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Hoenders R, Ghelman R, Portella C, Simmons S, Locke A, Cramer H, Gallego-Perez D, Jong M. A review of the WHO strategy on traditional, complementary, and integrative medicine from the perspective of academic consortia for integrative medicine and health. Front Med (Lausanne) 2024; 11:1395698. [PMID: 38933107 PMCID: PMC11201178 DOI: 10.3389/fmed.2024.1395698] [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: 03/04/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Despite important progress in modern medicine, widely regarded as an indispensable foundation of healthcare in all highly advanced nations and regions, not all patients respond well to available treatments in biomedicine alone. Additionally, there are concerns about side effects of many medications and interventions, the unsustainable cost of healthcare and the low resolution of chronic non-communicable diseases and mental disorders whose incidence has risen in the last decades. Besides, the chronic stress and burnout of many healthcare professionals impairs the therapeutic relationship. These circumstances call for a change in the current paradigm and practices of biomedicine healthcare. Most of the world population (80%) uses some form of traditional, complementary, and integrative medicine (T&CM), usually alongside biomedicine. Patients seem equally satisfied with biomedicine and T&CM, but in the field of T&CM there are also many challenges, such as unsupported claims for safety and/or efficacy, contamination of herbal medicines and problems with regulation and quality standards. As biomedicine and T&CM seem to have different strengths and weaknesses, integration of both approaches may be beneficial. Indeed, WHO has repeatedly called upon member states to work on the integration of T&CM into healthcare systems. Integrative medicine (IM) is an approach that offers a paradigm for doing so. It combines the best of both worlds (biomedicine and T&CM), based on evidence for efficacy and safety, adopting a holistic personalized approach, focused on health. In the last decades academic health centers are increasingly supportive of IM, as evidenced by the foundation of national academic consortia for integrative medicine in Brazil (2017), the Netherlands (2018), and Germany (2024) besides the pioneering American consortium (1998). However, the integration process is slow and sometimes met with criticism and even hostility. The WHO T&CM strategies (2002-2005 and 2014-2023) have provided incipient guidance on the integration process, but several challenges are yet to be addressed. This policy review proposes several possible solutions, including the establishment of a global matrix of academic consortia for IM, to update and extend the WHO T&CM strategy, that is currently under review.
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Affiliation(s)
- Rogier Hoenders
- Dutch Consortium for Integrative Care and Health, Center for Integrative Psychiatry, Lentis, Groningen, The Netherlands and Faculty of Religion, Culture and Society, University of Groningen, Groningen, Netherlands
| | - Ricardo Ghelman
- Brazilian Academic Consortium for Integrative Health and Department of Medicine on Primary Care, Faculty of Medicine Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Caio Portella
- Brazilian Academic Consortium for Integrative Health and Universidade de São Paulo, Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina FMUSP, São Paulo, Brazil
| | - Samantha Simmons
- Academic Consortium for Integrative Medicine and Health, Lake Oswego, OR, United States
| | - Amy Locke
- Academic Consortium for Integrative Medicine and Health and Department of Family and Preventive Medicine University of Utah Health, Salt Lake City, UT, United States
| | - Holger Cramer
- Academic Consortium for Traditional & Integrative Medicine and Health, Germany and Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany and Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Daniel Gallego-Perez
- Physical Medicine and Rehabilitation Department University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Miek Jong
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Townsend L, Gillespie P, McGrath J, Kenny C, Bergin C, Fleming C. Health Care Personnel Workdays Lost and Direct Health Care Salary Costs Incurred due to COVID-19 Infection in the Age of Widespread Vaccine Availability. J Infect Dis 2024:jiae223. [PMID: 38771075 DOI: 10.1093/infdis/jiae223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/27/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Vaccination against coronavirus disease 2019 (COVID-19) can mitigate the burden of health care worker (HCW) infection. We investigate the burden of HCW illness and its associated direct health care personnel costs in the setting of widespread vaccine availability and explore factors influencing these outcomes. METHODS This multicenter prospective study followed HCWs over an 8-month period from January to August 2023. Data recorded included incident COVID-19 infection, symptom burden, workdays missed, and vaccine history. Workdays lost due to illness were used to calculate direct health care personnel costs due to COVID-19 infection. Univariate analysis and multivariable regression investigated the factors associated with workdays lost and direct health care personnel. RESULTS In total, 1218 participants were enrolled and followed for 8 months, with 266 incidents of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 1191 workdays lost, and health care personnel costs of €397 974. Multivariable regression revealed that workdays lost were associated with incomplete primary COVID-19 vaccination course. Being unvaccinated, older age, and male were associated with increased health care personnel costs. CONCLUSIONS Health care workdays lost remain a significant issue and are associated with health care system burden despite vaccine availability. These can be mitigated via targeted implementation of vaccine programs. Seasonal variation in health care workdays lost should inform workforce planning to accommodate surge periods.
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Affiliation(s)
- Liam Townsend
- Department of Infectious Diseases, St James's Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Paddy Gillespie
- Health Economics and Policy Analysis Centre, Institute for Lifecourse and Society, University of Galway, Galway, Ireland
- CÚRAM, Science Foundation Ireland Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Jonathan McGrath
- Department of Infectious Diseases, St James's Hospital, Dublin, Ireland
| | - Claire Kenny
- Department of Infectious Diseases, University Hospital Galway, Galway, Ireland
| | - Colm Bergin
- Department of Infectious Diseases, St James's Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Catherine Fleming
- Department of Infectious Diseases, University Hospital Galway, Galway, Ireland
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Fredriksen-Goldsen KI, Romanelli M, Jung HH, Kim HJ. Health, Economic, and Social Disparities among Lesbian, Gay, Bisexual, and Sexually Diverse Adults: Results from a Population-Based Study. Behav Med 2024; 50:141-152. [PMID: 36729025 PMCID: PMC10394107 DOI: 10.1080/08964289.2022.2153787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 02/03/2023]
Abstract
We investigated health, economic, and social disparities among lesbian, gay, bisexual, and sexually diverse adults, 18 years and older. Analyzing 2011-2019 Washington State Behavioral Risk Factor Surveillance System (N = 109,527), we estimated and compared the prevalence rates of background characteristics, economic and social indicators, health outcomes, chronic conditions, health care access, health behaviors, and preventive care by gender and sexual identity. Sexual minority adults reported heightened risks of poor general health, physical and mental health, disability, subjective cognitive decline, and financial barriers to health care, compared with their straight counterparts. Economic disparities and disability were evident for lesbians and both bisexual adult women and men. We found higher rates of smoking and excessive drinking among lesbians and bisexual women, and higher rates of smoking and living alone among gay men. Sexually diverse adults experience disparities in health care access. This study is one of the first to identify disparities among sexually diverse populations, in addition to lesbian, gay, and bisexual adults. More research is required to understand the mechanisms of disparities within these groups to address their distinct intervention needs.
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Dore EC, Shrivastava S, Homan P. Structural Sexism and Preventive Health Care Use in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024; 65:2-19. [PMID: 37675877 PMCID: PMC10918039 DOI: 10.1177/00221465231194043] [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] [Indexed: 09/08/2023]
Abstract
Preventive health care use can reduce the risk of disease, disability, and death. Thus, it is critical to understand factors that shape preventive care use. A growing body of research identifies structural sexism as a driver of population health, but it remains unknown if structural sexism is linked to preventive care use and, if so, whether the relationship differs for women and men. Gender performance and gendered power and resource allocation perspectives lead to competing hypotheses regarding these questions. This study explores the relationship between structural sexism and preventive care in gender-stratified, multilevel models that combine data from the Behavioral Risk Factor Surveillance System with state-level data (N = 425,454). We find that in states with more structural sexism, both men and women were less likely to seek preventive care. These findings support the gender performance hypothesis for men and the gendered power and resource allocation hypothesis for men and women.
