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Wang S, Xia BX, Luo T, Wang P. Association between physical activity and diet quality of obese and non-obese MAFLD. Nutr Metab Cardiovasc Dis 2024; 34:75-89. [PMID: 37949716 DOI: 10.1016/j.numecd.2023.07.022] [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: 04/22/2023] [Revised: 07/04/2023] [Accepted: 07/15/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND AIM Clinical data on the prevalence of metabolic-associated fatty liver disease (MAFLD) in obese and non-obese individuals within a diverse US population is scarce. Furthermore, the influence of physical activity (PA) and dietary quality (DQ) on MAFLD risk remains unclear. This study aims to assess the prevalence and clinical features of MAFLD and examine the relationship between PA and DQ with the risk of developing MAFLD. METHODS AND RESULTS A cross-sectional analysis of data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES) was conducted. The overall MAFLD prevalence was 41.9%, with 28.6% of participants being obese and 13.4% non-obese. Among those with MAFLD, 67.1% (95% confidence interval (CI): 59.1%-75.1%) were obese, and 32.9% (95% CI: 29.1%-36.7%) were non-obese. Non-obese MAFLD was more frequent in Asians (27.2%), while obese MAFLD was more prevalent in Blacks (66.3%). Metabolic comorbidities were more common in individuals with obese MAFLD, who also exhibited more advanced fibrosis. A high-quality diet (HQD) and increased PA were linked to reduced odds of both obese and non-obese MAFLD (odds ratio (OR) and 95% CI: 0.67 [0.51-0.88] and 0.57 [0.47-0.69]; 0.62 [0.43-0.90] and 0.63 [0.46-0.87], respectively). PA and HQD significantly decreased the risk of obese and non-obese MAFLD (OR and 95% CI: 0.46 [0.33-0.64] and 0.42 [0.31-0.57]). CONCLUSION A substantial proportion of the US population is affected by both obese and non-obese MAFLD. A strong association exists between a lower risk of both types of MAFLD and adherence to an HQD and engagement in PA.
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Affiliation(s)
- Shuang Wang
- Department of Geriatrics, The People's Hospital of Changshou, Chongqing, China
| | - Bing Xin Xia
- Department of Geriatrics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tingting Luo
- Department of Gynaecology, Three Gorges Hospital, Chongqing, China
| | - Peng Wang
- Department of Geriatrics, The People's Hospital of Changshou, Chongqing, China.
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Meng DD, Ruan Z, Tang YL, Ji ZH, Su Y, Xu T, Cui BZ, Ren DL, Chang T, Yang Q. Factors associated with the disease family burden of caregivers of myasthenia gravis patients in northwestern China: A cross-sectional study. J Clin Neurosci 2024; 119:70-75. [PMID: 37988975 DOI: 10.1016/j.jocn.2023.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Patients with myasthenia gravis (MG) lose part of their working or living ability due to illness, and bring burden to caregivers. The purpose of this study was to explore the factors related to caregivers' disease family burden for MG patients in Northwest China. METHODS The study utilized our Myasthenia Gravis database and distributed online questionnaires to both MG patients and their caregivers. The questionnaires included a general data collection form, the Patient Health Questionnaire-9 (PHQ-9) scale, and the Caregivers' Family Burden Scale of Disease (FBSD). Univariate analysis and multivariate linear regression analysis were run, with FBSD as the outcome variable for separate analyses. RESULTS 178 MG patients were eligible for inclusion in the analysis, of whom 80 patients' caregivers had a positive family burden of MG. The daily activity burden of the family and the economic burden of the family were the heaviest among the six dimensions of the caregivers' family disease burdens. The factors independently associated with FBSD were depression symptom level, MG severity classification and family's monthly per capita income (p < 0.05). CONCLUSIONS Depression symptom level, MG severity classification and family's monthly per capita income are independent factors related to the caregivers' disease family burden for MG patients.
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Affiliation(s)
- Dong-Dong Meng
- Department of Experimental Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, Shaanxi Province, China.
| | - Zhe Ruan
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, Shaanxi Province, China.
| | - Yong-Lan Tang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, Shaanxi Province, China.
| | - Zhao-Hua Ji
- Department of Epidemiology, School of Public Health, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Air Force Medical University, Xi'an 710032, Shaanxi Province, China
| | - Yue Su
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, Shaanxi Province, China
| | - Tuo Xu
- Department of Experimental Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, Shaanxi Province, China
| | - Bo-Zhou Cui
- Department of Experimental Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, Shaanxi Province, China
| | - Da-Lin Ren
- Department of Experimental Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, Shaanxi Province, China
| | - Ting Chang
- Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, Shaanxi Province, China.
| | - Qian Yang
- Department of Experimental Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, Shaanxi Province, China.
