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Fleury MJ, Imboua A, Grenier G. Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation. Community Ment Health J 2024; 60:869-884. [PMID: 38383882 DOI: 10.1007/s10597-024-01239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
This qualitative study explored reasons for high emergency department (ED) use (3 + visits/year) among 299 patients with mental disorders (MD) recruited in four ED in Quebec, Canada. A conceptual framework including healthcare system and ED organizational features, patient profiles, and professional practice guided the content analysis. Results highlighted insufficient access to and inadequacy of outpatient care. While some patients were quite satisfied with ED care, most criticized the lack of referrals or follow-up care. Patient profiles justifying high ED use were strongly associated with health and social issues perceived as needing immediate care. The main barriers in professional practice involved lack of MD expertise among primary care clinicians, and insufficient follow-up by psychiatrists in response to patient needs. Collaboration with outpatient care may be prioritized to reduce high ED use and improve ED interventions by strengthening the discharge process, and increasing access to outpatient care.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Armelle Imboua
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
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Johnson PJ, Mentzer KM, Jou J, Upchurch DM. Unmet healthcare needs among midlife adults with mental distress and multiple chronic conditions. Aging Ment Health 2022; 26:775-783. [PMID: 33792432 PMCID: PMC10843861 DOI: 10.1080/13607863.2021.1904830] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Limited attention has focused on midlife health. Yet, this is a time of great change, including onset of chronic conditions and changes in mental health. OBJECTIVE To examine unmet healthcare needs among midlife adults (50-64 years) in the US with severe psychological distress (SPD) and/or multiple chronic conditions (MCC). METHODS Nationally representative data for midlife adults (50-64 years) from NHIS 2014-2018 were examined (n = 39,329). Multimorbidity status: no MCC/SPD, MCC alone, SPD alone, or both. We used logistic regression to estimate adjusted odds ratios (AOR) of delayed or foregone care by multimorbidity status. RESULTS Nearly 40% of midlife adults had MCC, SPD, or SPD/MCC. SPD with or without MCC had higher prevalence of social disadvantage, fair/poor health, activity limitations, and delayed/foregone healthcare. Compared to those with neither, adults with SPD/MCC were more likely to delay care due to limited office hours (AOR = 4.2, 95% CI 3.1-5.5) and had nearly three to four times higher odds of delays for all other reasons. Those with SPD/MCC had higher odds of needing but not getting mental healthcare (AOR = 6.4, 95% CI 4.5-9.1), prescriptions (AOR = 4.8, 95% CI 3.9-5.9), or follow-up care (AOR = 5.0, 95% CI 3.7-6.6), and three to four times higher odds of all other types of foregone care. CONCLUSIONS Midlife adults with SPD/MCC have substantial unmet healthcare needs. Midlife is a critical time to manage both chronic conditions and mental illness. Coordinated efforts by policymakers and healthcare systems are crucial to address complex healthcare needs of this population at a critical stage of the life-course.
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Affiliation(s)
- Pamela Jo Johnson
- Department of Public Health, North Dakota State University, Fargo, ND, USA
| | | | - Judy Jou
- Health Science Department, California State University-Long Beach, Long Beach, CA, USA
| | - Dawn M Upchurch
- Department of Community Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
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Liu J, Zhang Y, Kaplan C. Differential Effects by Mental Health Status of Filling the Medicare Part D Coverage Gap. Med Care 2022; 60:133-139. [PMID: 35030562 PMCID: PMC8813000 DOI: 10.1097/mlr.0000000000001668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to study how changes in insurance benefit design affect medication use of older adults with mental disorders. DATA SOURCES US Medicare claims data from 2007 to 2018. STUDY DESIGN Exploiting the gradual elimination of the Medicare prescription drug coverage gap beginning in 2011, we examine the effects on medication use and out-of-pocket spending by drug type with a difference-in-differences approach. We identify subpopulations by mental disorder and compare the estimates across mental health groups and to the general Medicare population. PRINCIPAL FINDINGS Closing the gap substantially reduced individuals' out-of-pocket spending, and the reduction was larger for those with more severe mental disorders. The policy led to a statistically significant increase in branded drugs used for the Medicare population (0.91; P<0.01; 12.12% increase), beneficiaries with severe mental disorders (2.71; P<0.01; 11.13% increase), and common mental disorders (2.63; P<0.01; 11.62% increase), whereas such effect for beneficiaries with Alzheimer disease and dementia (AD) is substantially smaller (0.44; P<0.01; 1.83% increase). In contrast, the policy decreased generic drugs used by about 3%-5% for all groups. Overall, beneficiaries without mental health illness have a statistically significant increase in total medication use (2.05%) following the coverage gap closure, while all 3 mental health groups have either no statistically significant changes or a small reduction in total mediation use (AD, -1.26%). CONCLUSIONS Patients' responses to price changes vary across mental disorders and by drug type. The impact on branded drug utilization among those with AD is particularly small. Our findings suggest that lowering medication costs has differential impacts across diseases and may not be sufficient to improve adherence for all conditions, in particular those with severe mental health disorders such as AD.