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Babu M, Lautman Z, Lin X, Sobota MHB, Snyder MP. Wearable Devices: Implications for Precision Medicine and the Future of Health Care. Annu Rev Med 2024; 75:401-415. [PMID: 37983384 DOI: 10.1146/annurev-med-052422-020437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Wearable devices are integrated analytical units equipped with sensitive physical, chemical, and biological sensors capable of noninvasive and continuous monitoring of vital physiological parameters. Recent advances in disciplines including electronics, computation, and material science have resulted in affordable and highly sensitive wearable devices that are routinely used for tracking and managing health and well-being. Combined with longitudinal monitoring of physiological parameters, wearables are poised to transform the early detection, diagnosis, and treatment/management of a range of clinical conditions. Smartwatches are the most commonly used wearable devices and have already demonstrated valuable biomedical potential in detecting clinical conditions such as arrhythmias, Lyme disease, inflammation, and, more recently, COVID-19 infection. Despite significant clinical promise shown in research settings, there remain major hurdles in translating the medical uses of wearables to the clinic. There is a clear need for more effective collaboration among stakeholders, including users, data scientists, clinicians, payers, and governments, to improve device security, user privacy, data standardization, regulatory approval, and clinical validity. This review examines the potential of wearables to offer affordable and reliable measures of physiological status that are on par with FDA-approved specialized medical devices. We briefly examine studies where wearables proved critical for the early detection of acute and chronic clinical conditions with a particular focus on cardiovascular disease, viral infections, and mental health. Finally, we discuss current obstacles to the clinical implementation of wearables and provide perspectives on their potential to deliver increasingly personalized proactive health care across a wide variety of conditions.
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Affiliation(s)
- Mohan Babu
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
| | - Ziv Lautman
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
- Department of Bioengineering, Stanford University School of Medicine, Stanford, California, USA
| | - Xiangping Lin
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
| | - Milan H B Sobota
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
| | - Michael P Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
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Roystonn K, AshaRani PV, Devi F, Wang P, Zhang Y, Jeyagurunathan A, Abdin E, Car LT, Chong SA, Subramaniam M. Exploring views and experiences of the general public's adoption of digital technologies for healthy lifestyle in Singapore: a qualitative study. Front Public Health 2023; 11:1227146. [PMID: 37794896 PMCID: PMC10545896 DOI: 10.3389/fpubh.2023.1227146] [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: 05/22/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Objective Little is known about the general adult population's adoption of digital technology to support healthy lifestyle, especially when they are expected to take greater personal responsibility for managing their health and well-being today. The current qualitative study intended to gain an in-depth understanding of determinants of digital technology adoption for healthy lifestyle among community-dwelling adults in Singapore. Design A qualitative study design, with thematic framework analysis was applied to develop themes from the data. Setting Semi-structured individual interviews were conducted with participants either face-to-face or online through a videoconferencing platform. Participants 14 women and 16 men from the general population who were between the ages of 22 and 71 years. Results Three major themes were developed: (1) digitally disempowered (2) safety and perceived risks and harm; (3) cultural values and drives. Adoption of technology among the general population is needs-driven, and contingent on individual, technological and other cross-cultural contextual factors. Conclusion Our findings highlight there is no one solution which fits all individuals, emphasizing the challenges of catering to diverse groups to reduce barriers to adoption of digital technologies for healthy lifestyle. Digital guidance and training, as well as social influences, can motivate technological adoption in the population. However, technical problems as well as data security and privacy concerns should first be adequately addressed. This study provides rich cross-cultural insights and informs policy-making due to its alignment with government public health initiatives to promote healthy lifestyle.
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Affiliation(s)
| | - P. V. AshaRani
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Fiona Devi
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Yunjue Zhang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Lorainne Tudor Car
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Lee J, Jukarainen S, Karvanen A, Dixon P, Davies NM, Smith GD, Natarajan P, Ganna A. Quantifying the causal impact of biological risk factors on healthcare costs. Nat Commun 2023; 14:5672. [PMID: 37704630 PMCID: PMC10499912 DOI: 10.1038/s41467-023-41394-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
Understanding the causal impact that clinical risk factors have on healthcare-related costs is critical to evaluate healthcare interventions. Here, we used a genetically-informed design, Mendelian Randomization (MR), to infer the causal impact of 15 risk factors on annual total healthcare costs. We calculated healthcare costs for 373,160 participants from the FinnGen Study and replicated our results in 323,774 individuals from the United Kingdom and Netherlands. Robust causal effects were observed for waist circumference (WC), adult body mass index, and systolic blood pressure, in which a standard deviation increase corresponded to 22.78% [95% CI: 18.75-26.95], 13.64% [10.26-17.12], and 13.08% [8.84-17.48] increased healthcare costs, respectively. A lack of causal effects was observed for certain clinically relevant biomarkers, such as albumin, C-reactive protein, and vitamin D. Our results indicated that increased WC is a major contributor to annual total healthcare costs and more attention may be given to WC screening, surveillance, and mitigation.
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Affiliation(s)
- Jiwoo Lee
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sakari Jukarainen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Antti Karvanen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Padraig Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Neil M Davies
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
- Department of Statistical Sciences, University College London, London, WC1E 6BT, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, BS8 2BN, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, BS8 2BN, Bristol, UK
| | - Pradeep Natarajan
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Andrea Ganna
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.
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Tegegne TK, Islam SMS, Maddison R. Longitudinal patterns of lifestyle risk behaviours among UK adults with established cardiovascular disease: a latent transition analysis. Front Cardiovasc Med 2023; 10:1116905. [PMID: 37731520 PMCID: PMC10507625 DOI: 10.3389/fcvm.2023.1116905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Background People with cardiovascular disease (CVD) need to engage in healthy lifestyle behaviours. However, there is a gap in identifying longitudinal patterns of change in lifestyle behaviours among people with CVD. This study aimed to identify clustering of lifestyle risk behaviours and their 4 ± year changes among UK adults with CVD, and to determine the associated factors. Methods We used the UK Biobank data collected at two time points (2006-2010/baseline data = T0 and 2014+/third visit data = T4). Six key lifestyle risk behaviours were assessed: smoking, high alcohol intake, poor fruit and vegetable consumption, physical inactivity, poor sleep balance (<7 or >8 h/night) and prolonged sitting. A random intercept latent transition analysis was performed to identify patterns of lifestyle risk behaviours at T0 and their changes from T0 to T4. Results We included 5,304 participants with CVD whose data on lifestyle risk behaviours were collected at two-time points. Alcohol intake and current smoking were 75.7% and 5.4% at baseline, respectively, and 67.4% and 3.0% at follow-up. Three latent classes emerged: Latent class (LC) 1-"high alcohol intake, poor sleep balance and poor fruit and vegetable intake", LC2-"high alcohol intake and poor fruit and vegetable intake", and LC3-"high alcohol intake". Most adults remained in the same LC over the 4 + years (range: 83.9%-100.0%). After 4 + years, 3.5% from LC3 and 10.4% from LC2 at baseline moved into LC1. The odds of transitioning to LC2 relative to staying in LC1 and LC3 were 2.22 and 4.13 times higher for males than for females, respectively. A single-year increase in participants' age was associated with a 1.16 times increase in the odds of moving to LC1 relative to staying in LC2. Conclusion People with CVD did not show improvement in lifestyle risk behaviours, and interventions targeting multiple lifestyle risk behaviours are needed to improve CVD.