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Kato H, Goto R, Tsuji T, Kondo K. The effects of patient cost-sharing on health expenditure and health among older people: Heterogeneity across income groups. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:847-861. [PMID: 34779932 PMCID: PMC9170661 DOI: 10.1007/s10198-021-01399-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
Despite rapidly rising health expenditure associated with population aging, empirical evidence on the effects of cost-sharing on older people is still limited. This study estimated the effects of cost-sharing on the utilization of healthcare and health among older people, the most intensive users of healthcare. We employed a regression discontinuity design by exploiting a drastic reduction in the coinsurance rate from 30 to 10% at age 70 in Japan. We used large administrative claims data as well as income information at the individual level provided by a municipality. Using the claims data with 1,420,252 person-month observations for health expenditure, we found that reduced cost-sharing modestly increased outpatient expenditure, with an implied price elasticity of - 0.07. When examining the effects of reduced cost-sharing by income, we found that the price elasticities for outpatient expenditure were almost zero, - 0.08, and - 0.11 for lower-, middle-, and higher-income individuals, respectively, suggesting that lower-income individuals do not have more elastic demand for outpatient care compared with other income groups. Using large-scale mail survey data with 3404 observations for self-reported health, we found that the cost-sharing reduction significantly improved self-reported health only among lower-income individuals, but drawing clear conclusions about health outcomes is difficult because of a lack of strong graphical evidence to support health improvement. Our results suggest that varying cost-sharing by income for older people (i.e., smaller cost-sharing for lower-income individuals and larger cost-sharing for higher-income individuals) may reduce health expenditure without compromising health.
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Affiliation(s)
- Hirotaka Kato
- Graduate School of Business Administration, Keio University, 4-1-1 Hiyoshi, Yokohama, Kanagawa 223-8521 Japan
- Graduate School of Health Management, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Rei Goto
- Graduate School of Business Administration, Keio University, 4-1-1 Hiyoshi, Yokohama, Kanagawa 223-8521 Japan
| | - Taishi Tsuji
- Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
- Faculty of Health and Sport Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo, 112-0012 Japan
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu-shi, Aichi, 474-8511 Japan
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Adhikari M, Kaphle S, Dhakal Y, Duwadi S, Subedi R, Shakya S, Tamang S, Khadka M. Too long to wait: South Asian migrants' experiences of accessing health care in Australia. BMC Public Health 2021; 21:2107. [PMID: 34789215 PMCID: PMC8596381 DOI: 10.1186/s12889-021-12132-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 10/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migrants settling in a new country experience multiple complexities in navigating health care systems and adapting to a new way of life in the host country. In South Asia, migrating to another country for better life opportunities has been an ongoing trend and migration to Australia has significantly increased in recent years. Lower utilisation of health services and higher risks of chronic diseases among South Asian migrants poses a continuing challenge for the Australian health care system and little is known about why this demographic group does not access health services at the same rate. This study aimed to explore factors influencing access to health care by South Asian migrants in Australia. METHODS Using a mixed-method design, we conducted 62 online survey and 14 in-depth interviews with participants from four South Asian countries: Nepal, India, Bhutan, and Sri Lanka. Participants were recruited using a purposive snowball sampling approach following a standard ethical approval process. Survey data were analysed descriptively in SPSS and interview data were recorded, transcribed, and analysed thematically. RESULTS South Asian migrants experienced various complexities while accessing health services in Australia. The findings of this study highlighted a number of negative factors influencing their experiences of accessing health care: long waiting times for public health care, the expense of private health care, and communication problems due to socio-cultural differences. South Asian migrants also expressed their concern for a greater investment of resources into public health care to enable them to access quality and affordable care in these settings. CONCLUSIONS Given limited evidence available to help understand factors leading to the lower utilisation of health care and higher risks of chronic diseases among South Asian migrants, this study plays an important role in highlighting social, cultural, financial, and institutional factors that are critical to designing appropriate health-care strategies. This study recommends incorporating a collaborative and culturally competent model of care to increase access to health care and thereby help reduce existing disparities in health outcomes among South Asian migrant populations.
