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Chay J, Jafar TH, Su RJ, Shirore RM, Tan NC, Finkelstein EA. Cost-Effectiveness of a Multicomponent Primary Care Intervention for Hypertension. J Am Heart Assoc 2024; 13:e033631. [PMID: 38606776 DOI: 10.1161/jaha.123.033631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND The SingHypertension primary care clinic intervention, which consisted of clinician training in hypertension management, subsidized single-pill combination medications, nurse-delivered motivational conversations and telephone follow-ups, improved blood pressure control and cardiovascular disease (CVD) risk scores relative to usual care among patients with uncontrolled hypertension in Singapore. This study quantified the incremental cost-effectiveness, in terms of incremental cost per unit reduction disability-adjusted life years, of SingHypertension relative to usual care for patients with hypertension from the health system perspective. METHODS AND RESULTS We developed a Markov model to simulate CVD events and associated outcomes for a hypothetical cohort of patients over a 10-year period. Costs were measured in US dollars, and effectiveness was measured in disability-adjusted life years averted. We present base-case results and conducted deterministic and probabilistic sensitivity analyses. Based on a willingness-to-pay threshold of US $55 500 per DALY averted, SingHypertension was cost-effective for patients with hypertension (incremental cost-effectiveness ratio: US $24 765 per disability-adjusted life year averted) relative to usual care. This result held even if risk reduction was assumed to decline linearly to 0 over 10 years but not sooner than 7 years. Incremental cost-effectiveness ratios were most sensitive to the magnitude of the reduction in CVD risk; at least a 0.13% to 0.16% point reduction in 10-year CVD risk is required for cost-effectiveness. Probabilistic sensitivity analysis indicates that SingHypertension has a 78% chance of being cost-effective at the willingness-to-pay threshold. CONCLUSIONS SingHypertension represents good value for the money for reducing CVD incidence, morbidity, and mortality and should be considered for wide-scale implementation in Singapore and possibly other countries. REGISTRATION INFORMATION REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02972619.
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Affiliation(s)
- Junxing Chay
- Program in Health Services & Systems Research Duke-NUS Medical School Singapore
| | - Tazeen H Jafar
- Program in Health Services & Systems Research Duke-NUS Medical School Singapore
- Department of Renal Medicine Singapore General Hospital Singapore
- Duke Global Health Institute Durham NC USA
| | - Rebecca J Su
- Program in Health Services & Systems Research Duke-NUS Medical School Singapore
| | - Rupesh M Shirore
- Program in Health Services & Systems Research Duke-NUS Medical School Singapore
| | | | - Eric A Finkelstein
- Program in Health Services & Systems Research Duke-NUS Medical School Singapore
- Duke Global Health Institute Durham NC USA
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Tan JWC, Yeo TJ, Tan DS, Chua TSJ, Yeo KK, Koh NSY, Subramaniam T, Kwan YS, Lim MCL, Low LP, Tan HC. Strategies to prevent cardiovascular disease in Singapore: A call to action from Singapore Heart Foundation, Singapore Cardiac Society and Chapter of Cardiologists of the Academy of Medicine, Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:23-33. [PMID: 38920212 DOI: 10.47102/annals-acadmedsg.2023141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction In 2022, the Minister for Health of Singapore launched Healthier SG, a national strategy in championing the shift towards a population health approach. Method The Singapore Heart Foundation conducted a series of roundtable discussions, also attended by representatives of the Singapore Cardiac Society and the Chapter of Cardiologists of the Academy of Medicine Singapore. During the meetings, the authors formulated interventions supportive of Healthier SG that specifically aimed to uplift the state of cardiovascular (CV) preventive care in Singapore. Results In line with Healthier SG, the authors propose a 3-pronged approach ("Healthier Heart SG") to augment the success of Healthier SG in achieving good CV outcomes. This proposal includes the following components: (1) a call to update the standards of care in addressing the 5 main modifiable risk factors of cardiovascular disease (CVD); (2) patient education through cooperation between healthcare professionals and community partners for a whole-of-system approach; and (3) support for integrated care, including access to cardiac rehabilitation in the community, improved referral processes and access to nutrition/dietetics counselling and tobacco cessation, optimal use of information technology, and continued CV research. Conclusion Healthier Heart SG would bring the standards of care and CV care delivery in Singapore closer to achieving the vision of proactive prevention of CVD and CV morbidity and mortality. This can only be achieved through the concerted efforts of healthcare professionals, policymakers and community partners, coupled with the cooperation of community members.
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Affiliation(s)
- Jack Wei Chieh Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Department of Cardiology, Sengkang General Hospital, Singapore
- Singapore Heart Foundation
- Singapore Cardiac Society
- Chapter of Cardiologists, College of Physicians, Academy of Medicine, Singapore
| | - Tee Joo Yeo
- Singapore Heart Foundation
- Singapore Cardiac Society
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Doreen Sy Tan
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Pharmacy and Pharmaceutical Science, National University of Singapore, Singapore
| | - Terrance Siang Jin Chua
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Singapore Heart Foundation
- Singapore Cardiac Society
- Chapter of Cardiologists, College of Physicians, Academy of Medicine, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Department of Cardiology, Sengkang General Hospital, Singapore
- Singapore Cardiac Society
- Chapter of Cardiologists, College of Physicians, Academy of Medicine, Singapore
| | - Natalie Si Ya Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Department of Cardiology, Sengkang General Hospital, Singapore
- Chapter of Cardiologists, College of Physicians, Academy of Medicine, Singapore
| | - Tavintharan Subramaniam
- Diabetes Centre, Admiralty Medical Centre, Singapore
- Department of Medicine, Khoo Teck Puat Hospital, Singapore
| | | | - Michael Chun Leng Lim
- Chapter of Cardiologists, College of Physicians, Academy of Medicine, Singapore
- Royal Heart, Stroke and Cancer Centre, Singapore
| | - Lip Ping Low
- Singapore Heart Foundation
- Low Cardiology Clinic, Singapore
| | - Huay Cheem Tan
- Singapore Heart Foundation
- Singapore Cardiac Society
- Chapter of Cardiologists, College of Physicians, Academy of Medicine, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Sum KK, Tint MT, Aguilera R, Dickens BSL, Choo S, Ang LT, Phua D, Law EC, Ng S, Tan KML, Benmarhnia T, Karnani N, Eriksson JG, Chong YS, Yap F, Tan KH, Lee YS, Chan SY, Chong MFF, Huang J. The socioeconomic landscape of the exposome during pregnancy. ENVIRONMENT INTERNATIONAL 2022; 163:107205. [PMID: 35349911 DOI: 10.1016/j.envint.2022.107205] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/08/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND While socioeconomic position (SEP) is consistently related to pregnancy and birth outcome disparities, relevant biological mechanisms are manifold, thus necessitating more comprehensive characterization of SEP-exposome associations during pregnancy. OBJECTIVES We implemented an exposomic approach to systematically characterize the socioeconomic landscape of prenatal exposures in a setting where social segregation was less distinct in a hypotheses-generating manner. METHODS We described the correlation structure of 134 prenatal exogenous and endogenous sources (e.g., micronutrients, hormones, immunomodulatory metabolites, environmental pollutants) collected in a diverse, population-representative, urban, high-income longitudinal mother-offspring cohort (N = 1341; 2009-2011). We examined the associations between maternal, paternal, household, and areal level SEP indicators and 134 exposures using multiple regressions adjusted for precision variables, as well as potential effect measure modification by ethnicity and nativity. Finally, we generated summary SEP indices using Multiple Correspondence Analysis to further explore possible curved relationships. RESULTS Individual and household SEP were associated with anthropometric/adiposity measures, folate, omega-3 fatty acids, insulin-like growth factor-II, fasting glucose, and neopterin, an inflammatory marker. We observed paternal education was more strongly and consistently related to maternal exposures than maternal education. This was most apparent amongst couples discordant on education. Analyses revealed additional non-linear associations between areal composite SEP and particulate matter. Environmental contaminants (e.g., per- and polyfluoroalkyl substances) and micronutrients (e.g., folate and copper) showed opposing associations by ethnicity and nativity, respectively. DISCUSSION SEP-exposome relationships are complex, non-linear, and context specific. Our findings reinforce the potential role of paternal contributions and context-specific modifiers of associations, such as between ethnicity and maternal diet-related exposures. Despite weak presumed areal clustering of individual exposures in our context, our approach reinforces subtle non-linearities in areal-level exposures.