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Affiliation(s)
- Teketo Kassaw Tegegne
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
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Pedersen K, Schlichter BR. Improving Predictability and Effectiveness in Preventive Digital Health Interventions: Scoping Review. Interact J Med Res 2023; 12:e40205. [PMID: 37471129 PMCID: PMC10401197 DOI: 10.2196/40205] [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: 06/10/2022] [Revised: 11/01/2022] [Accepted: 06/09/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Lifestyle-related diseases caused by inadequate diet and physical activity cause premature death, loss of healthy life years, and increased health care costs. Randomized controlled trial (RCT) studies indicate that preventive digital health interventions (P-DHIs) can be effective in preventing these health problems, but the results of these studies are mixed. Adoption studies have identified multiple factors related to individuals and the context in which they live that complicate the transfer of positive results from RCT studies to practical use. Implementation studies have revealed barriers to the large-scale implementation of mobile health (mHealth) solutions in general. Consequently, there is no clear path to delivering predictable outcomes from P-DHIs and achieving effectiveness when scaling up interventions to reduce health problems in society. OBJECTIVE This research aimed to expand our understanding of how to increase the outcome predictability of P-DHIs by focusing on physical activity and diet behaviors and amplify our understanding of how to improve effectiveness in large-scale implementations. METHODS The research objective was pursued through a multidisciplinary scoping review. This scoping review used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) as a guide. A comprehensive search of Web of Science and PubMed limited to English-language journal articles published before January 2022 was conducted. Google Scholar was used for hand searches. Information systems theory was used to identify key constructs influencing outcomes of IT in general. Public health and mHealth literature were used to identify factors influencing the adoption of, outcomes from, and implementation of P-DHIs. Finally, the P-DHI investment model was developed based on information systems constructs and factors from the public health and mHealth literature. RESULTS In total, 203 articles met the eligibility criteria. The included studies used a variety of methodologies, including literature reviews, interviews, surveys, and RCT studies. The P-DHI investment model suggests which constructs and related factors should be emphasized to increase the predictability of P-DHI outcomes and improve the effectiveness of large-scale implementations. CONCLUSIONS The research suggests that outcome predictability could be improved by including descriptions of the constructs and factors in the P-DHI investment model when reporting from empirical studies. Doing so would increase our understanding of when and why P-DHIs succeed or fail. The effectiveness of large-scale implementations may be improved by using the P-DHI investment model to evaluate potential difficulties and possibilities in implementing P-DHIs to create better environments for their use before investing in them and when designing and implementing them. The cost-effectiveness of large-scale implementations is unknown; implementations are far more complicated than just downloading and using apps, and there is uncertainty accompanying implementations given the lack of coordinated control over the constructs and factors that influence the outcome.
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Affiliation(s)
- Keld Pedersen
- Information Systems, Department of Management, Aarhus University, Aarhus C, Denmark
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Tan V, Lim J, Akksilp K, Chow WL, Ma S, Chen C. The societal cost of modifiable risk factors in Singapore. BMC Public Health 2023; 23:1285. [PMID: 37403019 PMCID: PMC10318651 DOI: 10.1186/s12889-023-16198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Singapore is one of the most rapidly ageing populations in the world. Nearly half of all disease burdens in Singapore are attributable to modifiable risk factors. This indicates that many illnesses are preventable by modifying behaviours such as increasing physical activity levels or maintaining a healthy diet. Prior cost-of-illness studies have estimated the cost of selected modifiable risk factors. However, no local study has compared costs between groups of modifiable risks. This study aims to estimate the societal cost attributable to a comprehensive list of modifiable risks in Singapore. METHODS Our study builds on the comparative risk assessment framework from the Global Burden of Disease (GBD) 2019 study. A top-down prevalence-based cost-of-illness approach was undertaken to estimate the societal cost of modifiable risks in 2019. These include healthcare costs from inpatient hospitalisation and productivity losses from absenteeism and premature mortality. RESULTS Metabolic risks had the highest total cost of US$1.62 billion (95% uncertainty interval [UI] US$1.51-1.84 billion), followed by lifestyle risks of US$1.40 billion (95% UI US$1.36-1.66 billion) and substance risks of US$1.15 billion (95% UI US$1.10-1.24 billion). Across the risk factors, the costs were driven by productivity losses, heavily skewed towards the older working-age group and among males. Most of the costs were driven by cardiovascular diseases. CONCLUSION This study provides evidence of the high societal cost of modifiable risks and highlights the importance of developing holistic public health promotion programmes. As modifiable risks often do not occur in isolation, implementing effective population-based programmes targeting multiple modifiable risks has a strong potential to manage the cost of the rising disease burden in Singapore.
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Affiliation(s)
- Vanessa Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #09-01T, Singapore, 117549, Singapore
| | - Julian Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #09-01T, Singapore, 117549, Singapore
| | - Katika Akksilp
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #09-01T, Singapore, 117549, Singapore
| | - Wai Leng Chow
- Epidemiology & Disease Control Division, Ministry of Health, Singapore, Singapore
| | - Stefan Ma
- Epidemiology & Disease Control Division, Ministry of Health, Singapore, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #09-01T, Singapore, 117549, Singapore.
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, USA.
- Department of Non-Communicable Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK.
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Hild B. [The microbiome and metabolic syndrome: is this a chicken-or-egg problem?]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023:10.1007/s00108-023-01531-z. [PMID: 37286801 DOI: 10.1007/s00108-023-01531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/09/2023]
Abstract
The microbiome has become recognized as a critical player in the understanding of human physiology and pathophysiology, especially with regard to the metabolic syndrome. While recent findings emphasize the impact of the microbiome on metabolic health, new questions simultaneously arise: Is there a dysbiotic microbiome before the onset of metabolic disorders or is dysbiosis caused by a deranged metabolism? Furthermore, are there opportunities to employ the microbiome as a tool for novel treatment strategies in patients with metabolic syndrome? The intention of this review article is to describe the fashionable term "microbiome" beyond its current research approaches, which will be relevant to the practicing internist.
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Affiliation(s)
- Benedikt Hild
- Klinik für Gastroenterologie, Hepatologie und Transplantationsmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
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Li L, Zhan S, Mckendrick K, Yang C, Mazumdar M, Kelley AS, Aldridge MD. Examining annual transitions in healthcare spending among U.S. medicare beneficiaries using multistate Markov models: Analysis of medicare current beneficiary survey data, 2003-2019. Prev Med Rep 2023; 32:102171. [PMID: 36950178 PMCID: PMC10025088 DOI: 10.1016/j.pmedr.2023.102171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/25/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
Many studies have examined factors associated with individuals of high or low healthcare spending in a given year. However, few have studied how healthcare spending changes over multiple years and which factors are associated with the changes. In this study, we examined the dynamic patterns of healthcare spending over a three-year period, among a nationally representative cohort of Medicare beneficiaries in the U.S. and identified factors associated with these patterns. We extracted data for 30,729 participants from the national Medicare Current Beneficiary Survey (MCBS), for the period 2003-2019. Using multistate Markov (MSM) models, we estimated the probabilities of year-to-year transitions in healthcare spending categorized as three states (low (L), medium (M) and high (H)), or to the terminal state, death. The participants, 13,554 (44.1%), 13,715 (44.6%) and 3,460 (11.3%) were in the low, medium and high spending states at baseline, respectively. The majority of participants remained in the same spending category from one year to the next (L-to-L: 76.8%; M-to-M: 71.7%; H-to-H: 56.6 %). Transitions from the low to high spending state were significantly associated with older age (75-84, ≥85 years), residing in a long-term care facility, greater assistance with activities of daily living, enrollment in fee-for-service Medicare, not receiving a flu shot, and presence of specific medical conditions, including cancer, dementia, and heart disease. Using data from a large population-based longitudinal survey, we have demonstrated that MSM modelling is a flexible framework and useful tool for examining changes in healthcare spending over time.