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Affiliation(s)
- Manju Adhikari
- LA GRANDEE International College, Pokhara Metropolitan City, Province 4 Nepal
| | | | - Yamuna Dhakal
- Central Queensland University, Melbourne, VIC Australia
| | - Sabina Duwadi
- Central Queensland University, Melbourne, VIC Australia
| | - Rajan Subedi
- Central Queensland University, Melbourne, VIC Australia
| | - Sonu Shakya
- Central Queensland University, Melbourne, VIC Australia
| | - Sunil Tamang
- Central Queensland University, Melbourne, VIC Australia
| | - Mukesh Khadka
- Central Queensland University, Melbourne, VIC Australia
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Zissimopoulou O, Leontidou E, Tsiptsios D, Manolis A, Ioannides D, Trypsiani I, Steiropoulos P, Constantinidis TC, Tripsianis G, Nena E. Association of Family Income with Health Indices and Healthcare Utilization in a Large Sample of Residents in Northern Greece. MAEDICA 2020; 15:490-502. [PMID: 33603907 PMCID: PMC7879352 DOI: 10.26574/maedica.2020.15.4.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective:To describe the impact of subjects' family income, which was used as a proxy for socioeconomic status, with health characteristics and healthcare utilization of a large representative sample of population in Northern Greece, taking into account several socio-demographic characteristics and health behaviors of the participants. Material and method:Eight hundred and twelve participants (43.7% males) with a mean age of 49.±14.8 years (range 19-83 years), from the area of Thrace, Greece, were enrolled in this cross-sectional populational study. A two-stage stratified sampling scheme was used and subjects were classified, according to the net mean monthly household income, into three financial levels: low .1000 Euro; medium 1001-2000 Euro; and high >2000 Euro. Self-reported questionnaires for socio-demographic, lifestyle and health related characteristics were collected. Sleep characteristics, utilizing Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index and Berlin Questionnaire, and mental health, using Zung Self-rating Anxiety Scale and Beck Depression Inventory have been also assessed. Results:The majority of participants belonged to the lower income level (476 subjects, 58.6%). Lower income level was associated with a higher prevalence of high alcohol consumption (p=0.030), low adherence to Mediterranean diet (p=0.016), low physical activity (p<0.001) and either short or long nocturnal sleep duration (p<0.001). After adjusting for all socio-demographic and lifestyle characteristics, subjects with low income had a higher risk for anxiety (aOR=1.97, p=0.017), depression (aOR=4.88, p<0.001), dyslipidemia (aOR=2.50, p=0.007), diabetes (aOR=3.58, p<0.001), obesity (aOR=1.97, p=0.038), cardiovascular disease (aOR=3.04, p=0.015) and sleep disorders, as well as for primary (aOR=3.56, p=0.017) and secondary (aOR=2.49, p=0.010) healthcare utilization compared to subjects with high income. Conclusion:Low income is an important factor, which adversely affects the health of individuals via different pathways such as adaptation of harmful everyday habits. Large-scale prospective cohort studies are necessary to verify these associations in a methodologically more robust way.
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Affiliation(s)
- Orestia Zissimopoulou
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Eleni Leontidou
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Tsiptsios
- Neurophysiology Department, South Tyneside & Sunderland NHS Foundation Trust, Sunderland, United Kingdom
| | - Apostolos Manolis
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Ioanna Trypsiani
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Theodoros C Constantinidis
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Gregory Tripsianis
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Social Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Gao W, Lv X, Xu X, Zhang Z, Yan J, Mao G, Xing W. Telemedicine intervention-reduced blood pressure in a chronic disease population: A meta-analysis. J Telemed Telecare 2020; 28:621-631. [PMID: 33045905 DOI: 10.1177/1357633x20959581] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Elevated blood pressure (BP) is a leading risk factor for many chronic diseases. Many investigations conducted using telemedicine (TM)-based interventions have the potential to control BP. The purpose of this study was to assess the efficacy of TM-based interventions in reducing BP. METHODS Studies were selected from PubMed, PMC, Web of Science, Embase, Google Scholar, Cochrane Library, the Chinese National Knowledge Infrastructure (CNKI) and the Chinese Biomedical Literature Database (CBM) according to the inclusion and exclusion criteria. The mean and standard deviation changes in systolic BP (SBP) and diastolic BP (DBP) were analysed using standard mean difference (SMD) and 95% confidence intervals (CI) with a random-effects model or fixed-effects model to assess the efficiency of controlling BP. Subgroup analysis, influence analysis and publication bias analysis were also conducted. RESULTS Sixteen randomised clinical trials were included in this meta-analysis. A TM-based lifestyle intervention significantly reduced daytime SBP (SMD = -0.18, 95% CI -0.27 to -0.10; p < 0.001) and DBP (SMD = -0.18, 95% CI -0.27 to -0.09; p < 0.001). The results of subgroup analysis indicated that this reduction in BP was reliable when BP interventions lasted for 6 months or longer in populations with cardiovascular disease and hypertension. Moreover, the detection data should be delivered by a device system to ensure accuracy. DISCUSSION A TM-based intervention could reduce daytime SBP and DBP in populations with hypertension and cardiovascular disease. This review provides intuitive evidence of a reduction in BP using TM-based interventions.