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Affiliation(s)
- Judith Liu
- Melbourne Institute: Applied Economic & Social Research, Faculty of Business and Economics, University of Melbourne, Melbourne, Australia
| | - Yuting Zhang
- Melbourne Institute: Applied Economic & Social Research, Faculty of Business and Economics, University of Melbourne, Melbourne, Australia
| | - Cameron Kaplan
- Gehr Center for Health Systems Science & Innovation, University of Southern California, Los Angeles, LA, USA
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Nash DB. Insights into the Use of Digital Tools for People with Mental Health Disorders. Popul Health Manag 2021; 24:S53-S54. [PMID: 34382865 DOI: 10.1089/pop.2021.29004.dbn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Desmond HE, Lindner C, Troost JP, Held Z, Callaway A, Oh GJ, Lafayette R, O'Shaughnessy M, Elliott M, Adler SG, Kamil ES, Pesenson A, Selewski DT, Gipson PE, Carlozzi NE, Gipson DS, Massengill SF. Association between Psychiatric Disorders and Glomerular Disease. GLOMERULAR DISEASES 2021; 1:118-128. [PMID: 36751494 PMCID: PMC9677713 DOI: 10.1159/000516359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/06/2021] [Indexed: 01/20/2023]
Abstract
Introduction Patients with chronic health conditions, particularly chronic kidney disease, are at heightened risk for psychiatric disorders; yet, there are limited data on those with primary glomerular disease. Methods This study included patients with glomerular disease enrolled in the kidney research network multisite patient registry. Registry data include encounter, diagnoses, medication, laboratory, and vital signs data extracted from participants' electronic health records. ICD-9/10 diagnosis codes were used to identify a subset of psychiatric disorders focused on anxiety, mood, and behavioral disorders. Time-varying Cox proportional hazard models were used to analyze time from the onset of kidney disease to diagnosis of psychiatric disorder. Adjusted models retained significant covariates from the full list of potential confounders, including age, sex, race, ethnicity, time-varying treatment, the estimated glomerular filtration rate, and proteinuria (urine protein-to-creatinine ratio [UPCR]). Analogous models examined diagnosis of psychiatric disorder as a predictor of time to end-stage kidney disease (ESKD). Results Data were available for 950 participants, with a median of 58 months of follow-up. 110 (12%) participants were diagnosed with psychiatric disorder during the follow-up. The estimated rate of psychiatric diagnosis after kidney disease was 14.7 cases per 1,000 person-years and was highest among those of adolescent age at the time of kidney disease diagnosis. Adjusted analyses found adolescent age (vs. adult, hazard ratio [HR] = 3.11, 95% confidence interval [CI] 1.87-5.17) and Asian race (vs. white, HR = 0.34, 95% CI 0.16-0.71) were associated with psychiatric diagnosis. A higher UPCR per 1 log unit (HR 1.13, 95% CI 1.01-1.27) and a higher total number of oral medications were associated with psychiatric disorder (p < 0.001). Psychiatric diagnosis was also associated with progression to ESKD (HR = 2.45, 95% CI 1.53-3.92) in adjusted models. Discussion/Conclusion Psychiatric disorders were documented in approximately one-eighth of patients with glomerular disease and correlated with clinical disease characteristics such as age, race, proteinuria, and oral medication burden. These findings suggest mental health screening is warranted in patients of all ages with glomerular disease.