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Affiliation(s)
- Ka Kei Sum
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore.
| | - Mya Thway Tint
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Rosana Aguilera
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sue Choo
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Li Ting Ang
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Desiree Phua
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Evelyn C Law
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Sharon Ng
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Karen Mei-Ling Tan
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Neerja Karnani
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Bioinformatics Institute, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Yap-Seng Chong
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Fabian Yap
- Duke-NUS Medical School, Singapore, Singapore; Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Singapore; Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mary F F Chong
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jonathan Huang
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Centre for Quantitative Medicine (CQM), Duke-NUS Medical School, Singapore, Singapore
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Banchani E, Tenkorang EY, Midodzi W. Examining the effects of individual and neighbourhood socioeconomic status/wealth on hypertension among women in the Greater Accra Region of Ghana. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:714-725. [PMID: 33016517 DOI: 10.1111/hsc.13185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
Hypertension is one of the leading causes of morbidity and mortality among women in sub-Saharan Africa. Although research on the relationship between individual-level socioeconomic status (SES) and hypertension exists, to the best of our knowledge, limited empirical studies examined the effects of neighbourhood-level SES/wealth on the risks of living with hypertension in Ghana. Using data from the 2009 Women's Health Study of Accra (WHSA-II), and applying multilevel logistic regression, this study investigates the effects of both individual and neighbourhood wealth status on hypertension among women in the Greater Accra Region of Ghana. The results show that individual-level SES/wealth is a significant determinant of hypertension among Ghanaian women in Accra. Specifically, wealthy women are more likely to be hypertensive compared to poorer women. However, the effect of neighbourhood SES/wealth was attenuated after adjusting for individual-level SES/wealth. These findings suggest that it is important to develop health promotion programs targeted at a segment of SES group in the prevention, control and management of hypertension among women in the Greater Accra Region of Ghana.
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Affiliation(s)
| | - Eric Y Tenkorang
- Department of Sociology, Memorial University, St. John's, Canada
| | - William Midodzi
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Canada
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Maksimov SA, Balanova YA, Shalnova SA, Muromtseva GA, Kapustina AV, Drapkina OM. Regional living conditions and the prevalence, awareness, treatment, control of hypertension at the individual level in Russia. BMC Public Health 2022; 22:202. [PMID: 35094684 PMCID: PMC8801098 DOI: 10.1186/s12889-022-12645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The objective of our study was to investigate the associations of characteristics inherent in large Russian Federation (RF) regions with prevalence, awareness, treatment and control of hypertension at the individual level.
Methods
Regional characteristics were obtained from the official website of the Federal State Statistics Service of the RF. We employed principal component analysis to reduce the dimensionality of data, which allowed defining five integral regional indices. Prevalence, awareness, treatment and control of hypertension were assessed from the data of the cross-sectional stage of ESSE-RF study conducted in 2013–2014. The final sample included 19,791 patients from 12 RF regions. Generalized estimating equations were used to identify the associations of regional indices with prevalence, awareness, treatment and control of hypertension at the individual level, taking into consideration nested data structures (study subjects in the regions).
Results
The index characterizing deterioration of social living conditions and societal marginalization exhibited positive associations with the prevalence of hypertension among men (OR = 1.18; 95% CI: 1.05–1.32) and elderly people (OR = 1.16; 95% CI: 1.02–1.32). Moreover, deterioration in the social environment was associated with a reduction in treatment (OR = 0.76; 95% CI: 0.64–0.90) and control of hypertension (OR = 0.79; 95% CI: 0.69–0.90). Hypertension awareness was directly connected with demographic crisis (OR = 1.13; 95% CI: 1.02–1.25) and augmented industrial development (OR = 1.15; 95% CI: 1.01–1.33) in the regions. The association of regional living conditions with the prevalence of hypertension is relatively weak, compared to predictors at the individual level, but this influence is important for awareness, treatment and control of hypertension.
Conclusion
The study contributed to evaluating the associations of the vital characteristics inherent in population of large RF regions with arterial hypertension prevalence, as well as with awareness, treatment and control of this disease. Our results provided original insights from the standpoint of cardiovascular disease epidemiology in the RF, as well as in the context of investigating the impact of living conditions on population health.
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Maksimov SA, Shalnova SA, Kutsenko VA, Balanova YA, Muromtseva GA, Kapustina AV, Evstifeeva SE, Imaeva AE, Karamnova NS, Drapkina OM. Effect of regional living conditions on middle-term cardiovascular outcomes: data from prospective stage of the ESSE-RF study. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To assess regional living conditions with cardiovascular outcomes based on prospective stage of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study.Material and methods. We used data from a 3- and 5-year prospective stage of the ESSE-RF study (2012-2013). For initial screening, 16210 people aged 25-64 were included. To characterize the regions of residence, 5 regional indices (RIs) were used. The following endpoints were considered: cardiovascular death, myocardial infarction, stroke, composite endpoint (cardiovascular death + myocardial infarction + stroke). To assess the correlations, generalized estimating equations with nested data structure (individuals in the regions) were used. The studied associations were adjusted for a wide range of potential effect modifiers.Results. There are multiple direct associations of RIs with the likelihood of all endpoints. The exception was the reverse association of Industrial RI with cardiovascular death. The most stable associations regarded Mixed RI, Industrial RI and Socio-geographical RI, with a high RI significance in endpoint development, compared with well-known individual cardiovascular risk factors. Separate associations were noted for Economic RI and Demographic RI.Conclusion. The results indicate a significant contribution of a number of regional living conditions to individual risk of fatal and non-fatal cardiovascular outcomes.