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Affiliation(s)
- Wenyan Gao
- Key Laboratory of Neuropsychiatric Drug Research of Zhejiang Province, Institute of Materia Medica, Zhejiang Academy of Medical Sciences and Hangzhou Medical College, PR China
| | - Xiaoling Lv
- Zhejiang Provincial Key Lab of Geriatrics, Department of Geriatrics, Zhejiang Hospital, PR China
| | - Xiaogang Xu
- Zhejiang Provincial Key Lab of Geriatrics, Department of Geriatrics, Zhejiang Hospital, PR China
| | - Zhongshan Zhang
- Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, Huzhou University, PR China.,Huzhou Cent Hospital, Huzhou University, PR China
| | - Jing Yan
- Zhejiang Provincial Key Lab of Geriatrics, Department of Geriatrics, Zhejiang Hospital, PR China
| | - Genxiang Mao
- Zhejiang Provincial Key Lab of Geriatrics, Department of Geriatrics, Zhejiang Hospital, PR China
| | - Wenmin Xing
- Zhejiang Provincial Key Lab of Geriatrics, Department of Geriatrics, Zhejiang Hospital, PR China
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Liu J, Yu W, Zhou J, Yang Y, Chen S, Wu S. Relationship between the Number of Noncommunicable Diseases and Health-Related Quality of Life in Chinese Older Adults: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145150. [PMID: 32708844 PMCID: PMC7400205 DOI: 10.3390/ijerph17145150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022]
Abstract
China has the largest population of older adults, most of whom suffer from one or more noncommunicable diseases (NCDs). The harm of the number of NCDs on the health-related quality of life (HRQOL) of older adults should be taken seriously. A sample of 5166 adults, aged 60 years and older, was included in this study. The Chinese version of the World Health Organization Quality of Life-Old (WHOQOL-OLD) instrument was used to assess the HRQOL. Multiple linear regression models were established to determine the relationship between the number of NCDs and the total score and scores of each dimension of the WHOQOL-OLD scale. After adjusting for confounding factors, suffering from one NCD (B = −0.87, 95% CI = −1.67 to −0.08, p < 0.05), two NCDs (B = −2.89, 95% CI = −3.87 to −1.90, p < 0.001), and three or more NCDs (B = −4.20, 95% CI = −5.36 to −3.05, p < 0.001), all had negative impacts on the HRQOL of older adults. NCDs had significant negative impacts on the HRQOL of older adults, and as the number of NCDs increased, the HRQOL of older adults deteriorated. Therefore, we should pay attention to the prevention and management of NCDs of older adults to prevent the occurrence of multiple NCDs.
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Affiliation(s)
- Jianjian Liu
- School of Health Sciences, Wuhan University, Wuhan 430071, China; (J.L.); (W.Y.); (J.Z.); (Y.Y.); (S.C.)
- Global Health Institute, Wuhan University, Wuhan 430072, China
| | - Wei Yu
- School of Health Sciences, Wuhan University, Wuhan 430071, China; (J.L.); (W.Y.); (J.Z.); (Y.Y.); (S.C.)
| | - Jiayi Zhou
- School of Health Sciences, Wuhan University, Wuhan 430071, China; (J.L.); (W.Y.); (J.Z.); (Y.Y.); (S.C.)
| | - Yifan Yang
- School of Health Sciences, Wuhan University, Wuhan 430071, China; (J.L.); (W.Y.); (J.Z.); (Y.Y.); (S.C.)
| | - Shuoni Chen
- School of Health Sciences, Wuhan University, Wuhan 430071, China; (J.L.); (W.Y.); (J.Z.); (Y.Y.); (S.C.)
| | - Shaotang Wu
- School of Health Sciences, Wuhan University, Wuhan 430071, China; (J.L.); (W.Y.); (J.Z.); (Y.Y.); (S.C.)