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Affiliation(s)
- Hailey E. Desmond
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA,*Hailey E. Desmond,
| | - Clare Lindner
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan P. Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Zack Held
- Division of Pediatric Nephrology, Department of Pediatrics, Levine Children's Hospital, Atrium Health, Charlotte, North Carolina, USA
| | | | - Gia J. Oh
- Department of Pediatric Nephrology, Randall Children's Hospital at Legacy Emanuel Medical Center, Legacy Health, Portland, Oregon, USA
| | - Richard Lafayette
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Matthew Elliott
- Metrolina Nephrology Associates, Charlotte, North Carolina, USA
| | - Sharon G. Adler
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-University of California, Torrance, California, USA
| | - Elaine S. Kamil
- Division of Pediatric Nephrology, Department of Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | | | - David T. Selewski
- Division of Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Patrick E. Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA,Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Debbie S. Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan F. Massengill
- Division of Pediatric Nephrology, Department of Pediatrics, Levine Children's Hospital, Atrium Health, Charlotte, North Carolina, USA
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Vogel WB, Morris HL, Muller K, Huo T, Parish A, Stoner D, Shenkman E. Cost-Effectiveness of the Wellness Incentives and Navigation (WIN) Program. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:361-368. [PMID: 33641770 DOI: 10.1016/j.jval.2020.06.019] [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: 10/09/2019] [Revised: 05/17/2020] [Accepted: 06/14/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Promoting patient involvement in managing co-occurring physical and mental health conditions is increasingly recognized as critical to improving outcomes and controlling costs in this growing chronically ill population. The main objective of this study was to conduct an economic evaluation of the Wellness Incentives and Navigation (WIN) intervention as part of a longitudinal randomized pragmatic clinical trial for chronically ill Texas Medicaid enrollees with co-occurring physical and mental health conditions. METHODS The WIN intervention used a personal navigator, motivational interviewing, and a flexible wellness expense account to increase patient activation, that is, the patient's knowledge, skills, and confidence in managing their self-care and co-occurring physical and mental health conditions. Regression models were fit to both participant-level quality-adjusted life years (QALYs) and total costs of care (including the intervention) controlling for demographics, health status, poverty, Medicaid managed care plan, intervention group, and baseline health utility and costs. Incremental costs and QALYs were calculated based on the difference in predicted costs and QALYs under intervention versus usual care and were used to calculate the incremental cost-effectiveness ratios (ICERs). Confidence intervals were calculated using Fieller's method, and sensitivity analyses were performed. RESULTS The mean ICER for the intervention compared with usual care was $12 511 (95% CI $8971-$16 842), with a sizable majority of participants (70%) having ICERs below $40 000. The WIN intervention also produced higher QALY increases for participants who were sicker at baseline compared to those who were healthier at baseline. CONCLUSION The WIN intervention shows considerable promise as a cost-effective intervention in this challenging chronically ill population.
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Affiliation(s)
- Walter Bruce Vogel
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, Clinical and Translational Science Institute, University of Florida, and the Institute for Child Health Policy, Gainesville, FL, USA.
