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Chhabra N, Smith DL, Maloney CM, Archer J, Sharma B, Thompson HM, Afshar M, Karnik NS. The Identification of Subphenotypes and Associations with Health Outcomes in Patients with Opioid-Related Emergency Department Encounters Using Latent Class Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148882. [PMID: 35886733 PMCID: PMC9321801 DOI: 10.3390/ijerph19148882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 02/05/2023]
Abstract
The emergency department (ED) is a critical setting for the treatment of patients with opioid misuse. Detecting relevant clinical profiles allows for tailored treatment approaches. We sought to identify and characterize subphenotypes of ED patients with opioid-related encounters. A latent class analysis was conducted using 14,057,302 opioid-related encounters from 2016 through 2017 using the National Emergency Department Sample (NEDS), the largest all-payer ED database in the United States. The optimal model was determined by face validity and information criteria-based metrics. A three-step approach assessed class structure, assigned individuals to classes, and examined characteristics between classes. Class associations were determined for hospitalization, in-hospital death, and ED charges. The final five-class model consisted of the following subphenotypes: Chronic pain (class 1); Alcohol use (class 2); Depression and pain (class 3); Psychosis, liver disease, and polysubstance use (class 4); and Pregnancy (class 5). Using class 1 as the reference, the greatest odds for hospitalization occurred in classes 3 and 4 (Ors 5.24 and 5.33, p < 0.001) and for in-hospital death in class 4 (OR 3.44, p < 0.001). Median ED charges ranged from USD 2177 (class 1) to USD 2881 (class 4). These subphenotypes provide a basis for examining patient-tailored approaches for this patient population.
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Affiliation(s)
- Neeraj Chhabra
- Division of Medical Toxicology, Department of Emergency Medicine, Cook County Health, Chicago, IL 60612, USA
- Department of Emergency Medicine, Rush Medical College, Rush University, Chicago, IL 60612, USA
- Correspondence:
| | - Dale L. Smith
- Addiction Data Science Laboratory, Department of Psychiatry & Behavioral Science, Rush University Medical Center, Chicago, IL 60612, USA; (D.L.S.); (B.S.); (H.M.T.); (N.S.K.)
- Department of Psychology, Olivet Nazarene University, Bourbonnais, IL 60914, USA
| | - Caitlin M. Maloney
- Doctor of Medicine Program, Rush Medical College, Rush University, Chicago, IL 60612, USA;
| | - Joseph Archer
- School of Medicine and Public Health, University of Wisconsin, Madison, WI 53715, USA;
| | - Brihat Sharma
- Addiction Data Science Laboratory, Department of Psychiatry & Behavioral Science, Rush University Medical Center, Chicago, IL 60612, USA; (D.L.S.); (B.S.); (H.M.T.); (N.S.K.)
| | - Hale M. Thompson
- Addiction Data Science Laboratory, Department of Psychiatry & Behavioral Science, Rush University Medical Center, Chicago, IL 60612, USA; (D.L.S.); (B.S.); (H.M.T.); (N.S.K.)
| | - Majid Afshar
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53715, USA;
| | - Niranjan S. Karnik
- Addiction Data Science Laboratory, Department of Psychiatry & Behavioral Science, Rush University Medical Center, Chicago, IL 60612, USA; (D.L.S.); (B.S.); (H.M.T.); (N.S.K.)
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois Chicago, Chicago, IL 60612, USA
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Henrique-Araújo R, Quarantini LC, Morais-de-Jesus M, Jesus-Nunes AP, Dantas-Duarte A, Caribé AC, Argolo FC, Marback RF, Costa TV, Oliveira IRD. Comparative study of impulsiveness and risk behaviors among infected individuals with hepatitis C virus and human T-cell lymphotropic virus type 1. Ann Hepatol 2021; 19:166-171. [PMID: 31711914 DOI: 10.1016/j.aohep.2019.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 08/27/2019] [Accepted: 09/10/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Hepatitis C virus (HCV) and human T-cell lymphotropic virus type 1 (HTLV-1) infections have chronic courses. HCV is primarily transmitted via the hematogenous route, whereas HTLV-1 is primarily transmitted sexually, although it can also be transmitted by blood. Individuals chronically infected with either HTLV-1 or HCV can differ in terms of behavioral characteristics and personality traits. This study compared the occurrence of risk behaviors and impulsivity aspects between HCV and HTLV-1 carriers. MATERIALS AND METHODS Observational, comparative and cross-sectional study that involved a sample of outpatients who had HCV or HLTV-1, by way of a sociodemographic and behavioral questionnaire and the Barratt Impulsiveness Scale - BIS-11. 143 individuals with HCV and 113 individuals with HTLV-1 were evaluated. RESULTS There was a difference with regards to gender among patients, with mostly males affected in the HCV group. Risk behaviors commonly mediated by impulsiveness were significantly more frequent in the HCV group. Similarly, overall impulsiveness and domain nonplanning were higher in the HCV group. Multivariate analysis showed that increased age, male gender, higher nonplanning scores and HCV infection were independent factors for the occurrence of risk behaviors. Both groups presented high rates of other sexually transmitted diseases and a low rate of condom use in sexual relations. CONCLUSIONS This study confirms the higher rate of risk behaviors and the levels of impulsiveness commonly observed in patients with HCV, along with comparisons to patients with HTLV-1.