- Global Health Institute, Wuhan University, Wuhan 430072, China
- Correspondence:
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Jang S, Han E, Kang C, Cho HM, Sohn HS, Lee JY. Assessment of a medication management program targeting hypertension and diabetes patients: Impact on medication adherence. Res Social Adm Pharm 2020; 17:419-427. [PMID: 32197921 DOI: 10.1016/j.sapharm.2020.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The National Health Insurance Service in South Korea has conducted a telephone outreach program to improve medication adherence for hypertension and diabetes patients since 2014. OBJECTIVES To evaluate the direct outcomes of the program. METHODS Patients were identified among those who visited an outpatient clinic at least twice or used an inpatient service at least once for hypertension or diabetes during 6-month intervals and who were nonadherent based on the proportion of days covered (PDC) calculated. As a preliminary intervention, participants were mailed an information leaflet on their own medication adherence and other tips for effective self-management of chronic diseases. For the intervention, two phone calls and three phone messages were made to patients by 24 participating regional offices. Ultimately, 2,428 hypertension patients and 884 diabetes patients received the intervention. Propensity matching was used based on age, sex, and the Charlson Comorbidity Index to select 12,140 hypertension and 4,420 diabetes patients as controls in the non-participating regions. The outcome was PDC. Multivariate ordinary least squares or logistic regression analysis were used with difference-in-difference specification. RESULTS The adjusted quarterly PDC increased by 1.96%p for hypertension (p = 0.023) and by 7.79%p for diabetes patients (p < 0.001). Approximately 40.6% and 51.7% of hypertension and diabetes patients in the treatment arm (p = 0.0069) became adherent after the intervention, whereas the corresponding proportions were 37.7% and 41.4% (p < 0.001) in the control group. Both treatment groups showed a higher likelihood of good medication adherence (hypertension: odds ratio = 1.157, 95% CI [1.058, 1.265]; diabetes: odds ratio = 1.532, 95% CI [1.323, 1.774]). The control group, who received only a print intervention with a mailed leaflet, also showed a dramatic increase in medication adherence. CONCLUSIONS An insurer-coordinated telephone-administered program resulted in improvement of medication adherence among patients with hypertension and diabetes.
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Affiliation(s)
- Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Incheon, Gachon University, South Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Incheon, Yonsei University, South Korea.
| | - Cinoo Kang
- Graduate School of Public Health, Seoul, Seoul National University, South Korea
| | - Hye-Min Cho
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Incheon, Gachon University, South Korea
| | - Hyun Soon Sohn
- College of Pharmacy, Bundang, CHA University, South Korea
| | - Ju-Yeun Lee
- College of Pharmacy, Seoul, Seoul National University, South Korea
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9
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A new population-based risk stratification tool was developed and validated for predicting mortality, hospital admissions, and health care costs. J Clin Epidemiol 2019; 116:62-71. [PMID: 31472207 DOI: 10.1016/j.jclinepi.2019.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/05/2019] [Accepted: 08/23/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to develop a new population-based risk stratification tool (Chronic Related Score [CReSc]) for predicting 5-year mortality and other outcomes. STUDY DESIGN AND SETTING The score included 31 conditions selected from a list of 65 candidates whose weights were assigned according to the Cox model coefficients. The model was built from a sample of 5.4 million National Health Service (NHS) beneficiaries from the Italian Lombardy Region and applied to the remaining 2.7 million NHS beneficiaries. Predictive performance was assessed by discrimination and calibration. CReSc ability in predicting secondary endpoints (i.e., hospital admissions and health care costs) was investigated. Finally, the relationship between CReSc and income was considered. RESULTS Among individuals aged 50-85 years, CReSc performance showed (1) an area under the receiver operating characteristic curve of 0.730, (2) an improved reclassification from 44% to 52% with respect to other scores, and (3) a remarkable calibration. A trend toward increasing rates of all the considered endpoints as CReSc increases was observed. Compared with individuals on low-intermediate income, NHS beneficiaries on high income showed better CReSc profile. CONCLUSION We developed a risk stratification tool able to predict mortality, costs, and hospital admissions. The application of CReSc may generate clinically and operationally important effects.