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Affiliation(s)
- S. A. Maksimov
- National Medical Research Center for Therapy and Preventive Medicine
| | - S. A. Shalnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - V. A. Kutsenko
- National Medical Research Center for Therapy and Preventive Medicine
| | - Yu. A. Balanova
- National Medical Research Center for Therapy and Preventive Medicine
| | - G. A. Muromtseva
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. V. Kapustina
- National Medical Research Center for Therapy and Preventive Medicine
| | - S. E. Evstifeeva
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. E. Imaeva
- National Medical Research Center for Therapy and Preventive Medicine
| | - N. S. Karamnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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Wong FY, Wong RX, Zhou S, Ong WS, Pek PP, Yap YS, Tan BKT, Ngeow JYY, Tan VKM, Sim Y, Tan SM, Lim SH, Madhukumar P, Tan TJY, Loh KWJ, Ong MEH, Wong TH. Effects of housing value and medical subsidy on treatment and outcomes of breast cancer patients in Singapore: A retrospective cohort study. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2020; 6:100065. [PMID: 34327401 PMCID: PMC8315650 DOI: 10.1016/j.lanwpc.2020.100065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/23/2020] [Accepted: 11/19/2020] [Indexed: 11/22/2022]
Abstract
Background Socioeconomic status (SES) is likely to affect survival in breast cancer patients. Housing value is a reasonable surrogate for SES in Singapore where most residents own their own homes, which could be public (subsidised) or private housing. We evaluated effects of housing value and enhanced medical subsidies on patients’ presentation, treatment choices, compliance and survival in a setting of good access to healthcare. Methods A retrospective analysis of breast cancer patients treated in a tertiary hospital cluster from 2000 to 2016 was performed. Individual-level Housing value Index (HI) was derived from each patient's address and then grouped into 3 tiers: HI(high)(minimal subsidy), HI(med)(medium subsidy) and HI(low)(high subsidy). Cox regression was performed to evaluate the associations between overall survival (OS) and cancer-specific survival (CSS) with HI and various factors. Findings We studied a multiracial cohort of 15,532 Stage 0–IV breast cancer patients. Median age was 53.7 years and median follow-up was 7.7 years. Patients with lower HI presented with more advanced disease and had lower treatment compliance. On multivariable analysis, compared to HI(high) patients, HI(med) patients had decreased OS (HR=1.14, 95% CI 1.05–1.23) and CSS (HR=1.15, 95% CI 1.03–1.27), and HI(low) patients demonstrated reduced OS (HR=1.16, 95% CI 1.01–1.33). Ten-year non-cancer mortality was higher in lower HI-strata. Enhanced medical subsidy approximately halved treatment noncompliance rates but its receipt was not an independent prognostic factor for survival. Interpretation Despite good healthcare access, lower-HI patients have poorer survival from both cancer and non-cancer causes, possibly due to delayed health-seeking and poorer treatment compliance. Enhanced subsidies may mitigate socioeconomic disadvantages. Funding None.
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Affiliation(s)
- Fuh Yong Wong
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Ru Xin Wong
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Siqin Zhou
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Whee Sze Ong
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Pin Pin Pek
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Yoon-Sim Yap
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Benita Kiat Tee Tan
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore.,Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,SingHealth Duke NUS Breast Centre, 11 Hospital Crescent, Singapore, 169610, Singapore.,Sengkang General Hospital, 110 Sengkang E Way, Singapore, 544886, Singapore
| | | | - Veronique Kiak Mien Tan
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore.,Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Yirong Sim
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Su-Ming Tan
- Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Swee Ho Lim
- KK Women's and Children's Hospital, Bukit Timah Rd, 100, Singapore, 229899, Singapore
| | - Preetha Madhukumar
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore.,Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Tira Jing Ying Tan
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Kiley Wei-Jen Loh
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Marcus Eng Hock Ong
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Ting Hway Wong
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore
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Wee LE, Yee J, Lee S, Oen K, Tsang TYY, Koh GCH. Trends in health screening participation and lifestyle behaviours after participation in a free, access-enhanced screening intervention in a low-income Singaporean rental-flat community. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:439-447. [PMID: 31631433 DOI: 10.1111/hsc.12876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 09/16/2019] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
Our objective was to evaluate the impact of an access-enhanced health screening intervention on screening adherence in a rental-flat community. In Singapore, public rental flats provide heavily subsidised rentals for the needy who cannot afford to own their own homes; with a majority of Singaporeans (≥85%) staying in owner-occupied public housing. We observed trends in health screening adherence and health behaviours among residents of a multi-ethnic public rental-flat community in Singapore from 2013 to 2017, after participation in a free, access-enhanced multi-modality screening programme in 2011. Residents staying in neighbouring owner-occupied housing who participated in the same screening programme served as a basis of comparison. A total of 478 rental-flat residents and 505 owner-occupied flat residents participated. In the rental-flat community, hypertension screening rates improved from 18.3% (24/131) in 2013, to 61.2% (52/85) in 2015 and 44.2% (34/77) in 2017 (p < .001). For diabetes, rates improved from 26.2% (43/164) → 47.0% (54/115) → 49.5% (45/91; p < .001). For dyslipidaemia screening, rates improved from 18.2% (31/170) → 39.6% (38/96) → 47.5% (38/80; p < .001). In the owner-occupied community (n = 505), screening rates largely remained stagnant (hypertension: 52.2% → 75.0% → 54.5%, p = .059; diabetes: 66.0% → 56.5% → 66.7%, p = .434; dyslipidaemia: 53.1% → 50.0% → 57.1%, p = .818). In the rental-flat community, unhealthy behaviours increased from 2013 to 2017, with higher proportions of overweight (30.4% → 24.8% → 52.1%, p < .001), higher smoking (11.7% → 36.9% → 32.5%, p < .001) and higher drinking rates (1.4% → 0.7% → 8.1%, p < .001). This shift was also reflected in the owner-occupied community, with higher percentages of overweight and higher drinking rates (p < .001).