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Affiliation(s)
- Ricardo Henrique-Araújo
- Postgraduate Program in Interactive Processes of Organs and Systems, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil; Nova Esperança Medical School, João Pessoa, Brazil; Hospital Complex of Infectious Diseases Clementino Fraga, João Pessoa, Brazil.
| | - Lucas C Quarantini
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil; Psychiatry Service, University Hospital (Com-HUPES), Federal University of Bahia, Salvador, Brazil
| | - Mychelle Morais-de-Jesus
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil; Psychiatry Service, University Hospital (Com-HUPES), Federal University of Bahia, Salvador, Brazil
| | - Ana Paula Jesus-Nunes
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil; Psychiatry Service, University Hospital (Com-HUPES), Federal University of Bahia, Salvador, Brazil
| | - Adriana Dantas-Duarte
- Psychiatry Service, University Hospital (Com-HUPES), Federal University of Bahia, Salvador, Brazil
| | - André C Caribé
- Psychiatry Service, University Hospital (Com-HUPES), Federal University of Bahia, Salvador, Brazil
| | - Felipe C Argolo
- Postgraduate Program in Psychiatry and Medical Psychology, Federal University of São Paulo, São Paulo, Brazil
| | - Roberta F Marback
- Psychiatry Service, University Hospital (Com-HUPES), Federal University of Bahia, Salvador, Brazil
| | | | - Irismar Reis de Oliveira
- Postgraduate Program in Interactive Processes of Organs and Systems, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil; Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
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Henrique-Araújo R, Quarantini LC, Caribé AC, Argolo FC, Jesus-Nunes AP, Morais-de-Jesus M, Dantas-Duarte A, Moreira TM, Oliveira IRD. Quality of life, risk behaviors and depression among carriers of hepatitis C virus and human T-cell lymphotropic virus type 1: a comparative study. Braz J Infect Dis 2019; 23:224-230. [PMID: 31344356 PMCID: PMC9427947 DOI: 10.1016/j.bjid.2019.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/31/2019] [Accepted: 06/08/2019] [Indexed: 02/07/2023] Open
Abstract
Human T-cell lymphotropic virus type 1 (HTLV-1) has low prevalence rates, but is endemic in some regions of the world. It is usually a chronic asymptomatic infection, but it can be associated with serious neurologic and urinary conditions. Hepatitis C virus (HCV) is broadly spread out worldwide. The majority of these infections have a chronic course that may progress to cirrhosis and hepatocellular carcinoma. Objectives To compare sociodemographic and mental health (risk behaviors, depression, and suicide) aspects, and quality of life among patients with HCV or HTLV-1. Methods Observational, comparative and cross-sectional study involving outpatients with HCV or HLTV-1 infection. Sociodemographic characteristics, risk behaviors and quality of life were assessed through the questionnaires Mini International Neuropsychiatric Interview – MINI Plus (depression and suicide) and Medical Outcomes Study 36-Item Short-Form Health Survey (quality of life). Univariate and multivariate statistical analyses (hierarchical logistic regression) were conducted. Results 143 individuals with HCV and 113 individuals with HTLV-1 infection were included. Males were predominant in the HCV group (68.8%) and females in the HTLV-1 group (71.7%). The frequency of risk behaviors (sexual and drug use) was greater in those with HCV (p < 0.05). A past depressive episode was more common in the HTLV-1 group (p = 0.037). Quality of life was significantly worse in the physical functioning, vitality, mental health, and social functioning domains in those with HTLV-1 (p < 0.05). HTLV-1 infection remained independently associated with worse quality of life in multivariate analysis. Conclusions Risk behaviors are frequent among those infected with HCV. Additionally, despite HTLV-1 being considered an infection with low morbidity, issues related to mental health (depressive episode) and decreased quality of life are relevant.