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Lee H, Park JH, Floyd JS, Park S, Kim HC. Combined Effect of Income and Medication Adherence on Mortality in Newly Treated Hypertension: Nationwide Study of 16 Million Person-Years. J Am Heart Assoc 2019; 8:e013148. [PMID: 31422733 PMCID: PMC6759906 DOI: 10.1161/jaha.119.013148] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Low socioeconomic status and poor medication adherence are known to be associated with increased morbidity and mortality among patients with hypertension, but their combined effects have not been studied. We therefore evaluated the joint association of household income and medication adherence with death and cardiovascular disease in patients newly treated for hypertension. Methods and Results This was a nationwide cohort study using the Korean National Health Insurance database. We included 1 651 564 individuals, aged 30 to 80 years, with newly treated hypertension and no prior cardiovascular disease and followed them for 10 years. Main exposures were household income in quintiles and adherence to antihypertensive medication, estimated by medication possession ratio: good (≥0.8), moderate (0.5 to <0.8), or poor (<0.5). The primary outcomes were all-cause and cardiovascular deaths. Higher mortality risk was observed in patients with low income (adjusted hazard ratio=1.50, 99% CI=1.46-1.53; lowest versus highest quintile) and poor medication adherence (adjusted hazard ratio=1.66, 99% CI=1.63-1.68; poor versus good adherence). When compared with the highest-income and good-adherence group, adjusted hazard ratio (99% CI) of death was 1.56 (1.52-1.61) for highest-income poor-adherers, 1.46 (1.41-1.51) for lowest-income good-adherers, and 2.46 (2.38-2.54) for lowest-income poor-adherers (P for interaction <0.001). Conclusions Low socioeconomic status and poor adherence to antihypertensive medication are associated with increased mortality and cardiovascular disease risks, but patients with low income are subject to larger excess risks by nonadherence. This highlights the potential importance of promoting medication adherence for risk reduction, especially in low-income patients with hypertension.
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Affiliation(s)
- Hokyou Lee
- Department of Preventive Medicine Yonsei University College of Medicine Seoul Korea.,Department of Internal Medicine Yonsei University College of Medicine Seoul Korea.,Graduate School Yonsei University College of Medicine Seoul Korea
| | - Jong Heon Park
- Big Data Steering Department National Health Insurance Service Wonju Korea
| | - James S Floyd
- Department of Medicine University of Washington Seattle WA.,Department of Epidemiology University of Washington Seattle WA
| | - Sungha Park
- Department of Internal Medicine Yonsei University College of Medicine Seoul Korea.,Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine Yonsei University College of Medicine Seoul Korea.,Department of Internal Medicine Yonsei University College of Medicine Seoul Korea.,Big Data Steering Department National Health Insurance Service Wonju Korea
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Choi KK, Kim SH, Yoo KD, Kim HJ, Park JI, Hwang S, Chin HJ, Ku HS. Variation in the rate of well-controlled status of chronic disease by income level in Korea: 2010 to 2015. Medicine (Baltimore) 2018; 97:e12059. [PMID: 30142862 PMCID: PMC6113021 DOI: 10.1097/md.0000000000012059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Although it is known that the prevalence rates of chronic diseases depend on income level, annual changes of the control rate have not been evaluated. In this cross-sectional study, we analyzed the variation in rate of well-controlled status of chronic diseases based on the annual income level using data from national nutrition surveys conducted between 2010 and 2015.Prevalence and controlled rate of hypertension, diabetes mellitus, and chronic kidney disease were analyzed in relation to annual income levels, using data from the Korea National Health and Nutrition Examination Survey (KNHANES), obtained from 2010 to 2015. We also analyzed the incidence of use of necessary medical care services and the reasons cited for not using these services.The data of 28,759 persons were analyzed. The average age increased, and sex ratio remained unchanged over the study period. Although the prevalence rates of diabetes increased, that of increased glycated hemoglobin gradually decreased. A significant change has been shown recently on the prevalence rates of hypertension patients. The prevalence rates of chronic kidney disease stayed unchanged during the course of the study period. The incidence of controlled chronic disease status increased with the income level, and over time during the study, in the case of diabetes and chronic kidney disease. However, while controlled hypertension status rate increased from year to year, there was no trend of increase with increased income level. The incidence of participants not using hospital services declined with increasing income level, but the rate of economic causes being cited as reasons for not using hospital services increased over time and showed no change among income levels. Results of regression analysis of prevalence rates of chronic diseases by income level showed that lower income groups tended to have higher odds ratios for chronic diseases.Our results suggest that the incidence rate of well-controlled chronic disease status remains low in lower income groups. These results imply that financial status may play an important role in the management of chronic diseases.
