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Bershteyn A, Richard E, Zhou Q, Khan MR, Scheidell JD, Manandhar-Sasaki P, Ban K, Crystal S, Gordon AJ, Justice AC, Bryant KJ, Braithwaite RS. Potential health benefits of integrated screening strategies for alcohol, tobacco, other substance use, depression, anxiety, and chronic pain among people living with HIV in the USA: a mathematical modelling study. Lancet HIV 2023; 10:e118-e125. [PMID: 36731986 DOI: 10.1016/s2352-3018(22)00361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Alcohol use, tobacco use, and other substance use often co-occur with depression, anxiety, and chronic pain, forming a constellation of alcohol, substance, and mood-related (CASM) conditions that disproportionately affects people with HIV in the USA. We used a microsimulation model to evaluate how alternative screening strategies accounting for CASM interdependence could affect life expectancy in people with HIV in the USA. METHODS We augmented a microsimulation model previously validated to predict US adult life expectancy, including in people with HIV. Using data from the Veterans Aging Cohort Study, we incorporated CASM co-occurrence, inferred causal relationships between CASM conditions, and assessed the effects of CASM on HIV treatment and preventive care. We simulated an in-care HIV cohort exposed to alternative CASM screening and diagnostic assessment strategies, ranging from currently recommended screenings (alcohol, tobacco, and depression, with diagnostic assessments for conditions screening positive) to a series of integrated strategies (screening for alcohol, tobacco, or depression with additional diagnostic assessments if any screened positive) to a maximal saturation strategy (diagnostic assessments for all CASM conditions). FINDINGS The saturation strategy increased life expectancy by 0·95 years (95% CI 0·93-0·98) compared with no screening. Recommended screenings provided much less benefit: 0·06 years (0·03-0·09) gained from alcohol screening, 0·08 years (0·06-0·11) from tobacco screening, 0·10 years (0·08-0·11) from depression screening, and 0·25 years (0·22-0·27) from all three screenings together. One integrated strategy (screening alcohol, tobacco, and depression with diagnostic assessment for all CASM conditions if any screened positive) produced near-maximal benefit (0·82 years [0·80-0·84]) without adding substantial screening burden, albeit requiring additional diagnostic assessments. INTERPRETATION Primary care providers for people with HIV should consider comprehensive diagnostic assessment of CASM conditions if one or more conditions screen positive. FUNDING US National Institute on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Emma Richard
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Qinlian Zhou
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Maria R Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Joy D Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Prima Manandhar-Sasaki
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Kaoon Ban
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Stephen Crystal
- Center for Health Services Research, Rutgers University, New Brunswick, NJ, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA) and Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Amy C Justice
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA; Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
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Macina D, Evans KE. Pertussis in Individuals with Co-morbidities: A Systematic Review. Infect Dis Ther 2021; 10:1141-1170. [PMID: 34117998 PMCID: PMC8322178 DOI: 10.1007/s40121-021-00465-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022] Open
Abstract
Pertussis is a highly contagious disease of the respiratory tract caused by Bordetella pertussis. Although the burden of pertussis is highest in children, available data suggests that pertussis in the elderly and those with underlying chronic conditions or illnesses can result in significant morbidity, mortality and costs. We undertook a comprehensive review to assess the association between pertussis and chronic conditions/illnesses. A search was undertaken on 17 June 2019 across EMBASE, Medline and BIOSIS. Citations were limited to those in English, in humans and published since 1 January 1990. There were 1179 papers identified with an additional 70 identified through a review of the reference lists. Of these, 34 met the inclusion criteria. Papers included were categorised in groups, those which reported: associations between prior pertussis and subsequent chronic conditions or illnesses; a link between chronic conditions/illnesses and subsequent risk of pertussis; and those which reported on the effect of the chronic conditions/illnesses on pertussis complications or exacerbations. Pertussis appears to increase the likelihood of developing some chronic conditions/illnesses, but also appears to decrease the likelihood of developing some haematological cancers. There were several chronic conditions/illnesses where the study results were mixed, and several studies that found no association with previous pertussis. There were also studies which showed that having some comorbid health condition(s) might increase the risk of developing pertussis. Three studies showed pertussis can lead to increased exacerbations of chronic conditions/illnesses and associated hospitalisations, although one study showed it reduced the effects of chronic bronchitis. Previous pertussis appears to contribute to the increased likelihood of developing some respiratory conditions like asthma, and conversely those with asthma or COPD are at increased risk of severe pertussis requiring further intervention. Further research is required to confirm or disprove these associations, and to characterise the pathophysiological mechanisms behind the potential associations with pertussis.
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Affiliation(s)
- Denis Macina
- Vaccines Epidemiology and Modelling, Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France.
| | - Keith E Evans
- inScience Communications, Chowley Oak Business Park, Chowley Oak Lane, Tattenhall, Cheshire, UK
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