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Affiliation(s)
- Lihua Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Healthcare Delivery Science, Mount Sinai Health System, New York, NY, United States
- Tisch Cancer Institute, New York, NY, United States
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Serena Zhan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Healthcare Delivery Science, Mount Sinai Health System, New York, NY, United States
- Tisch Cancer Institute, New York, NY, United States
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Karen Mckendrick
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Chen Yang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Healthcare Delivery Science, Mount Sinai Health System, New York, NY, United States
- Tisch Cancer Institute, New York, NY, United States
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Healthcare Delivery Science, Mount Sinai Health System, New York, NY, United States
- Tisch Cancer Institute, New York, NY, United States
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Amy S. Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Melissa D. Aldridge
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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13
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Helbach A, Dumm M, Moll K, Böttrich T, Leineweber CG, Mueller W, Matthes J, Polidori MC. Improvement of Dietary Habits among German Medical Students by Attending a Nationwide Online Lecture Series on Nutrition and Planetary Health ( "Eat This!"). Nutrients 2023; 15:nu15030580. [PMID: 36771284 PMCID: PMC9920441 DOI: 10.3390/nu15030580] [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: 11/20/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
Nutrition is a major influential factor in optimizing human health and environmental sustainability. Medical students often do not follow national dietary guideline recommendations. Raising awareness of a healthy lifestyle is important as physicians with healthy lifestyle behaviors are more likely to counsel on nutrition. Our study aims to evaluate a Germany-wide online lecture series on nutritional medicine, "Eat This!". Before and after the course, 520 medical students who participated and 64 who did not participate in the course (comparison group) filled out an online survey. To assess the students' dietary habits, a validated FFQ was used. According to this questionnaire, only 31% of the lecture participants consumed enough fruits and 24% consumed enough vegetables, while almost half of the students exceeded the recommended maximum amount of crisps and sweets. After attending the lecture series, guideline adherence with respect to fruits and vegetables showed a significant increase, as did awareness of healthy nutrition and percentage of students with low-risk lifestyle habits. Our results show that low-threshold approaches, such as "Eat This!", can positively influence the dietary behaviors and lifestyle habits of medical students. This can help future doctors fulfill their role in the fight against the global burden of non-communicable diseases.
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Affiliation(s)
- Anna Helbach
- Department II of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- Institute of General Practice, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
| | - Moritz Dumm
- Center of Pharmacology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50931 Cologne, Germany
| | - Katharina Moll
- Faculty of Medicine, University Clinic Hamburg Eppendorf, 20251 Hamburg, Germany
| | - Tim Böttrich
- Faculty of Medicine, University of Gießen, 35392 Gießen, Germany
| | - Can Gero Leineweber
- Medical Department B of Internal Medicine, Brandenburg Medical School, University Hospital Ruppin-Brandenburg, 16816 Neuruppin, Germany
| | - Wiebke Mueller
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
| | - Jan Matthes
- Center of Pharmacology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50931 Cologne, Germany
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress-Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
- Correspondence:
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14
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Duan KI, Birger M, Au DH, Spece LJ, Feemster LC, Dieleman JL. Health Care Spending on Respiratory Diseases in the United States, 1996-2016. Am J Respir Crit Care Med 2023; 207:183-192. [PMID: 35997678 PMCID: PMC9893322 DOI: 10.1164/rccm.202202-0294oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/23/2022] [Indexed: 02/02/2023] Open
Abstract
Rationale: Respiratory conditions account for a large proportion of health care spending in the United States. A full characterization of spending across multiple conditions and over time has not been performed. Objectives: To estimate health care spending in the United States for 11 respiratory conditions from 1996 to 2016, providing detailed trends and an evaluation of factors associated with spending growth. Methods: We extracted data from the Institute of Health Metrics and Evaluation's Disease Expenditure Project Database, producing annual estimates in spending for 38 age and sex groups, 7 types of care, and 3 payer types. We performed a decomposition analysis to estimate the change in spending associated with changes in each of five factors (population growth, population aging, disease prevalence, service usage, and service price and intensity). Measurements and Main Results: Total spending across all respiratory conditions in 2016 was $170.8 billion (95% confidence interval [CI], $164.2-179.2 billion), increasing by $71.7 billion (95% CI, $63.2-80.8 billion) from 1996. The respiratory conditions with the highest spending in 2016 were asthma and chronic obstructive pulmonary disease, contributing $35.5 billion (95% CI, $32.4-38.2 billion) and $34.3 billion (95% CI, $31.5-37.3 billion), respectively. Increasing service price and intensity were associated with 81.4% (95% CI, 70.3-93.0%) growth from 1996 to 2016. Conclusions: U.S. spending on respiratory conditions is high, particularly for chronic conditions like asthma and chronic obstructive pulmonary disease. Our findings suggest that service price and intensity, particularly for pharmaceuticals, should be a key focus of attention for policymakers seeking to reduce health care spending growth.
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Affiliation(s)
- Kevin I Duan
- Division of Pulmonary, Critical Care, and Sleep Medicine
- Center of Innovation for Veteran-centered and Value-driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | | | - David H Au
- Division of Pulmonary, Critical Care, and Sleep Medicine
- Center of Innovation for Veteran-centered and Value-driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Laura J Spece
- Division of Pulmonary, Critical Care, and Sleep Medicine
- Center of Innovation for Veteran-centered and Value-driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Laura C Feemster
- Division of Pulmonary, Critical Care, and Sleep Medicine
- Center of Innovation for Veteran-centered and Value-driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Joseph L Dieleman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; and
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15
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Rhubart D, Kowalkowski J, Yerger J. Rural-Urban disparities in self-reported physical/mental multimorbidity: A cross-sectional study of self-reported mental health and physical health among working age adults in the U.S. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231218560. [PMID: 38024542 PMCID: PMC10666663 DOI: 10.1177/26335565231218560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
Purpose Self-rated physical health (SRPH) and self-rated mental health (SRMH) are both linked to excess morbidity and premature mortality and can vary across rural and urban contexts. This can be particularly problematic for rural residents who have less access to important health care infrastructure. In this paper, we assess the prevalence of and rural-urban disparities at the intersection of SRPH and SRMH, specifically self-rated physical/mental multimorbidity (SRPMM) overall and across rural-urban contexts. Methods Using a cross-sectional demographically representative national dataset of over 4000 working age adults in the U.S., we expose rural-urban differences in the prevalence of SRPMM and explore individual-level factors that may explain this disparity. Results Approximately 15 percent of working age adults reported SRPMM, but rural adults were at higher risk than their urban counterparts. However, this disadvantage disappeared for remote rural working-age adults and was attenuated for metro-adjacent rural working-age adults when we controlled for the fact that rural adults had lower household incomes. Conclusion Findings reveal a higher risk of SRPMM among rural adults, in part because of lower incomes among this group. This work acts as the foundation for facilitating research on and addressing rural-urban disparities in SRPMM.
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Affiliation(s)
- Danielle Rhubart
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - Jennifer Kowalkowski
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - Jordan Yerger
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
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16
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Wattanapisit A, Abdul Rahman H, Car J, Abdul-Mumin KH, de la Cruz MHTO, Chia M, Rosenberg M, Ho MHR, Chaiyasong S, Mahmudiono T, Rodjarkpai Y, Dinov ID, Ottom M, Amornsriwatanakul A. The clusters of health-risk behaviours and mental wellbeing and their sociodemographic correlates: a study of 15,366 ASEAN university students. BMC Public Health 2022; 22:1840. [PMID: 36183060 PMCID: PMC9525932 DOI: 10.1186/s12889-022-14233-2] [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: 04/01/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study investigated, through cluster analysis, the associations between behavioural characteristics, mental wellbeing, demographic characteristics, and health among university students in the Association of Southeast Asian Nations (ASEAN) University Network – Health Promotion Network (AUN-HPN) member universities. Methods Data were retrieved from a cross-sectional self-administered online survey among undergraduate students in seven ASEAN countries. A two-step cluster analysis was employed, with cluster labels based on the predominant characteristics identified within the clusters. The ‘healthy’ cluster was assigned as the reference group for comparisons using multinomial logistic regression analysis. Results The analytic sample size comprised 15,366 university students. Five clusters of student-types were identified: (i) ‘Healthy’ (n = 1957; 12.7%); (ii) ‘High sugary beverage consumption’ (n = 8482; 55.2%); (iii) ‘Poor mental wellbeing’ (n = 2009; 13.1%); (iv) ‘Smoker’ (n = 1364; 8.9%); and (v) ‘Alcohol drinker’ (n = 1554; 10.1%). Being female (OR 1.28, 95%CI 1.14, 1.45) and being physically inactive (OR 1.20, 95%CI 1.04, 1.39) increased the odds of belonging to the ‘High sugary beverage consumption’ cluster. Being female (OR 1.21, 95%CI 1.04, 1.41), non-membership in a sports club (OR 1.83, 95%CI 1.43, 2.34) were associated with ‘Poor mental wellbeing’. Obesity (OR 2.03, 95%CI 1.47, 2.80), inactively commuting to campus (OR 1.34, 95%CI 1.09, 1.66), and living in high-rise accommodation (OR 2.94, 95%CI 1.07, 8.07) were associated with membership in the ‘Smoker’ cluster. Students living in The Philippines, Singapore, Thailand, and Vietnam had a higher likelihood of being alcohol drinkers, compared with those who lived in Brunei. Conclusions ASEAN university students exhibited health-risk behaviours that typically clustered around a specific health behaviour and mental wellbeing. The results provided support for focusing interventions on one dominant health-risk behaviour, with associated health-risk behaviours within clusters being potential mediators for consideration.