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Affiliation(s)
- Liang En Wee
- Singhealth Internal Medicine, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Jaime Yee
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Shannon Lee
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kellynn Oen
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | | | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
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Wee LE, Low LL, Thumboo J, Chan A, Lee KH. Factors associated with emergency room visits and hospitalisation amongst low-income public rental flat dwellers in Singapore. BMC Public Health 2019; 19:713. [PMID: 31174499 PMCID: PMC6556005 DOI: 10.1186/s12889-019-7009-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 05/20/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In Singapore, a densely urbanised Asian society, more than 80% of the population stays in public housing estates and the majority (90%) own their own homes. For the needy who cannot afford home ownership, public rental flats are available. Staying in a public rental flat is associated with higher hospital readmission rates and poorer access to health services. We sought to examine sociodemographic factors associated with hospital admissions and emergency room visits amongst public rental flat residents. METHODS We surveyed all residents aged ≥60 years in a public rental housing precinct in central Singapore in 2016. Residents self-reported their number of emergency room visits, as well as hospitalisations, in the past 6 months. We obtained information on residents' sociodemographic characteristics, medical, functional and social status via standardised questionnaires. We used chi-square to identify associations between emergency room visits/hospitalisations and sociodemographic characteristics, on univariate analysis; and logistic regression for multivariate analysis. RESULTS Of 1324 contactable residents, 928 participated in the survey, with a response rate of 70.1%. A total of 928 residents participated in our study, of which 59.5% were male (553/928) and 51.2% (476/928) were ≥ 70 years old. Around 9% (83/928) of residents had visited the emergency room in the last 6 months; while 10.5% (100/928) had been admitted to hospital in the past 6 months. On multivariable analysis, being religious (aOR = 0.43, 95%CI = 0.24-0.76) and having seen a primary care practitioner in the last 6 months (aOR = 0.46, 95%CI = 0.27-0.80) were independently associated with lower odds of emergency room visits, whereas loneliness (aOR = 1.96, 95%CI = 1.13-3.43), poorer coping (aOR = 1.72, 95%CI = 1.01-3.03) and better adherence (aOR = 2.23, 95%CI = 1.29-3.83) were independently associated with higher odds of emergency room visits. For hospitalisations, similarly poorer coping (aOR = 1.85, 95%CI = 1.12-3.07), better adherence (aOR = 1.69, 95%CI = 1.04-2.75) and poorer functional status (aOR = 1.85, 95%CI = 1.15-2.98) were all independently associated with higher odds of hospitalisations, whereas those who were religious (aOR = 0.62, 95%CI = 0.37-0.99) and those who were currently employed (aOR = 0.46, 95%CI = 0.37-0.99) had lower odds of being hospitalised. CONCLUSION In this public rental flat population, functional status, coping and adherence, and having a religion were independently associated with emergency room visits and hospitalisation. Residents who had seen a primary care practitioner in the last 6 months had lower odds of visiting the emergency room.
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Affiliation(s)
- Liang En Wee
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
| | - Julian Thumboo
- Department of Rheumatology, Singapore General Hospital, Singapore, Singapore
| | - Angelique Chan
- Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Kheng Hock Lee
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
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Tan ST, Quek RYC, Haldane V, Koh JJK, Han EKL, Ong SE, Chuah FLH, Legido-Quigley H. The social determinants of chronic disease management: perspectives of elderly patients with hypertension from low socio-economic background in Singapore. Int J Equity Health 2019; 18:1. [PMID: 30606218 PMCID: PMC6318975 DOI: 10.1186/s12939-018-0897-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background In Singapore, the burden of hypertension disproportionately falls on the elderly population of low socio-economic status. Despite availability of effective treatment, studies have shown high prevalence of sub-optimal blood pressure control in this group. Poor hypertension management can be attributed to a number of personal factors including awareness, management skills and overall adherence to treatment. However, these factors are also closely linked to a broader range of community and policy factors. This paper explores the perceived social and physical environments of low socio-economic status and elderly patients with hypertension; and how the interplay of factors within these environments influences their ability to mobilise resources for hypertension management. Methods In-depth interviews were conducted in English, Chinese, Chinese dialects and Malay with 20 hypertensive patients of various ethnic backgrounds. Purposive sampling was adopted for recruitment of participants from a previous community health screening campaign. Interviews were translated into English and transcribed verbatim. We deductively analysed leveraging on the Social Model of Health to identify key themes, while inductive analysis was used simultaneously to allow sub-themes to emerge. Results and discussion Our finding shows that financing is an overarching topic embedded in most themes. Despite the availability of multiple safety nets, some patients were left out and lacked capital to navigate systems effectively, which resulted in delayed treatment or debt. The built environment played a significant role in enabling patients to access care easily and lead a more active lifestyle. A closer look is needed to enhance the capacity of patients with mobility challenges to enjoy equitable access. Furthermore, the establishment of community based elderly centres has enabled patients to engage in meaningful and healthy social activities. In contrast, participants’ descriptions showed that their communication with healthcare professionals remained brief, and that personalised and meaningful interactions that are context and culturally specific are essential to advocate for patients’ overall treatment adherence and lifestyle modification. Conclusion Elderly patients with hypertension from lower socio-economic background have various unmet needs in managing their hypertension and other comorbidities. These needs are closely related to broader societal factors such as socio-demographic characteristics, support systems, urban planning and public policies, and health systems factors. Policy decisions to address these needs require an integrated multi-sectoral approach grounded in the principles of health equity.
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Affiliation(s)
- Sok Teng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Rina Yu Chin Quek
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Victoria Haldane
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Joel Jun Kai Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Emeline Kai Lin Han
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Suan Ee Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Fiona Leh Hoon Chuah
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore. .,London School of Hygiene and Tropical Medicine, WC1H 9SH, London, UK.
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11
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Seng JJB, Kwan YH, Goh H, Thumboo J, Low LL. Public rental housing and its association with mortality - a retrospective, cohort study. BMC Public Health 2018; 18:665. [PMID: 29843652 PMCID: PMC5975624 DOI: 10.1186/s12889-018-5583-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/22/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Socioeconomic status (SES) is a well-established determinant of health status and home ownership is a commonly used composite indicator of SES. Patients in low-income households often stay in public rental housing. The association between public rental housing and mortality has not been examined in Singapore. METHODS A retrospective, cohort study was conducted involving all patients who utilized the healthcare facilities under SingHealth Regional Health (SHRS) Services in Year 2012. Each patient was followed up for 5 years. Patients who were non-citizens or residing in a non-SHRS area were excluded from the study. RESULTS A total of 147,004 patients were included in the study, of which 7252 (4.9%) patients died during the study period. The mean age of patients was 50.2 ± 17.2 years old and 7.1% (n = 10,400) of patients stayed in public rental housing. Patients who passed away had higher utilization of healthcare resources in the past 1 year and a higher proportion stayed in public rental housing (p < 0.001). They also had higher rates of co-morbidities such as hypertension, hyperlipidaemia and diabetes. (p < 0.001) After adjustment for demographic and clinical covariates, residence in public rental housing was associated with increased risk of all-cause mortality (Adjusted hazard ratio: 1.568, 95% CI: 1.469-1.673). CONCLUSION Public rental housing was an independent risk factor for all-cause mortality. More studies should be conducted to understand health-seeking behavior and needs of public rental housing patients, to aid policymakers in formulating better plans for improving their health outcomes.
