographic groups.
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Affiliation(s)
- Hiroko Furo
- Department of Psychiatry and Behavioral
Sciences, The University of Texas Health at San Antonio, San Antonio, TX, USA
- Department of Pathology and Laboratory
Medicine, The University of Texas Health at San Antonio, San Antonio, TX, USA
- Department of Biomedical Informatics,
State University of New York (SUNY) at Buffalo, Buffalo, NY, USA
- Department of Family Medicine, State
University of New York (SUNY) at Buffalo, Buffalo, NY, USA
| | - Ankita Podichetty
- McWilliams School of Biomedical
Informatics, The University of Texas Health Science Center at Houston, Houston, TX,
USA
| | - Marisa Whitted
- Department of Pathology and Laboratory
Medicine, The University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Yi Yuan Zhou
- Department of Pathology and Laboratory
Medicine, The University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Francis Torres
- Department of Pathology and Laboratory
Medicine, University Health System, San Antonio, TX, USA
| | - Bradley B. Brimhall
- Department of Pathology and Laboratory
Medicine, The University of Texas Health at San Antonio, San Antonio, TX, USA
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Mokhtari M. Opioids ease my pain: Early-life malnutrition and elderly outcomes. Soc Sci Med 2023; 327:115940. [PMID: 37178551 DOI: 10.1016/j.socscimed.2023.115940] [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: 12/22/2022] [Revised: 04/08/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
Despite a large body of evidence showing that early-life malnutrition influences adult outcomes, there is no evidence that early-life starvation causes use of opioids. Studying the long-term effects of a food shortage in Iran caused by WWII, we find that the rate of people who use drugs in this cohort increased significantly higher than in surrounding cohorts. Then, we examine a broad spectrum of outcomes for this cohort to shed light on potential causes of opioid use in the survivors of this cohort. Our findings suggest that pain contributes significantly to opioid use.
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Affiliation(s)
- MohammadAli Mokhtari
- Institute of Economics (IdEP), Università della Svizzera Italiana, Via Giuseppe Buffi 13, 6900, Lugano, Switzerland.
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Yang TC, Shoff C, Shaw BA, Strully K. Neighborhood characteristics and opioid use disorder among older Medicare beneficiaries: An examination of the role of the COVID-19 pandemic. Health Place 2023; 79:102941. [PMID: 36442317 DOI: 10.1016/j.healthplace.2022.102941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/28/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
Abstract
This study investigates how the associations between residential characteristics and the risk of opioid user disorder (OUD) among older Medicare beneficiaries (age≥65) are altered by the COVID-19 pandemic. Applying matching techniques and multilevel modeling to the Medicare fee-for-service claims data, this study finds that county-level social isolation, concentrated disadvantage, and residential stability are significantly associated with OUD among older adults (N = 1,080,350) and that those living in counties with low levels of social isolation and residential stability experienced a heightened risk of OUD during the pandemic. The results suggest that the COVID-19 pandemic has aggravated the impacts of residential features on OUD.
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Affiliation(s)
- Tse-Chuan Yang
- Department of Sociology, University at Albany, State University of New York, Albany, NY, USA; Department of Epidemiology, University of Texas Medical Branch, Galveston, TX, USA.