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Affiliation(s)
- Apichai Wattanapisit
- School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand.,Walailak University Hospital, Nakhon Si Thammarat, Thailand
| | - Hanif Abdul Rahman
- Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam.,University of Michigan, Ann Arbor, MI, USA
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Khadizah Haji Abdul-Mumin
- Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam.,School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
| | | | - Michael Chia
- Physical Education & Sports Science, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Michael Rosenberg
- School of Human Sciences (Sport Science, Exercise and Health), University of Western Australia, Perth, WA, Australia.,College of Sports Science and Technology, 999 Mahidol University, Phutthamonthon Sai 4 Rd, Salaya, Phutthamonthon District, Nakhon Pathom, 73170, Thailand
| | - Moon-Ho Ringo Ho
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Surasak Chaiyasong
- Alcohol and Health Promotion Policy Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Mahasarakham, Thailand
| | - Trias Mahmudiono
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Yuvadee Rodjarkpai
- Faculty of Public Health, Burapha University, Saen Suk, Chon Buri, Thailand
| | | | - Mohammad Ottom
- University of Michigan, Ann Arbor, MI, USA.,Department of Information Systems, Yarmouk University, Irbid, Jordan
| | - Areekul Amornsriwatanakul
- School of Human Sciences (Sport Science, Exercise and Health), University of Western Australia, Perth, WA, Australia. .,College of Sports Science and Technology, 999 Mahidol University, Phutthamonthon Sai 4 Rd, Salaya, Phutthamonthon District, Nakhon Pathom, 73170, Thailand.
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17
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Bernstein AS, Stevens KL, Koh HK. Patient-Centered Climate Action and Health Equity. JAMA 2022; 328:419-420. [PMID: 35834232 DOI: 10.1001/jama.2022.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Aaron S Bernstein
- Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | | | - Howard K Koh
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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18
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Dogra S, Copeland JL, Altenburg TM, Heyland DK, Owen N, Dunstan DW. Start with reducing sedentary behavior: A stepwise approach to physical activity counseling in clinical practice. PATIENT EDUCATION AND COUNSELING 2022; 105:1353-1361. [PMID: 34556383 DOI: 10.1016/j.pec.2021.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED Recently, sedentary behavior recommendations have been included in the public health guidelines of multiple countries, pointing to new opportunities for prevention of chronic disease as well as a potential strategy for initiating long-term behavior change. OBJECTIVE To propose an evidence-informed approach to physical activity counseling that starts with a focus on reducing sedentary time. METHODS We put forward a case for addressing changes in sedentary behavior in clinical practice using a narrative review. We also propose a new approach for the assessment and counselling of patients with respect to movement behaviors. RESULTS There is evidence to support a stepwise approach to physical activity counseling that starts with targeting sedentary behavior, particularly in those who are highly sedentary, or those who have chronic disease, or physical impairments. CONCLUSIONS Our approach encourages clinicians to consider sedentary behavior counseling as a critical first step to physical activity counseling. For many patients, this initial step of reducing sedentary behavior could build a pathway to an active lifestyle. PRACTICAL IMPLICATIONS A shift from long periods of sedentary time to daily routines incorporating more light intensity physical activity could result in meaningful health improvements. Importantly, this approach may be more feasible for highly inactive patients.
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Affiliation(s)
- Shilpa Dogra
- Faculty of Health Sciences (Kinesiology), University of Ontario Institute of Technology, Canada.
| | - Jennifer L Copeland
- Department of Kinesiology, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Teatske M Altenburg
- Department of Public and Occupational Health, UMC Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Daren K Heyland
- Department of Critical Care Medicine and Public Health, Queen's University, Kingston, Canada
| | - Neville Owen
- Baker Heart and Diabetes Institute, Melbourne, Australia; Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Australia
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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19
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Koh J, Ang G, Tan KB, Chen C. The social cost of high sodium diet in Singapore. Br J Nutr 2022; 129:1-9. [PMID: 35614498 DOI: 10.1017/s0007114522001568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
High sodium (Na) diet is one of the leading behavioural risks of disease identified in the Singapore Burden of Disease Study. We aim to estimate the cost attributable to a high Na diet in Singapore in 2019 from a societal perspective by employing a prevalence-based approach in cost-of-illness studies. We extracted national-level healthcare data and population attributable fractions by sex and age. Costs included direct and indirect costs from inpatient treatment and productivity losses. In 2019, the annual societal cost attributable to a high Na diet was conservatively estimated to be USA$262 million (95 % uncertainty interval (UI) 218, 359 million). At least USA$67·8 million (95 % UI 48·4, 120 million) and USA$194 million (95 % UI 153, 274 million) could be saved on healthcare and indirect costs, respectively, if the daily Na intake of Singaporeans was reduced to an average of 3 g. Overall, males had higher costs compared with females at USA$221 million (95 % UI 174, 312 million) and USA$41·1 million (95 % UI 33·5, 61·7 million), respectively. Productivity loss from foregone wages due to premature mortality had the largest cost at USA$191 million (95 % UI 150, 271 million). CVD had the largest healthcare expenditure at USA$61·4 million (95 % UI 41·6, 113 million), driven by ischaemic heart disease at USA$41·0 million (95 % UI 21·4, 88·9 million). Our study found that reducing Na intake could reduce future healthcare expenditures and productivity losses. This result is vital for policy evaluation in a rapidly ageing society like Singapore, where the burden of diseases associated with high Na diet is expected to increase.
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Affiliation(s)
- Jemima Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Gregory Ang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Kelvin-Bryan Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Ministry of Health, Singapore, Singapore
- Centre for Regulatory Excellence, Duke-NUS Medical School, Singapore, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
- Department of Non-Communicable Disease Epidemiology, The London School of Hygiene & Tropical Medicine, UK
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20
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Ethnicity, Social, and Clinical Risk Factors to Tooth Loss among Older Adults in the U.S., NHANES 2011-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042382. [PMID: 35206567 PMCID: PMC8875070 DOI: 10.3390/ijerph19042382] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/01/2022] [Accepted: 02/10/2022] [Indexed: 11/19/2022]
Abstract
Background. Many older adults suffer from poor oral health, including tooth loss, and disparities among racial/ethnic and socially disadvantaged populations continue to exist. Methods. Data were obtained from the National Health and Nutrition Examination Survey among the adult population in the U.S. The prevalence of edentulism and multiple regression models were conducted on 15,821 adults, including Asians, Blacks, Hispanics, Whites, and others to assess the relationships between tooth loss and their predictors. Results. The prevalence of complete tooth loss increased with age from 0.7% for ages 20–44 to 20.2% for ages 65 and over. There are disparities in complete tooth loss regarding race/ethnicity, with the highest percentages (9%) among Whites and Blacks and the lowest percentages among Asians (3%) and Hispanics (4%). After adjusting for predictors, their impact on tooth loss was not consistent within racial/ethnic groups, as Asians had more tooth loss from Model 1 (β = −1.974, p < 0.0001) to Model 5 (β = −1.1705, p < 0.0001). Conclusion. Tooth loss was significantly higher among older adults and racial/ethnic groups even after controlling for other predictors among a nationally representative sample. The findings point to the fact that subgroup-tailored preventions are necessary.