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Affiliation(s)
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Hendra Goh
- Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Julian Thumboo
- Health Services Research Centre, Singapore Health Services, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
| | - Lian Leng Low
- SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
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12
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Chan CQH, Lee KH, Low LL. A systematic review of health status, health seeking behaviour and healthcare utilisation of low socioeconomic status populations in urban Singapore. Int J Equity Health 2018; 17:39. [PMID: 29609592 PMCID: PMC5879561 DOI: 10.1186/s12939-018-0751-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/20/2018] [Indexed: 02/08/2023] Open
Abstract
Introduction It is well-established that low socioeconomic status (SES) influences one’s health status, morbidity and mortality. Housing type has been used as an indicator of SES and social determinant of health in some studies. In Singapore, home ownership is among the highest in the world. Citizens who have no other housing options are offered heavily subsidised rental housings. Residents staying in such rental housings are characterised by low socioeconomic status. Our aim is to review studies on the association between staying in public rental housing in Singapore and health status. Methods A PubMed and Scopus search was conducted in January 2017 to identify suitable articles published from 1 January 2000 to 31 January 2017. Only studies that were done on Singapore public rental housing communities were included for review. A total of 14 articles including 4 prospective studies, 8 cross-sectional studies and 2 retrospective cohort studies were obtained for the review. Topics addressed by these studies included: (1) Health status; (2) Health seeking behaviour; (3) Healthcare utilisation. Results Staying in public rental housing was found to be associated with poorer health status and outcomes. They had lower participation in health screening, preferred alternative medicine practitioners to western-trained doctors for primary care, and had increased hospital utilisation. Several studies performed qualitative interviews to explore the causes of disparity and concern about cost was one of the common cited reason. Conclusion Staying in public rental housing appears to be a risk marker of poorer health and this may have important public health implications. Understanding the causes of disparity will require more qualitative studies which in turn will guide interventions and the evaluation of their effectiveness in improving health outcome of this sub-population of patients.
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Affiliation(s)
- Catherine Qiu Hua Chan
- Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore, Singapore. .,Family Medicine, Duke-NUS Medical School, Singapore, Singapore.
| | - Kheng Hock Lee
- Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore, Singapore.,Family Medicine, Duke-NUS Medical School, Singapore, Singapore.,Family Medicine Academic Clinical Program, SingHealth Duke-NUS, Singapore, Singapore
| | - Lian Leng Low
- Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore, Singapore. .,Family Medicine, Duke-NUS Medical School, Singapore, Singapore. .,Family Medicine Academic Clinical Program, SingHealth Duke-NUS, Singapore, Singapore.
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13
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Koh JJK, Cheng RX, Yap Y, Haldane V, Tan YG, Teo KWQ, Srivastava A, Ong PS, Perel P, Legido-Quigley H. Access and adherence to medications for the primary and secondary prevention of atherosclerotic cardiovascular disease in Singapore: a qualitative study. Patient Prefer Adherence 2018; 12:2481-2498. [PMID: 30538432 PMCID: PMC6255116 DOI: 10.2147/ppa.s176256] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Atherosclerotic cardiovascular disease (ASCVD) is a growing public health threat globally, and many individuals remain undiagnosed, untreated, and their condition remains uncontrolled. The key to effective ASCVD management is adherence to pharmacotherapy, and non-adherence has been associated with an increased risk of cardiovascular events and complications such as stroke, further impacting a patient's ability to be adherent. Our qualitative study aimed to explore factors influencing medication adherence in the primary and secondary prevention of ASCVD in Singapore. We propose a synthesized framework, which expands on current understandings of the factors of medication adherence, as a frame of analysis in this study. METHODS We conducted in-depth, semi-structured interviews with 20 patients over the age of 40 with ASCVD and/or its risk factors in Singapore. QSR Nvivo 11 was used to conduct thematic analysis using an inductive approach. RESULTS Using a synthesized framework, we reported that complex medication regimens, the lack of support received during regimen changes, and the perceived seriousness of a condition could impact a patient's medication adherence. Key findings suggest that the relationship between health care professionals and patients impacted patient acceptability of the medication regimen and consequently medication adherence. Different patient beliefs regarding diagnosis, medication, and adherence had some bearing on the ability to perceive the need to adhere to their medication. Patients also reported that they could afford medication, sometimes with the help of family members. Patients also largely reported not needing help managing their medication, considering it an individual responsibility. CONCLUSION We identified key factors which future interventions looking to improve medication adherence ought to consider. These include changing patient perceptions of health systems, diagnosis, medication, and adherence; patient-centeredness in developing interventions that facilitate adherence through building self-efficacy and stronger support networks via patient empowerment and engagement; decreasing patient co-payments on medication; and cultivating a trusting patient-provider relationship.
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Affiliation(s)
- Joel Jun Kai Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,
| | - Rui Xiang Cheng
- Department of Pharmacy, National University of Singapore, Singapore
| | - Yicheng Yap
- Department of Pharmacy, National University of Singapore, Singapore
| | - Victoria Haldane
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,
| | - Yao Guo Tan
- Department of Pharmacy, National University of Singapore, Singapore
| | | | - Aastha Srivastava
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,
| | - Pei Shi Ong
- Department of Pharmacy, National University of Singapore, Singapore
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, UK,
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,
- London School of Hygiene and Tropical Medicine, London, UK,
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Lim KK, Kwan YH, Tan CS, Low LL, Chua AP, Lee WY, Pang L, Tay HY, Chan SY, Ostbye T. The association between distance to public amenities and cardiovascular risk factors among lower income Singaporeans. Prev Med Rep 2017; 8:116-121. [PMID: 29021948 PMCID: PMC5633842 DOI: 10.1016/j.pmedr.2017.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 08/21/2017] [Accepted: 09/09/2017] [Indexed: 01/05/2023] Open
Abstract
Existing evidence on the association between built environment and cardiovascular disease (CVD) risk factors focused on the general population, which may not generalize to higher risk subgroups such as those with lower socio-economic status (SES). We examined the associations between distance to 5 public amenities from residential housing (public polyclinic, subsidized private clinic, healthier eatery, public park and train station) and 12 CVD risk factors (physical inactivity, medical histories and unhealthy dietary habits) among a study sample of low income Singaporeans aged ≥ 40 years (N = 1972). Using data from the Singapore Heart Foundation Health Mapping Exercise 2013–2015, we performed a series of logistic mixed effect regressions, accounting for clustering of respondents in residential blocks and multiple comparisons. Each regression analysis used the minimum distance (in km) between residential housing and each public amenity as an independent continuous variable and a single risk factor as the dependent variable, controlling for demographic characteristics. Increased distance (geographical inaccessibility) to a train station was significantly associated with lower odds of participation in sports whereas greater distance to a subsidized private clinic was associated with lower odds of having high cholesterol diagnosed. Increasing distance to park was positively associated with higher odds of less vegetable and fruits consumption, deep fried food and fast food consumption in the preceding week/month, high BMI at screening and history of diabetes, albeit not achieving statistical significance. Our findings highlighted potential effects of health-promoting amenities on CVD risk factors in urban low-income setting, suggesting gaps for further investigations. We examined associations between access to 5 amenities and 12 CVD risk factors. Only 2/60 associations were statistically significant. Poorer access to train station was associated with lower odds of sports. Poorer access to primary care was associated with lower high cholesterol diagnosis.