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Affiliation(s)
- Ricardo Henrique-Araújo
- Federal University of Bahia, Institute of Health Sciences, Postgraduate Program in Interactive Processes of Organs and Systems, Salvador, BA, Brazil; Nova Esperança Medical School, João Pessoa, PB, Brazil; Hospital Complex of Infectious Diseases Clementino Fraga, João Pessoa, PB, Brazil.
| | - Lucas C Quarantini
- Federal University of Bahia, Postgraduate Program in Medicine and Health, Salvador, BA, Brazil; Federal University of Bahia, Psychiatry Service, University Hospital (Com-HUPES), Salvador, BA, Brazil
| | - André C Caribé
- Federal University of Bahia, Psychiatry Service, University Hospital (Com-HUPES), Salvador, BA, Brazil
| | - Felipe C Argolo
- Federal University of São Paulo, Postgraduate Program in Psychiatry and Medical Psychology, São Paulo, SP, Brazil
| | - Ana Paula Jesus-Nunes
- Federal University of Bahia, Postgraduate Program in Medicine and Health, Salvador, BA, Brazil; Federal University of Bahia, Psychiatry Service, University Hospital (Com-HUPES), Salvador, BA, Brazil
| | - Mychelle Morais-de-Jesus
- Federal University of Bahia, Postgraduate Program in Medicine and Health, Salvador, BA, Brazil; Federal University of Bahia, Psychiatry Service, University Hospital (Com-HUPES), Salvador, BA, Brazil
| | - Adriana Dantas-Duarte
- Federal University of Bahia, Psychiatry Service, University Hospital (Com-HUPES), Salvador, BA, Brazil
| | - Tayne Miranda Moreira
- Federal University of Bahia, Psychiatry Service, University Hospital (Com-HUPES), Salvador, BA, Brazil
| | - Irismar Reis de Oliveira
- Federal University of Bahia, Institute of Health Sciences, Postgraduate Program in Interactive Processes of Organs and Systems, Salvador, BA, Brazil; Federal University of Bahia, Postgraduate Program in Medicine and Health, Salvador, BA, Brazil
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Ottman AA, Townsend ML, Hashem MG, Britt RB. Impact of Substance Use Disorder on the Rate of Sustained Virological Response in Veterans With Chronic Hepatitis C Treated With Direct-Acting Antivirals. Ann Pharmacother 2019; 53:581-587. [PMID: 30654625 DOI: 10.1177/1060028018824988] [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: 01/26/2023] Open
Abstract
BACKGROUND Substance use disorders (SUDs) are commonly encountered in patients with chronic hepatitis C virus (HCV) infection. It is important to consider the impact of SUDs on HCV treatment. OBJECTIVE To compare the rate of clinical cure (sustained virological response at least 12 weeks after end of therapy [SVR12]) in veterans with chronic HCV infection treated with direct-acting antivirals (DAAs) with and without ongoing or recent substance use. METHODS This single-center, retrospective cohort study evaluated 220 HCV patients treated with DAAs based on 2 groups: SUD (ongoing or recent substance use) or non-SUD (without ongoing or recent substance use). The primary end point was SVR12 achievement. Secondary end points included safety, adherence, early discontinuation, SVR12 achievement among SUD subgroups, and enrollment in a SUD treatment program. RESULTS Most patients were African American men with an average age of 60 years and infected with HCV genotype 1. Almost half of the patients had advanced fibrosis or cirrhosis. There was no difference in SVR12 between groups (SUD: 96.2%; non-SUD: 94.3%; P = 0.54). Overall, 35.5% of patients missed at least 1 dose of DAA therapy, with a significant difference noted between groups (SUD: 44.5%; non-SUD: 26.4%; P = 0.005). Early discontinuation of DAA therapy was similar between groups. SVR12 among SUD subgroups ranged from 92.9% to 100%. In the SUD group, 27.3% of patients were enrolled in a SUD treatment program. Conclusion and Relevance: This study suggests that recent/ongoing substance use does not affect achievement of clinical cure of chronic HCV and reinforces treatment in this patient population.