| | - Heather L Morris
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, Clinical and Translational Science Institute, University of Florida, and the Institute for Child Health Policy, Gainesville, FL, USA
| | - Keith Muller
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, Clinical and Translational Science Institute, University of Florida, and the Institute for Child Health Policy, Gainesville, FL, USA
| | - Tianyao Huo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, Clinical and Translational Science Institute, University of Florida, and the Institute for Child Health Policy, Gainesville, FL, USA
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, BERD Methods Core, Duke University, Durham, NC, USA
| | - Dena Stoner
- Texas Department of State Health Services, Austin, TX, USA
| | - Elizabeth Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, Clinical and Translational Science Institute, University of Florida, and the Institute for Child Health Policy, Gainesville, FL, USA
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Palzes VA, Parthasarathy S, Chi FW, Kline-Simon AH, Lu Y, Weisner C, Ross TB, Elson J, Sterling SA. Associations Between Psychiatric Disorders and Alcohol Consumption Levels in an Adult Primary Care Population. Alcohol Clin Exp Res 2020; 44:2536-2544. [PMID: 33151592 PMCID: PMC7756330 DOI: 10.1111/acer.14477] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022]
Abstract
Background Unhealthy alcohol use frequently co‐occurs with psychiatric disorders; however, little is known about the relationship between psychiatric disorders and alcohol consumption levels. Understanding varying levels of unhealthy alcohol use among individuals with a variety of psychiatric disorders in primary care would provide valuable insight for tailoring interventions. Methods We conducted a cross‐sectional study of 2,720,231 adult primary care patients screened for unhealthy alcohol use between 2014 and 2017 at Kaiser Permanente Northern California, using electronic health record data. Alcohol consumption level was classified as no reported use, low‐risk use, and unhealthy use, per National Institute on Alcohol Abuse and Alcoholism guidelines. Unhealthy use was further differentiated into mutually exclusive groups: exceeding only daily limits, exceeding only weekly limits, or exceeding both daily and weekly limits. Multivariable multinomial logistic regression models were fit to examine associations between 8 past‐year psychiatric disorders (depression, bipolar disorder, anxiety disorder, obsessive–compulsive disorder, schizophrenia, schizoaffective disorder, anorexia nervosa, and bulimia nervosa) and alcohol consumption levels, adjusting for sociodemographic and health characteristics. Results In the full sample [53% female, 48% White, mean (SD) age = 46 (18) years], patients with psychiatric disorders (except eating disorders), compared to those without, had lower odds of reporting low‐risk and unhealthy alcohol use relative to no use. Among patients who reported any alcohol use (n = 861,427), patients with depression and anxiety disorder, compared to those without, had higher odds of exceeding only weekly limits and both limits; patients with bulimia nervosa were also more likely to exceed both limits. Conclusions Findings suggest that patients with anxiety disorder, depression, and bulimia nervosa who drink alcohol are more likely to exceed recommended limits, increasing risk of developing more serious problems. Health systems and clinicians may wish to consider implementing more robust screening, assessment, and intervention approaches to support these vulnerable subgroups in limiting their drinking.
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Affiliation(s)
- Vanessa A Palzes
- From the, Division of Research, (VAP, SP, FWC, AHK-S, YL, CW, TBR, SAS), Kaiser Permanente Northern California, Oakland, California, USA
| | - Sujaya Parthasarathy
- From the, Division of Research, (VAP, SP, FWC, AHK-S, YL, CW, TBR, SAS), Kaiser Permanente Northern California, Oakland, California, USA
| | - Felicia W Chi
- From the, Division of Research, (VAP, SP, FWC, AHK-S, YL, CW, TBR, SAS), Kaiser Permanente Northern California, Oakland, California, USA
| | - Andrea H Kline-Simon
- From the, Division of Research, (VAP, SP, FWC, AHK-S, YL, CW, TBR, SAS), Kaiser Permanente Northern California, Oakland, California, USA
| | - Yun Lu
- From the, Division of Research, (VAP, SP, FWC, AHK-S, YL, CW, TBR, SAS), Kaiser Permanente Northern California, Oakland, California, USA
| | - Constance Weisner
- From the, Division of Research, (VAP, SP, FWC, AHK-S, YL, CW, TBR, SAS), Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry, (CW), Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Thekla B Ross
- From the, Division of Research, (VAP, SP, FWC, AHK-S, YL, CW, TBR, SAS), Kaiser Permanente Northern California, Oakland, California, USA
| | - Joseph Elson
- The Permanente Medical Group, (JE), San Francisco, California, USA
| | - Stacy A Sterling
- From the, Division of Research, (VAP, SP, FWC, AHK-S, YL, CW, TBR, SAS), Kaiser Permanente Northern California, Oakland, California, USA