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Affiliation(s)
- K K Lim
- Health Systems & Services Research, Duke NUS Medical School, Republic of Singapore
| | - Y H Kwan
- Health Systems & Services Research, Duke NUS Medical School, Republic of Singapore
| | - C S Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Republic of Singapore
| | - L L Low
- Department of Family Medicine & Continuing Care, Singapore General Hospital, Republic of Singapore
| | - A P Chua
- Department of Medicine, Ng Teng Fong General Hospital, 1 Jurong East Street 21, 609606, Republic of Singapore
| | - W Y Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Republic of Singapore.,Department of Medical Informatics, Jurong Health Services, 1 Jurong East Street 21, 609606, Republic of Singapore
| | - L Pang
- Saw Swee Hock School of Public Health, National University of Singapore, Republic of Singapore
| | - H Y Tay
- Singapore Heart Foundation, 9 Bishan Place #07-01 Junction 8 (Office Tower), 579837, Republic of Singapore
| | - S Y Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, 117543, Republic of Singapore
| | - T Ostbye
- Health Systems & Services Research, Duke NUS Medical School, Republic of Singapore
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15
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Kiselev AR, Posnenkova OM, Belova OA, Romanchuk SV, Popova YV, Prokhorov MD, Gridnev VI. Impact of Clinical Factors on the Achievement of Target Blood Pressure in Hypertensive Patients from Ivanovo Region of Russia: Data of 2015. High Blood Press Cardiovasc Prev 2017; 24:425-435. [PMID: 28856581 DOI: 10.1007/s40292-017-0227-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/14/2017] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION In Russia, blood pressure (BP) control is below the optimal. The little is known about regional features and barriers to adequate BP control in Russian primary care. AIM To evaluate the impact of clinical factors on achieving the target BP in hypertensive patients in one region of Russia. METHODS Retrospective medical data of 2015 on 11,129 patients (31.4% male) with hypertension (Htn) from Ivanovo region of Russia were examined. Achievement of target BP was assessed in all patients. We study association between BP control and clinical factors. RESULTS 45.9% of studied patients with Htn had controlled BP. The frequency of achieving the target BP in subsets of hypertensive patients was 37.8% in patients with diabetes, 39.5% in patients with coronary artery disease, and 29.9% in patients with chronic heart failure. The main clinical factors associated with achieving the target BP in studied hypertensive patients were the advice on alcohol consumption, advice on smoking cessation, and advice on weight reduction. Therapy with main antihypertensive drugs (in particular, beta-blockers and thiazide diuretics) were also factors of optimal BP control in these patients. Comorbidities (chronic heart failure and cardiovascular diseases requiring the prescription of aspirin and statins) and family history of coronary artery disease were associated with inadequate BP control. A negative effect of some antihypertensive drugs (potassium sparing diuretics, ARBs, ACE-Is, and dihydropyridine CCBs) on BP control that was found out in our study requires further investigation. Other studied factors had no influence on BP control in patients with Htn from Ivanovo region. CONCLUSION We identified regional factors of BP control in hypertensive patients from Ivanovo region of Russia. It is shown that individual medical education (in particular, medical advices) is the most important factor of optimal BP control. The intervention with antihypertensive therapy (beta-blockers and thiazide diuretics) facilitates the achievement of target BP. Comorbidity and age reduce the frequency of achieving the target BP.
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Affiliation(s)
- A R Kiselev
- Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, 112, Bolshaya Kazachya str., Saratov, 410012, Russia.
| | - O M Posnenkova
- Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, 112, Bolshaya Kazachya str., Saratov, 410012, Russia
| | - O A Belova
- Ivanovo Regional Cardiology Dispensary, Ivanovo, Russia
| | - S V Romanchuk
- Healthcare Department of Ivanovo Region, Ivanovo, Russia
| | - Y V Popova
- Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, 112, Bolshaya Kazachya str., Saratov, 410012, Russia
| | - M D Prokhorov
- Saratov Branch of the Institute of Radio Engineering and Electronics of Russian Academy of Sciences, Moscow, Russia
| | - V I Gridnev
- Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, 112, Bolshaya Kazachya str., Saratov, 410012, Russia
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Okwuonu CG, Ojimadu NE, Okaka EI, Akemokwe FM. Patient-related barriers to hypertension control in a Nigerian population. Int J Gen Med 2014; 7:345-53. [PMID: 25061335 PMCID: PMC4086668 DOI: 10.2147/ijgm.s63587] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hypertension control is a challenge globally. Barriers to optimal control exist at the patient, physician, and health system levels. Patient-related barriers in our environment are not clear. The aim of this study was to identify patient-related barriers to control of hypertension among adults with hypertension in a semiurban community in South-East Nigeria. METHODS This was a cross-sectional descriptive study of patients with a diagnosis of hypertension and on antihypertensive medication. RESULTS A total of 252 participants were included in the survey, and comprised 143 males (56.7%) and 109 females (43.3%). The mean age of the participants was 56.6±12.7 years, with a diagnosis of hypertension for a mean duration of 6.1±3.3 years. Among these patients, 32.9% had controlled blood pressure, while 39.3% and 27.8%, respectively, had stage 1 and stage 2 hypertension according to the Seventh Report of the Joint National Committee on Prevention, Detection and Evaluation of High Blood Pressure. Only 23.4% knew the consequences of poor blood pressure control and 64% were expecting a cure from treatment even when the cause of hypertension was not known. Furthermore, 68.7% showed low adherence to medication, the reported reasons for which included forgetfulness (61.2%), financial constraints (56.6%), high pill burden (22.5%), side effects of medication (17.3%), and low measured blood pressure (12.1%). Finally, knowledge and practice of the lifestyle modifications necessary for blood pressure control was inadequate among the participants. CONCLUSION Poor knowledge regarding hypertension, unrealistic expectations of treatment, poor adherence with medication, unawareness of lifestyle modification, and failure to apply these were identified as patient-related barriers to blood pressure control in this study.
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Affiliation(s)
| | | | - Enajite Ibiene Okaka
- Renal Unit, Department of Internal Medicine University of Benin Teaching Hospital, Benin City, Nigeria
| | - Fatai Momodu Akemokwe
- Neurology Unit, Department of Internal Medicine University of Benin Teaching Hospital, Benin City, Nigeria
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17
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Wee LE, Yong YZ, Chng MWX, Chew SH, Cheng L, Chua QHA, Yek JJL, Lau LJF, Anand P, Hoe JTM, Shen HM, Koh GCH. Individual and area-level socioeconomic status and their association with depression amongst community-dwelling elderly in Singapore. Aging Ment Health 2014; 18:628-41. [PMID: 24392759 DOI: 10.1080/13607863.2013.866632] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Neighborhood socioeconomic status (SES) can be associated with depression. We aimed to assess prevalence of depression amongst community-dwelling elderly in a multiethnic, urban, low-SES, Asian neighborhood, comparing against a higher SES neighborhood. METHOD The study population involved all residents aged ≥60 years in two Singaporean housing estates comprising owner-occupied public housing (higher SES) and public rental housing (low SES) in 2012. Having lifetime prevalence of depression was defined as having a score ≥5 on the Geriatric Depression Scale-15 or a history of depression. Demographic/clinical details were collected via questionnaire. Those with depression were referred to local polyclinics. Multilevel multivariate logistic regression determined predictors of depression and depression screening. RESULTS Participation was 61.5% (559/909). In the low-SES community, 26.2% (104/397) had depression, compared with 14.8% (24/162) in the higher SES community. After adjusting for other sociodemographic variables, staying in a low-SES community (public rental housing) was independently a ssociated with depression [adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI) = 1.02-2.84]. Within the low-SES community, not being married (aOR = 2.27, CI = 1.35-3.70), falls (aOR = 2.72, CI = 1.59-4.67), visual impairment (aOR = 2.37, CI = 1.28-4.39), and poorer social network (aOR = 3.70, CI = 1.96-7.14) were associated with depression. CONCLUSION Residing in a low-SES community was independently associated with depression after controlling for individual SES.