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21
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McGrath A, Murphy N, Egan T, Ormond G, Richardson N. An Economic Evaluation of 'Sheds for Life': A Community-Based Men's Health Initiative for Men's Sheds in Ireland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042204. [PMID: 35206391 PMCID: PMC8871832 DOI: 10.3390/ijerph19042204] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 01/27/2023]
Abstract
Men’s Sheds (‘Sheds’) attract a diverse cohort of men and, as such, have been identified as spaces with the potential to engage marginalized subpopulations with more structured health promotion. ‘Sheds for Life’ is a 10-week men’s health initiative for Sheds in Ireland and the first structured health promotion initiative formally evaluated in Sheds. Cost is an important implementation outcome in the evaluation of Sheds for Life when operating in an environment where budgets are limited. Therefore, an economic evaluation is critical to highlight cost-effectiveness for decision makers who determine sustainability. This is the first study to evaluate the cost-effectiveness of health endeavors in Sheds. All costs from pre-implementation to maintenance phases were gathered, and questionnaires incorporating the SF-6D were administered to participants (n = 421) at baseline, 3, 6, and 12 months. Then, utility scores were generated to determine quality-adjusted life years (QALYS). Results demonstrate that the intervention group experienced an average 3.3% gain in QALYS from baseline to 3 months and a further 2% gain from 3 months to 6 months at an estimated cost per QALY of €15,724. These findings highlight that Sheds for Life is a cost-effective initiative that effectively engages and enhances the well-being of Shed members.
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Affiliation(s)
- Aisling McGrath
- School of Health Sciences, Waterford Institute of Technology, X91 K0EK Waterford, Ireland;
- Correspondence:
| | - Niamh Murphy
- School of Health Sciences, Waterford Institute of Technology, X91 K0EK Waterford, Ireland;
| | - Tom Egan
- School of Business, Waterford Institute of Technology, X91 K0EK Waterford, Ireland; (T.E.); (G.O.)
| | - Gillian Ormond
- School of Business, Waterford Institute of Technology, X91 K0EK Waterford, Ireland; (T.E.); (G.O.)
| | - Noel Richardson
- National Centre for Men’s Health, Institute of Technology Carlow, R93 V960 Carlow, Ireland;
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22
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Łyszczarz B, Sowa K. Production losses due to mortality associated with modifiable health risk factors in Poland. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:33-45. [PMID: 34236544 PMCID: PMC8882090 DOI: 10.1007/s10198-021-01345-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Epidemiological burden of modifiable mortality risk factors is recognized in literature; however, less is known on the economic losses due to a range of such risks. AIM To estimate production losses (indirect cost) of mortality associated with risk factors as classified in Global Burden of Disease 2019 Study in Poland in years 2000, 2010, and 2017. METHODS We relied on the human capital method and societal perspective and used sex-, age-, region-, and risk-specific data on mortality due to modifiable risk factors and a set of socio-economic measures. RESULTS The production losses due to mortality attributable to all investigated risk factors accounted for 19.6-21.0 billion PLN (Polish zloty; 2017 exchange rate: 1€ = 4.26 PLN) and 1.44-2.45% of gross domestic product, depending on year. Behavioural factors were the most important contributor to overall burden (16.7-18.2 billion PLN), followed by metabolic factors (6.8-7.6 billion PLN) and environmental and occupational factors (3.0-3.5 billion PLN). Of disaggregated risks, alcohol and tobacco, high systolic blood pressure, and dietary risks proved to lead to the highest losses. Cost per death was greatest for child and maternal malnutrition, followed by intimate partner violence and childhood sexual abuse and bullying. Moreover, a notable regional variation of indirect cost was identified with losses ranging from 1.21 to 1.81% of regional gross domestic product in 2017. CONCLUSION Our findings provide economically hierarchised list of modifiable risk factors and they contribute to inform policy-makers in prioritizing programmes to improve health.
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Affiliation(s)
- Błażej Łyszczarz
- Department of Health Economics, Nicolaus Copernicus University in Toruń, Toruń, Poland.
| | - Karolina Sowa
- Department of Analyses and Strategies, Ministry of Health, Warsaw, Poland
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Mitkova Z, Doneva M, Gerasimov N, Tachkov K, Dimitrova M, Kamusheva M, Petrova G. Analysis of Healthcare Expenditures in Bulgaria. Healthcare (Basel) 2022; 10:healthcare10020274. [PMID: 35206888 PMCID: PMC8872167 DOI: 10.3390/healthcare10020274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022] Open
Abstract
The growth of public expenditure worldwide has set the priority on assessment of trends and establishment of factors which generate the most significant public costs. The goal of the current study is to review the tendencies in public healthcare expenditures in Bulgaria and to analyze the influence of the demographic, economic, and healthcare system capacity indicators on expenditures dynamics. A retrospective, top-down, financial analysis of the healthcare system expenditures was performed. Datasets of the National Statistical Institute (NSI), National Health Insurance Fund (NHIF), and National Center of Public Health and Analysis (NCPHA) were retrospectively reviewed from2014–2019 to collect the information in absolute units of healthcare expenditures, healthcare system performance, demographics, and economic indicators. The research showed that increasing GDP led to higher healthcare costs, and it was the main factor affecting the cost growth in Bulgaria. The number of hospitalized patients and citizens in retirement age remained constant, confirming that their impact on healthcare costs was negligible. In conclusion, the population aging, average life expectancy, patient morbidity, and hospitalization rate altogether impacted healthcare costs mainly due to the multimorbidity of older people and the rising need for outpatient hospital services and medications.
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Affiliation(s)
- Zornitsa Mitkova
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 1000 Sofia, Bulgaria; (M.D.); (K.T.); (M.D.); (M.K.); (G.P.)
- Correspondence: ; Tel.: +359-888535759
| | - Miglena Doneva
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 1000 Sofia, Bulgaria; (M.D.); (K.T.); (M.D.); (M.K.); (G.P.)
| | | | - Konstantin Tachkov
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 1000 Sofia, Bulgaria; (M.D.); (K.T.); (M.D.); (M.K.); (G.P.)
| | - Maria Dimitrova
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 1000 Sofia, Bulgaria; (M.D.); (K.T.); (M.D.); (M.K.); (G.P.)
| | - Maria Kamusheva
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 1000 Sofia, Bulgaria; (M.D.); (K.T.); (M.D.); (M.K.); (G.P.)
| | - Guenka Petrova
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 1000 Sofia, Bulgaria; (M.D.); (K.T.); (M.D.); (M.K.); (G.P.)
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Shea A, Brophy L, Nininger J, Abbott M, Wilson L. Nutrition integration across the nursing curriculum: A novel teaching model within a pre-licensure program. J Prof Nurs 2021; 37:1162-1166. [PMID: 34887035 DOI: 10.1016/j.profnurs.2021.10.006] [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: 05/12/2021] [Indexed: 10/20/2022]
Abstract
Across the healthcare spectrum, the provision of evidence-based nutrition education is critical in supporting optimal patient care and health outcomes. Nurses are uniquely positioned to deliver nutrition-focused patient education related to health promotion and disease management; yet widespread evidence of sufficient nutrition instruction in nursing curricula is not available. Although lifestyle and nutrition recommendations have historically been the domain of registered dietitians, interprofessional collaboration requires that nurses are prepared to reinforce and support the dissemination of accurate nutrition education. Interdisciplinary teaching approaches are therefore imperative for consistent communication and execution of nutrition guidance. At a private nursing college, an innovative model for nutrition integration across a nursing curriculum has been developed and implemented. This model features an ongoing instructional partnership between registered dietitian faculty and nurse educators. This integrative model enhances nutrition-related nursing competencies demonstrated by undergraduate nursing students and aims to produce graduates who are confident in the delivery of nutrition-related nursing care.