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Cobb S, Bazargan M, Sandoval JC, Wisseh C, Evans MC, Assari S. Depression Treatment Status of Economically Disadvantaged African American Older Adults. Brain Sci 2020; 10:brainsci10030154. [PMID: 32156089 PMCID: PMC7139636 DOI: 10.3390/brainsci10030154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 11/25/2022] Open
Abstract
Background: It is known that depression remains largely untreated in underserved communities. Hence, it is desirable to gain more knowledge on the prevalence and correlates of untreated depression among African-American (AA) older adults in economically disadvantaged areas. This knowledge may have the public health benefit of improving detection of AA older adults with depression who are at high risk of not receiving treatment, thereby reducing this health disparity. Objective: To study health and social correlates of untreated depression among AA older adults in economically disadvantaged areas. Methods: Between 2015 and 2018, this cross-sectional survey was conducted in South Los Angeles. Overall, 740 AA older adults who were 55+ years old entered this study. Independent variables were age, gender, living arrangement, insurance type, educational attainment, financial strain, chronic medical conditions, and pain intensity. Untreated depression was the dependent variable. Logistic and polynomial regression models were used to analyze these data. Results: According to the polynomial regression model, factors such as number of chronic medical conditions and pain intensity were higher in individuals with depression, regardless of treatment status. As our binary logistic regression showed, age, education, and number of providers were predictive of receiving treatment for depression. Conclusion: Age, educational attainment, number of providers (as a proxy of access to and use of care) may be useful to detect AA older adults with depression who are at high risk of not receiving treatment. Future research may focus on decomposition of the role of individual-level characteristics and health system-level characteristics that operate as barriers and facilitators to AA older adults receiving treatment for depression.
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Affiliation(s)
- Sharon Cobb
- School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; (M.B.); (C.W.)
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA;
| | - Jessica Castro Sandoval
- School of Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
| | - Cheryl Wisseh
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; (M.B.); (C.W.)
- Department of Pharmacy Practice, West Coast University School of Pharmacy, Los Angeles, CA 91606, USA
| | - Meghan C. Evans
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA;
| | - Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; (M.B.); (C.W.)
- Correspondence: ; Tel.: +1-734-363-2678
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Zhang SL, Zhang ZY, Liu ZJ, Wang WR, Li ZM, Han B, Wang X, Wang LS. A real-world study of socioeconomic factors with survival in adults aged 18-64 years with renal cell carcinoma. Future Oncol 2019; 15:2503-2515. [PMID: 31240959 DOI: 10.2217/fon-2018-0827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: To evaluate the impact of socioeconomic factors (SEFs) on survival of renal cell carcinoma (RCC) patients. Materials & methods: RCC patients diagnosed between 2007 and 2015 were collected from the SEER database. The crude and multivariate Cox regression analysis was used to identify the independent prognostic factors and quantity the mortality risks for overall survival (OS). Results: Three SEFs including marital status, insurance status and median household income were identified as prognostic factors for OS. SEF-stage was built based on the three SEFs. Moreover, the SEF-stage 1 had superior OS than SEF-stage 2 within the respective American Joint Committee on Cancer stages. Conclusion: The SEF-stage was an independently prognostic factor for OS in RCC. Incorporation of SEF-stage into the American Joint Committee on Cancer staging system might be beneficial for better survival prediction and clinical management. However, further studies were needed to validate these findings in other populations.
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Affiliation(s)
- Shi-Long Zhang
- Institute of Fudan-Minhang Academic Health System, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai 201199, PR China
| | - Zheng-Yan Zhang
- Institute of Fudan-Minhang Academic Health System, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai 201199, PR China
| | - Ze-Juan Liu
- Department of Pharmacology, Capital Medical University, Beijing 100069, PR China
| | - Wen-Rong Wang
- College of Physical Education, Shandong Normal University, Jinan 250014, PR China
| | - Zhan-Ming Li
- Institute of Fudan-Minhang Academic Health System, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai 201199, PR China
| | - Bing Han
- Institute of Fudan-Minhang Academic Health System, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai 201199, PR China
| | - Xin Wang
- Department of Acupuncture & Moxibustion, Central Hospital of Shanghai Xuhui District, Shanghai 200031, PR China
| | - Li-Shun Wang
- Institute of Fudan-Minhang Academic Health System, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai 201199, PR China
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