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Affiliation(s)
- Liang En Wee
- a Yong Loo Lin School of Medicine , National University of Singapore, National University Health System , Singapore
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Wee LE, Lim LY, Shen T, Lee EY, Chia YH, Tan AYS, Koh GCH. Choice of primary health care source in an urbanized low-income community in Singapore: a mixed-methods study. Fam Pract 2014; 31:81-91. [PMID: 24253204 DOI: 10.1093/fampra/cmt064] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Cost and misperceptions may discourage lower income Singaporeans from utilizing primary care. We investigated sources of primary care in a low-income Singaporean community in a mixed-methods study. METHODS Residents of a low-income public rental flat neighbourhood were asked for sociodemographic details and preferred source of primary care relative to their higher income neighbours. In the qualitative component, interviewers elicited, from patients and health care providers, barriers/enablers to seeking care from Western-trained doctors. Interviewees were selected via purposive sampling. Transcripts were analyzed thematically, and iterative analysis was carried out using established qualitative method. RESULTS Participation was 89.8% (359/400). Only 11.1% (40/359) preferred to approach Western-trained doctors, 29.5% (106/359) preferred alternative medicine, 6.7% (24/359) approached family/friends and 52.6% (189/359) preferred self-reliance. Comparing against higher income neighbours, rental flat residents were more likely to turn to alternative medicine and family members but less likely to turn to Western-trained doctors (P < 0.001). For the qualitative component, a total of 20 patients and 9 providers were interviewed before data saturation was reached. Patient and provider comments fell into the following content areas: primary care characteristics, knowledge, costs, priorities, attitudes and information sources. Self-reliance was perceived as acceptable for 'small' illnesses but not for 'big' ones, communal spirit was cited as a reason for consulting family/friends and social distance from primary care practitioners was highlighted as a reason for not consulting Western-trained doctors. CONCLUSION Western-trained physicians are not the first choice of lower income Singaporeans for seeking primary care. Knowledge, primary care characteristics and costs were identified as potential barriers/enablers.
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Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studies. PLoS One 2014; 9:e84238. [PMID: 24454721 PMCID: PMC3893097 DOI: 10.1371/journal.pone.0084238] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 11/12/2013] [Indexed: 01/13/2023] Open
Abstract
Background Although the importance of detecting, treating, and controlling hypertension has been recognized for decades, the majority of patients with hypertension remain uncontrolled. The path from evidence to practice contains many potential barriers, but their role has not been reviewed systematically. This review aimed to synthesize and identify important barriers to hypertension control as reported by patients and healthcare providers. Methods Electronic databases MEDLINE, EMBASE and Global Health were searched systematically up to February 2013. Two reviewers independently selected eligible studies. Two reviewers categorized barriers based on a theoretical framework of behavior change. The theoretical framework suggests that a change in behavior requires a strong commitment to change [intention], the necessary skills and abilities to adopt the behavior [capability], and an absence of health system and support constraints. Findings Twenty-five qualitative studies and 44 quantitative studies met the inclusion criteria. In qualitative studies, health system barriers were most commonly discussed in studies of patients and health care providers. Quantitative studies identified disagreement with clinical recommendations as the most common barrier among health care providers. Quantitative studies of patients yielded different results: lack of knowledge was the most common barrier to hypertension awareness. Stress, anxiety and depression were most commonly reported as barriers that hindered or delayed adoption of a healthier lifestyle. In terms of hypertension treatment adherence, patients mostly reported forgetting to take their medication. Finally, priority setting barriers were most commonly reported by patients in terms of following up with their health care providers. Conclusions This review identified a wide range of barriers facing patients and health care providers pursuing hypertension control, indicating the need for targeted multi-faceted interventions. More methodologically rigorous studies that encompass the range of barriers and that include low- and middle-income countries are required in order to inform policies to improve hypertension control.
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Wee LE, Wong J, Chin RT, Lin ZY, Goh DEQ, Vijakumar K, Vong KY, Tay WL, Lim HT, Koh GCH. Hypertension Management and Lifestyle Changes Following Screening for Hypertension in an Asian Low Socioeconomic Status Community: A Prospective Study. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n9p451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: This study investigated the effect of an access-enhanced intervention on hypertension screening and management, as well as on health behaviours among newly diagnosed hypertensives, in a multi-ethnic low socioeconomic status (SES) community. Factors associated with hypertension screening, treatment, and control in the community were also determined. Materials and Methods: The study involved all residents aged ≥40 years in 2 public rental housing precincts (low SES), between 2009 and 2011, who were followed-up prospectively for 1 year after a 6-month community-based intervention comprising a 3-month access-enhanced screening component and a 3-month follow-up (outreach) component. Blood pressure was measured at baseline and follow-up. Multivariate Cox regression determined predictors of hypertension management at follow-up. Results: The follow-up rate was 80.9% (467/577). At baseline, 60.4% (282/467) were hypertensive; 53.5% (151/282) were untreated; 54.2% (71/131) uncontrolled. One year later, postintervention, 51.6% (78/151) of untreated hypertensives were treated; combined with treated hypertensives previously uncontrolled, 53.0% (79/149) achieved control. Older age independently predicted treatment (adjusted relative risk, aRR = 1.98, CI, 1.08 to 3.65); majority ethnicity (aRR = 1.76, CI, 1.05 to 2.96), employment (aRR = 1.85, CI, 1.26 to 2.80) and newly treated hypertension (aRR=1.52, CI, 1.01 to 2.32) predicted control. A total of 52.4% (97/185) were irregularly screened at baseline; at follow-up 61.9% (60/97) were regularly screened. Cost and misperceptions were common barriers to screening and treatment. Newly diagnosed hypertensives were also less likely to go for additional cardiovascular screening (aRR = 0.54, CI, 0.29 to 0.99). Conclusion: An access-enhanced intervention had some success in improving hypertension management within low SES communities; however, it was less successful in improving cardiovascular risk management, especially in encouraging lifestyle changes and additional cardiovascular screening amongst newly diagnosed hypertensives.