| | | | - Benjamin A Shaw
- Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Kate Strully
- Department of Sociology, University at Albany, State University of New York, Albany, NY, USA
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Yang TC, Shoff C, Choi SWE, Sun F. Multiscale dimensions of county-level disparities in opioid use disorder rates among older Medicare beneficiaries. Front Public Health 2022; 10:993507. [PMID: 36225787 PMCID: PMC9548636 DOI: 10.3389/fpubh.2022.993507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/07/2022] [Indexed: 01/26/2023] Open
Abstract
Background Opioid use disorder (OUD) among older adults (age ≥ 65) is a growing yet underexplored public health concern and previous research has mainly assumed that the spatial process underlying geographic patterns of population health outcomes is constant across space. This study is among the first to apply a local modeling perspective to examine the geographic disparity in county-level OUD rates among older Medicare beneficiaries and the spatial non-stationarity in the relationships between determinants and OUD rates. Methods Data are from a variety of national sources including the Centers for Medicare & Medicaid Services beneficiary-level data from 2020 aggregated to the county-level and county-equivalents, and the 2016-2020 American Community Survey (ACS) 5-year estimates for 3,108 contiguous US counties. We use multiscale geographically weighted regression to investigate three dimensions of spatial process, namely "level of influence" (the percentage of older Medicare beneficiaries affected by a certain determinant), "scalability" (the spatial process of a determinant as global, regional, or local), and "specificity" (the determinant that has the strongest association with the OUD rate). Results The results indicate great spatial heterogeneity in the distribution of OUD rates. Beneficiaries' characteristics, including the average age, racial/ethnic composition, and the average hierarchical condition categories (HCC) score, play important roles in shaping OUD rates as they are identified as primary influencers (impacting more than 50% of the population) and the most dominant determinants in US counties. Moreover, the percentage of non-Hispanic white beneficiaries, average number of mental health conditions, and the average HCC score demonstrate spatial non-stationarity in their associations with the OUD rates, suggesting that these variables are more important in some counties than others. Conclusions Our findings highlight the importance of a local perspective in addressing the geographic disparity in OUD rates among older adults. Interventions that aim to reduce OUD rates in US counties may adopt a place-based approach, which could consider the local needs and differential scales of spatial process.
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Affiliation(s)
- Tse-Chuan Yang
- Department of Sociology, University at Albany, State University of New York, Albany, NY, United States,*Correspondence: Tse-Chuan Yang
| | - Carla Shoff
- Independent Consultant, Baltimore, MD, United States
| | - Seung-won Emily Choi
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, Lubbock, TX, United States
| | - Feinuo Sun
- Global Aging and Community Initiative, Mount Saint Vincent University, Halifax, NS, Canada
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Yang TC, Shoff C, Kim S, Shaw BA. County social isolation and opioid use disorder among older adults: A longitudinal analysis of Medicare data, 2013-2018. Soc Sci Med 2022; 301:114971. [PMID: 35430465 DOI: 10.1016/j.socscimed.2022.114971] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 03/12/2022] [Accepted: 04/07/2022] [Indexed: 01/03/2023]
Abstract
This study aims to fill three knowledge gaps: (1) unclear role of ecological factors in shaping older adults' risk of opioid use disorder (OUD), (2) a lack of longitudinal perspective in OUD research among older adults, and (3) underexplored racial/ethnic differences in the determinants of OUD in older populations. This study estimates the effects of county-level social isolation, concentrated disadvantage, and income inequality on older adults' risk of OUD using longitudinal data analysis. We merged the 2013-2018 Medicare population (aged 65+) data to the American Community Survey 5-year county-level estimates to create a person-year dataset (N = 47,291,217 person-years) and used conditional logit fixed-effects modeling to test whether changes in individual- and county-level covariates alter older adults' risk of OUD. Moreover, we conducted race/ethnicity-specific models to compare how these associations vary across racial/ethnic groups. At the county-level, a one-unit increase in social isolation (mean = -0.197, SD = 0.511) increased the risk of OUD by 5.5 percent (OR = 1.055; 95% CI = [1.018, 1.094]) and a one-percentage-point increase in the working population employed in primary industry decreases the risk of OUD by 1 percent (OR = 0.990; 95% CI = [0.985, 0.996]). At the individual-level, increases in the Medicare Hierarchical Condition Categories risk score, physical comorbidity, and mental comorbidity all elevate the risk of OUD. The relationship between county-level social isolation and OUD is driven by non-Hispanic whites, while Hispanic beneficiaries are less sensitive to the changes in county-level factors than any other racial ethnic groups. Between 2013 and 2018, US older adults' risk of OUD was associated with both ecological and individual factors, which carries implications for intervention. Further research is needed to understand why associations of individual factors with OUD are comparable across racial/ethnic groups, but county-level social isolation is only associated with OUD among non-Hispanic white beneficiaries.
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Affiliation(s)
- Tse-Chuan Yang
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
| | | | - Seulki Kim
- Department of Sociology, University at Albany, State University of New York, Albany, NY, USA
| | - Benjamin A Shaw
- Division of Community Health Sciences, University of Illinois Chicago, Chicago, IL, USA
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