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Affiliation(s)
- Aimee Shea
- Mount Carmel College of Nursing, 127 S. Davis Ave, Columbus, OH 43222, United States of America.
| | - Larissa Brophy
- Mount Carmel College of Nursing, 127 S. Davis Ave, Columbus, OH 43222, United States of America
| | - Jami Nininger
- Mount Carmel College of Nursing, 127 S. Davis Ave, Columbus, OH 43222, United States of America
| | - Miriam Abbott
- Mount Carmel College of Nursing, 127 S. Davis Ave, Columbus, OH 43222, United States of America
| | - Lauren Wilson
- Mount Carmel College of Nursing, 127 S. Davis Ave, Columbus, OH 43222, United States of America
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Sanmarchi F, Esposito F, Bucci A, Toscano F, Golinelli D. Association between Economic Growth, Mortality, and Healthcare Spending in 31 High-Income Countries. Forum Health Econ Policy 2021; 24:101-118. [PMID: 36259392 DOI: 10.1515/fhep-2021-0035] [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: 06/28/2021] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
Abstract
This study aims to investigate the association between gross domestic product (GDP), mortality rate (MR) and current healthcare expenditure (CHE) in 31 high-income countries. We used panel data from 2000 to 2017 collected from WHO and OECD databases. The association between CHE, GDP and MR was investigated through a random-effects model. To control for reverse causality, we adopted a test of Granger causality. The model shows that the MR has a statistically significant and negative effect on CHE and that an increase in GDP is associated with an increase of CHE (p < 0.001). The Granger causality analysis shows that all the variables exhibit a bidirectional causality. We found a two-way relationship between GDP and CHE. Our analysis highlights the economic multiplier effect of CHE. In the debate on the optimal allocation of resources, this evidence should be taken into due consideration.
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Affiliation(s)
- Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
| | - Francesco Esposito
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
| | - Andrea Bucci
- Department of Economics, University of Chieti-Pescara, Pescara, Italy
| | - Fabrizio Toscano
- Department of Internal Medicine, Montefiore Medical Center, Bronx, New York City, USA
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
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Graham SA, Stein N, Shemaj F, Branch OH, Paruthi J, Kanick SC. Older Adults Engage With Personalized Digital Coaching Programs at Rates That Exceed Those of Younger Adults. Front Digit Health 2021; 3:642818. [PMID: 34713112 PMCID: PMC8521864 DOI: 10.3389/fdgth.2021.642818] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The US population is aging and has an expanding set of healthcare needs for the prevention and management of chronic conditions. Older adults contribute disproportionately to US healthcare costs, accounting for 34% of total healthcare expenditures in 2014 but only 15% of the population. Fully automated, digital health programs offer a scalable and cost-effective option to help manage chronic conditions. However, the literature on technology use suggests that older adults face barriers to the use of digital technologies that could limit their engagement with digital health programs. The objective of this study was to characterize the engagement of adults 65 years and older with a fully automated digital health platform called Lark Health and compare their engagement to that of adults aged 35-64 years. Methods: We analyzed data from 2,169 Lark platform users across four different coaching programs (diabetes prevention, diabetes care, hypertension care, and prevention) over a 12-month period. We characterized user engagement as participation in digital coaching conversations, meals logged, and device measurements. We compared engagement metrics between older and younger adults using nonparametric bivariate analyses. Main Results: Aggregate engagement across all users during the 12-month period included 1,623,178 coaching conversations, 588,436 meals logged, and 203,693 device measurements. We found that older adults were significantly more engaged with the digital platform than younger adults, evidenced by older adults participating in a larger median number of coaching conversations (514 vs. 428) and logging more meals (174 vs. 89) and device measurements (39 vs. 28) all p ≤ 0.01. Conclusions: Older adult users of a commercially available, fully digital health platform exhibited greater engagement than younger adults. These findings suggest that despite potential barriers, older adults readily adopted digital health technologies. Fully digital health programs may present a widely scalable and cost-effective alternative to traditional telehealth models that still require costly touchpoints with human care providers.
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Melariri HI, Kalinda C, Chimbari MJ. Enablers and hindrances to health promotion and disease prevention practices among healthcare workers in Nelson Mandela Bay Municipality, South Africa. Prev Med Rep 2021; 23:101462. [PMID: 34258174 PMCID: PMC8254112 DOI: 10.1016/j.pmedr.2021.101462] [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: 01/10/2021] [Revised: 05/16/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022] Open
Abstract
Health promotion (HP) and disease prevention (DP) practices among healthcare workers (HCWs) are key to achieving universal health coverage. This study identified HP and DP enablers and hindrances and compared them at different healthcare levels in Nelson Mandela Bay Municipality, South Africa. An exploratory cross-sectional study using a structured questionnaire was conducted among HCWs (n = 501) from 23 hospitals. Bivariate and multinomial regression were used to analyze the data. The highest number of participants (70.46%; n = 353) were from tertiary hospitals. Thirteen and Eight categories of enablers and hindrances respectively were identified. Of these, eleven enablers and six hindrances of HP and DP were associated with tertiary hospitals; no enabler was identified at both primary and secondary while one hindrance was associated with primary level of health care. Collaboration among disciplines and organizations (Coeff: 2.16, 95% CI: 1.28-3.66) and programme planning (Coeff: 0.375, 95% CI: 0.23-0.62) were the predictors of HP and DP among medical doctors, while staff induction training (Coeff: 0.62, 95% CI: 0.40-0.95) and performance appraisal (Coeff: 1.86, 95% CI: 1.16-2.98) were the enablers among allied health workers. On the other hand, 'facility promoting treatment more than prevention' (Coeff: 2.03, 95% CI: 1.30-3.14) and 'practice guidelines incorporating HP' (Coeff: 2.79, 95% CI: 1.66-4.70) were the predictors of HP and DP hindrances among medical doctors and allied health workers respectively. Our work indicates the need for an operational strategy designed considering enabling and hindering factors to HP and DP practices for empowering HCWs and enhancing health outcomes.