Key words: Cardiovascular screening, Control, Treatment
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Affiliation(s)
- Liang En Wee
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Jolene Wong
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Run Ting Chin
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Zhi Yong Lin
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Daniel EQ Goh
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Kalpana Vijakumar
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Kiat Yee Vong
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Wei Ling Tay
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Hui Ting Lim
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Gerald CH Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
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Yi-Bing W, De-Gui K, Long-Le M, Le-Xin W. Patient related factors for optimal blood pressure control in patients with hypertension. Afr Health Sci 2013; 13:579-83. [PMID: 24250292 DOI: 10.4314/ahs.v13i3.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Patient related factors hindering optimal blood pressure (BP) control in patients with hypertension are unclear. OBJECTIVES To investigate the barriers to optimal hypertension management. METHODS A survey on the awareness and management of hypertension was conducted in 556 patients (365 males, mean age 60.9 ± 10.1) from a rural community. RESULTS Of the 556 patients who had a clinical diagnosis of hypertension, 127 (22.8%) were unaware the existence of the condition and received no therapy. In the 429 patients who were aware the presence of hypertension, 206 (48.0%) did not receive any antihypertensive medication at the time of this study. Fifty-four (12.5%) had a BP of less than 140/90 mm Hg. Only 21 (4.9%) received formal counselling or education from health professionals and 74 (17.2%) were aware of the optimal level of BP. Difficulty in accessing a specialist doctor was reported by 126 (29.4%). In 279 (65.0%), missing regular antihypertensive medications was reported in the 4-week period prior to this study. Omitting prescribed antihypertensive drugs due to the costs was reported by 169 (39.4%). CONCLUSION Inadequate counselling, lack of understanding on the disease, difficulties in accessing specialist care and poor medication adherence are the barriers to optimal BP control.
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Affiliation(s)
- Wang Yi-Bing
- Department of Public Policy and Management, International Business College, Qingdao University, Qingdao, Shandong Province, PR China
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Xu R, Han QF, Zhu TY, Ren YP, Chen JH, Zhao HP, Chen MH, Dong J, Wang Y, Hao CM, Zhang R, Zhang XH, Wang M, Tian N, Wang HY. Impact of individual and environmental socioeconomic status on peritoneal dialysis outcomes: a retrospective multicenter cohort study. PLoS One 2012; 7:e50766. [PMID: 23226378 PMCID: PMC3511320 DOI: 10.1371/journal.pone.0050766] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/24/2012] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES We aimed to explore the impacts of individual and environmental socioeconomic status (SES) on the outcome of peritoneal dialysis (PD) in regions with significant SES disparity, through a retrospective multicenter cohort in China. METHODS Overall, 2,171 incident patients from seven PD centers were included. Individual SES was evaluated from yearly household income per person and education level. Environmental SES was represented by regional gross domestic product (GDP) per capita and medical resources. Undeveloped regions were defined as those with regional GDP lower than the median. All-cause and cardiovascular death and initial peritonitis were recorded as outcome events. RESULTS Poorer PD patients or those who lived in undeveloped areas were younger and less-educated and bore a heavier burden of medical expenses. They had lower hemoglobin and serum albumin at baseline. Low income independently predicted the highest risks for all-cause or cardiovascular death and initial peritonitis compared with medium and high income. The interaction effect between individual education and regional GDP was determined. In undeveloped regions, patients with an elementary school education or lower were at significantly higher risk for all-cause death but not cardiovascular death or initial peritonitis compared with those who attended high school or had a higher diploma. Regional GDP was not associated with any outcome events. CONCLUSION Low personal income independently influenced all-cause and cardiovascular death, and initial peritonitis in PD patients. Education level predicted all-cause death only for patients in undeveloped regions. For PD patients in these high risk situations, integrated care before dialysis and well-constructed PD training programs might be helpful.
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Affiliation(s)
- Rong Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Qing-Feng Han
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Tong-Ying Zhu
- Department of Nephrology, Huashan Hospital of Fudan University, Shanghai, China
| | - Ye-Ping Ren
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Jiang-Hua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hui-Ping Zhao
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Meng-Hua Chen
- Department of Nephrology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Yue Wang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Chuan-Ming Hao
- Department of Nephrology, Huashan Hospital of Fudan University, Shanghai, China
| | - Rui Zhang
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Xiao-Hui Zhang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Mei Wang
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Na Tian
- Department of Nephrology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Hai-Yan Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
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Wee LE, Yeo WX, Yang GR, Hannan N, Lim K, Chua C, Tan MY, Fong N, Yeap A, Chen L, Koh GCH, Shen HM. Individual and Area Level Socioeconomic Status and Its Association with Cognitive Function and Cognitive Impairment (Low MMSE) among Community-Dwelling Elderly in Singapore. Dement Geriatr Cogn Dis Extra 2012; 2:529-42. [PMID: 23277785 PMCID: PMC3522450 DOI: 10.1159/000345036] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background/Aims Neighborhood socioeconomic status (SES) can affect cognitive function. We assessed cognitive function and cognitive impairment among community-dwelling elderly in a multi-ethnic urban low-SES Asian neighborhood and compared them with a higher-SES neighborhood. Methods The study population involved all residents aged ≥60 years in two housing estates comprising owner-occupied housing (higher SES) and rental flats (low SES) in Singapore in 2012. Cognitive impairment was defined as <24 on the Mini Mental State Examination. Demographic/clinical details were collected via questionnaire. Multilevel linear regression was used to evaluate factors associated with cognitive function, while multilevel logistic regression determined predictors of cognitive impairment. Results Participation was 61.4% (558/909). Cognitive impairment was found in 26.2% (104/397) of residents in the low-SES community and in 16.1% (26/161) of residents in the higher-SES community. After adjusting for other sociodemographic variables, living in a low-SES community was independently associated with poorer cognitive function (β = −1.41, SD = 0.58, p < 0.01) and cognitive impairment (adjusted odds ratio 5.13, 95% CI 1.98–13.34). Among cognitively impaired elderly in the low-SES community, 96.2% (100/104) were newly detected. Conclusion Living in a low-SES community is independently associated with cognitive impairment in an urban Asian society.
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Affiliation(s)
- Liang En Wee
- Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
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Two new species of the genus Mecyclothorax Sharp from New Guinea (Coleoptera: Carabidae: Psydrinae). TIJDSCHRIFT VOOR ENTOMOLOGIE 2008; 19:ijerph19158979. [PMID: 35897349 PMCID: PMC9332044 DOI: 10.3390/ijerph19158979] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
Abstract
Chronic diseases typically require long-term management through healthy lifestyle practices and pharmacological intervention. Although efficacious treatments exist, disease control is often sub-optimal leading to chronic disease-related sequela. Poor disease control can partially be explained by the ‘one size fits all’ pharmacological approach. Precision medicine aims to tailor treatments to the individual. CURATE.AI is a dosing optimisation platform that considers individual factors to improve the precision of drug therapies. CURATE.AI has been validated in other therapeutic areas, such as cancer, but has yet to be applied in chronic disease care. We will evaluate the CURATE.AI system through a single-arm feasibility study (n = 20 hypertensives and n = 20 type II diabetics). Dosing decisions will be based on CURATE.AI recommendations. We will prospectively collect clinical and qualitative data and report on the clinical effect, implementation challenges, and acceptability of using CURATE.AI. In addition, we will explore how to enhance the algorithm further using retrospective patient data. For example, the inclusion of other variables, the simultaneous optimisation of multiple drugs, and the incorporation of other artificial intelligence algorithms. Overall, this project aims to understand the feasibility of using CURATE.AI in clinical practice. Barriers and enablers to CURATE.AI will be identified to inform the system’s future development.
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