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Affiliation(s)
- Kun Kug Choi
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine
| | - Seung Hyuk Kim
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju
| | - Hyo Jin Kim
- Division of Nephrology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju
| | - Ji In Park
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon
| | - Subin Hwang
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Kyeonggi-do, Republic of Korea
| | - Ho Suk Ku
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine
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Shin HY, Kang HT. Recent Trends in Blood Pressure According to Economic Status: Korean National Health and Nutrition Examination Survey From 2005 to 2015. Asia Pac J Public Health 2018. [DOI: 10.1177/1010539518761482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our study assessed recent blood pressure (BP) trends according to economic status based on data from 2005 to 2015. In total, 56 873 participants were included and were defined as low, middle-low, middle-high, and high according to their house income quartile. In men, the mean systolic BP ( P < .001, β = −1.95; P = .01, β = −0.61; P = .35, β = −0.19; and P = .04, β = −0.47, from the low to the high group, respectively) and diastolic BP were decreased significantly in all groups ( P < .001, β = −2.18; P < .001, β = −0.77; P = .02, β = −0.40; and P < .001, β = −0.69, from the low to the high group, respectively). In women, the decreasing trends in systolic BP and diastolic BP were statistically significant except in the high-income group. In addition, the percentages of less-than-normotensive and less-than-hypertensive BP in both sexes and the control rate of hypertension on antihypertensive medications increased in all groups. Decreasing BP trends were observed in the recent decade and the gap in health inequities has been decreased, particularly in men in Korea.
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Affiliation(s)
- Hyun-Young Shin
- Myongji Hospital, Gyeonggi-do, Republic of Korea
- Yonsei University, Seoul, Republic of Korea
| | - Hee-Taik Kang
- Chungbuk National University, Cheongju-city, Republic of Korea
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Cham B, Scholes S, Ng Fat L, Badjie O, Mindell JS. Burden of hypertension in The Gambia: evidence from a national World Health Organization (WHO) STEP survey. Int J Epidemiol 2018; 47:860-871. [PMID: 29394353 DOI: 10.1093/ije/dyx279] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/04/2017] [Accepted: 01/15/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Non-communicable diseases are increasing in sub-Saharan Africa and are estimated to account for 32% of adult deaths in The Gambia. Worldwide, prevalence of hypertension is highest in the African region (46%) and a very high proportion is undiagnosed. This study examined diagnosed and undiagnosed hypertension in The Gambian adult population. METHODS Data were collected in 2010 from a nationally representative random sample of 4111 adults aged 25-64 years, using the World Health Organization STEPwise cross-sectional survey methods. Analyses were restricted to non-pregnant participants with three valid blood pressure measurements (n = 3573). We conducted gender-stratified univariate and multivariate regression analyses to identify the strongest sociodemographic, behavioural and biological risk factors associated with hypertension. RESULTS Almost one-third of adults were hypertensive; a high proportion were undiagnosed, particularly among men (86% of men vs 71% of women with hypertension, P < 0.001). Rural and semi-urban residents and overweight/obese persons had increased odds of hypertension. Compared with urban residents, participants from one of the most rural regions had higher odds of hypertension among both men [adjusted odds ratio (AOR) 3.2; 95% CI: 1.6-6.4] and women (AOR 2.5; 95% CI: 1.3-4.6). Other factors strongly associated with hypertension in multivariate analyses were age, smoking, physical inactivity and ethnicity. CONCLUSIONS Rural and semi-urban residence were strongly associated with hypertension, contrary to what has been found in similar studies in sub-Saharan Africa. Intervention to reduce the burden of hypertension in The Gambia could be further targeted towards rural areas.
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Affiliation(s)
- Bai Cham
- University College London, Department of Epidemiology and Public Health, London, UK.,University of The Gambia, Department of Public Health, Brikama Campus, P.O. Box 3530, Serrekunda, The Gambia and
| | - Shaun Scholes
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Linda Ng Fat
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Omar Badjie
- Non-Communicable Diseases Unit, Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Jennifer S Mindell
- University College London, Department of Epidemiology and Public Health, London, UK
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