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Affiliation(s)
- Herbert I. Melariri
- University of KwaZulu-Natal, Department of Public Health, College of Health Sciences, Howard College Campus, Durban 4041, South Africa
- Eastern Cape Department of Health, South Africa
| | - Chester Kalinda
- University of KwaZulu-Natal, Department of Public Health, College of Health Sciences, Howard College Campus, Durban 4041, South Africa
- University of Namibia, Faculty of Agriculture, Engineering and Natural Sciences, School of Science, Katima Mulilo Campus, P/Bag 1096, Katima Mulilo, Namibia
| | - Moses J. Chimbari
- University of KwaZulu-Natal, Department of Public Health, College of Health Sciences, Howard College Campus, Durban 4041, South Africa
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Dieleman JL, Chen C, Crosby SW, Liu A, McCracken D, Pollock IA, Sahu M, Tsakalos G, Dwyer-Lindgren L, Haakenstad A, Mokdad AH, Roth GA, Scott KW, Murray CJL. US Health Care Spending by Race and Ethnicity, 2002-2016. JAMA 2021; 326:649-659. [PMID: 34402829 PMCID: PMC8371574 DOI: 10.1001/jama.2021.9937] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/04/2021] [Indexed: 12/15/2022]
Abstract
Importance Measuring health care spending by race and ethnicity is important for understanding patterns in utilization and treatment. Objective To estimate, identify, and account for differences in health care spending by race and ethnicity from 2002 through 2016 in the US. Design, Setting, and Participants This exploratory study included data from 7.3 million health system visits, admissions, or prescriptions captured in the Medical Expenditure Panel Survey (2002-2016) and the Medicare Current Beneficiary Survey (2002-2012), which were combined with the insured population and notified case estimates from the National Health Interview Survey (2002; 2016) and health care spending estimates from the Disease Expenditure project (1996-2016). Exposure Six mutually exclusive self-reported race and ethnicity groups. Main Outcomes and Measures Total and age-standardized health care spending per person by race and ethnicity for each year from 2002 through 2016 by type of care. Health care spending per notified case by race and ethnicity for key diseases in 2016. Differences in health care spending across race and ethnicity groups were decomposed into differences in utilization rate vs differences in price and intensity of care. Results In 2016, an estimated $2.4 trillion (95% uncertainty interval [UI], $2.4 trillion-$2.4 trillion) was spent on health care across the 6 types of care included in this study. The estimated age-standardized total health care spending per person in 2016 was $7649 (95% UI, $6129-$8814) for American Indian and Alaska Native (non-Hispanic) individuals; $4692 (95% UI, $4068-$5202) for Asian, Native Hawaiian, and Pacific Islander (non-Hispanic) individuals; $7361 (95% UI, $6917-$7797) for Black (non-Hispanic) individuals; $6025 (95% UI, $5703-$6373) for Hispanic individuals; $9276 (95% UI, $8066-$10 601) for individuals categorized as multiple races (non-Hispanic); and $8141 (95% UI, $8038-$8258) for White (non-Hispanic) individuals, who accounted for an estimated 72% (95% UI, 71%-73%) of health care spending. After adjusting for population size and age, White individuals received an estimated 15% (95% UI, 13%-17%; P < .001) more spending on ambulatory care than the all-population mean. Black (non-Hispanic) individuals received an estimated 26% (95% UI, 19%-32%; P < .001) less spending than the all-population mean on ambulatory care but received 19% (95% UI, 3%-32%; P = .02) more on inpatient and 12% (95% UI, 4%-24%; P = .04) more on emergency department care. Hispanic individuals received an estimated 33% (95% UI, 26%-37%; P < .001) less spending per person on ambulatory care than the all-population mean. Asian, Native Hawaiian, and Pacific Islander (non-Hispanic) individuals received less spending than the all-population mean on all types of care except dental (all P < .001), while American Indian and Alaska Native (non-Hispanic) individuals had more spending on emergency department care than the all-population mean (estimated 90% more; 95% UI, 11%-165%; P = .04), and multiple-race (non-Hispanic) individuals had more spending on emergency department care than the all-population mean (estimated 40% more; 95% UI, 19%-63%; P = .006). All 18 of the statistically significant race and ethnicity spending differences by type of care corresponded with differences in utilization. These differences persisted when controlling for underlying disease burden. Conclusions and Relevance In the US from 2002 through 2016, health care spending varied by race and ethnicity across different types of care even after adjusting for age and health conditions. Further research is needed to determine current health care spending by race and ethnicity, including spending related to the COVID-19 pandemic.
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Affiliation(s)
| | - Carina Chen
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Sawyer W. Crosby
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Angela Liu
- Johns Hopkins University, Baltimore, Maryland
| | - Darrah McCracken
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Ian A. Pollock
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Maitreyi Sahu
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Golsum Tsakalos
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | | | - Annie Haakenstad
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Gregory A. Roth
- Institute for Health Metrics and Evaluation, Seattle, Washington
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Patel J, Wallace J, Doshi M, Gadanya M, Ben Yahya I, Roseman J, Srisilapanan P. Oral health for healthy ageing. THE LANCET HEALTHY LONGEVITY 2021; 2:e521-e527. [DOI: 10.1016/s2666-7568(21)00142-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 12/20/2022]
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Heyland DK, Pope JP, Jiang X, Day AG. Determining the psychometric properties of a novel questionnaire to measure "preparedness for the future" (Prep FQ). Health Qual Life Outcomes 2021; 19:122. [PMID: 33858414 PMCID: PMC8048271 DOI: 10.1186/s12955-021-01759-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/31/2021] [Indexed: 11/10/2022] Open
Abstract
Background People are living longer than ever before. However, with living longer comes increased problems that negatively impact on quality of life and the quality of death. Tools are needed to help individuals assess whether they are practicing the best attitudes and behaviors that are associated with a future long life, high quality of life, high quality of death and a satisfying post-death legacy. The purpose of paper is to describe the process we used to develop a novel questionnaire (“Preparedness for the Future Questionnaire™ or Prep FQ”) and to define its psychometric properties. Methods Using a multi-step development procedure, items were generated, for the new questionnaire after which the psychometric properties were tested with a heterogeneous sample of 502 Canadians. Using an online polling panel, respondents were asked to complete demographic questions as well as the Prep-FQ, Global Rating of Life Satisfaction, the Keyes Psychological Well-Being scale and the Short-Form 12. Results The final version of the questionnaire contains 34 items in 8 distinct domains (“Medico-legal”, “Social”, “Psychological Well-being”, “Planning”, “Enrichment”, “Positive Health Behaviors”, “Negative Health Behaviors”, and “Late-life Planning”). We observed minimum missing data and good usage of all response options. The average overall Prep FQ score is 51.2 (SD = 13.3). The Cronbach alphas assessing internal reliability for the Prep FQ domains ranged from 0.33 to 0.88. The intra-class correlation coefficient (ICC) used to assess the test–retest reliability had an overall score of 0.87. For the purposes of establishing construct validity, all the pre-specified relationships between Prep FQ and the other questionnaires were met. Conclusion Analyses of this novel measure offered support for its face validity, construct validity, test–retest reliability, and internal consistency. With the development of this useful and valid scale, future research can utilize this measure to engage people in the process of comprehensively assessing and improving their state of preparedness for the future, tracking their progress along the way. Ultimately, this program of research aims to improve the quality and quantity of peoples live by helping them ‘think ahead’ and ‘plan ahead’ on the aspects of their daily life that matter to their future. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01759-z.
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Affiliation(s)
- Daren K Heyland
- Department of Critical Care Medicine, Kingston Health Science Centre, Kingston, ON, Canada. .,Clinical Evaluation Research Unit, Kingston Health Science Centre, Kingston, ON, Canada. .,Department of Public Health Sciences, Queen's University, Kingston, ON, K7L 2V7, Canada.
| | - J Paige Pope
- Department of Kinesiology and Physical Education, University of Lethbridge, Lethbridge, AB, Canada
| | - Xuran Jiang
- Department of Critical Care Medicine, Kingston Health Science Centre, Kingston, ON, Canada
| | - Andrew G Day
- Clinical Evaluation Research Unit, Kingston Health Science Centre, Kingston, ON, Canada
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Donohue JA, Severson T, Martin LP. The food pharmacy: Theory, implementation, and opportunities. Am J Prev Cardiol 2021; 5:100145. [PMID: 34327488 PMCID: PMC8315372 DOI: 10.1016/j.ajpc.2020.100145] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/11/2020] [Accepted: 12/29/2020] [Indexed: 01/03/2023] Open
Abstract
The food pharmacy is an emerging program model designed to increase the access to and consumption of healthful foods, particularly fruits and vegetables. Existing research on the efficacy of the food pharmacy model shows that these programs have been effective in improving patient understanding of nutrition and removing barriers to healthy eating, and in turn may have a significant impact on diet-related health outcomes. However, efforts to date aiming to evaluate program effectiveness have been small and lack rigorous research methods. More research is needed to adequately assess the longitudinal effects of food pharmacy programs on healthful food intake and diet-related health outcomes. In this review, we outline the strengths and limitations of previous programs and explore possible options to improve the scalability and sustainability of food pharmacy programs.
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Affiliation(s)
| | - Tracy Severson
- Oregon Health & Science University, Portland, OR, United States
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Galea S, Maani N. The cost of preventable disease in the USA. Lancet Public Health 2020; 5:e513-e514. [PMID: 33007204 PMCID: PMC7524435 DOI: 10.1016/s2468-2667(20)30204-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Sandro Galea
- Dean's Office, Boston University School of Public Health, Boston, MA 02119, USA.
| | - Nason Maani
- Dean's Office, Boston University School of Public Health, Boston, MA 02119, USA; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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