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Affiliation(s)
| | - Mary L Townsend
- 1 Durham Veterans Affairs Health Care System, Durham, NC, USA
| | | | - Rachel B Britt
- 1 Durham Veterans Affairs Health Care System, Durham, NC, USA
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North CS, Pollio DE, Sims OT, Jain MK, Hong BA. Prospective Longitudinal Substance Use Patterns in Patients Preparing for Hepatitis C Treatment. J Dual Diagn 2018; 14:60-69. [PMID: 29035169 PMCID: PMC6072267 DOI: 10.1080/15504263.2017.1380246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study prospectively examined the independent courses of alcohol, drugs, and smoking over 18 months in 154 patients preparing for hepatitis C virus (HCV) treatment in relation to functioning, negative coping, and satisfaction with quality of life in data collected from a randomized controlled trial of multiple-family group psychoeducation for patients preparing for HCV treatment. Patients with HCV who had consistent abstinence, consistent use, or achievement of abstinence after study entry were examined for outcomes pertaining to functioning in the context of HCV, negative coping, and satisfaction with quality of life. METHODS Of 309 patients considering treatment for HCV recruited from outpatient clinics at two major university medical centers and a Veterans Affairs medical center for a randomized controlled trial of a psychoeducation intervention, 154 completed baseline, 6-month, and 18-month assessments. The assessments included structured diagnostic interviews; questionnaires examining functioning, coping, and satisfaction with quality of life; medical record review; and urine testing for substances of abuse. For these analyses, substance use patterns were determined as consistent abstinence, consistent use, and achieving abstinence after study entry for alcohol and drug use and smoking. RESULTS The entire sample generally improved in all of these three outcomes over the course of the study. The course of alcohol, drugs, and smoking predicted HCV-related functioning, negative coping, and satisfaction with quality-of-life outcomes over 18 months. Three specific patterns of use (consistent abstinence, consistent use, and achievement of abstinence after study entry) of these substances diverged in association with outcomes related to functioning, negative coping, and satisfaction with quality of life, not only across trajectories over time within substance types but also among types of substances. CONCLUSIONS This study's finding that different substances were associated with distinct clinical outcomes suggests the need to conceptually unbundle different types of substances in managing HCV. Future research is needed to examine the clinical utility of further unbundling these substances and also to further investigate effects of various amounts of use of these substances.
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Affiliation(s)
- Carol S North
- a The Altshuler Center for Education and Research at Metrocare Services and Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - David E Pollio
- b The University of Alabama at Birmingham , Department of Social Work, College of Arts and Sciences , Birmingham , Alabama , USA
| | - Omar T Sims
- b The University of Alabama at Birmingham , Department of Social Work, College of Arts and Sciences , Birmingham , Alabama , USA
| | - Mamta K Jain
- c The University of Texas Southwestern Medical Center , Department of Internal Medicine/Division of Infectious Diseases , Dallas , Texas , USA
| | - Barry A Hong
- d Washington University School of Medicine , Department of Psychiatry , St. Louis , Missouri , USA
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Chirikov VV, Shaya FT, Mullins CD, dosReis S, Onukwugha E, Howell CD. Determinants of quality of care and treatment initiation in Medicare disabled patients with chronic hepatitis C. Expert Rev Gastroenterol Hepatol 2016; 9:1447-62. [PMID: 26524244 DOI: 10.1586/17474124.2015.1095087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Aligning with a national priority to bridge health disparities in disadvantaged populations, we explored contextual determinants of pretreatment quality of care and treatment receipt of Medicare disabled patients with hepatitis C virus (HCV) infection. METHODS We used Medicare claims (2006-2009) linked to the Area Health Resource Files. Ordinal partial proportional odds and weighted modified Poisson regressions were used to model the determinants of quality care receipt and interferon-based treatment, respectively. RESULTS We identified 1936 Medicare disabled HCV patients, of whom 10.4% were treated with peg-interferon. Despite the high comorbidity burden among HCV disabled patients, greater engagement in care correlated with greater likelihood of quality care and treatment receipt. CONCLUSION Our study highlights the need for process and linkage to care in Medicare disabled HCV patients, but future research relevant to novel interferon-free agents is needed to assess patterns of quality of care and treatment receipt in this vulnerable population.
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Affiliation(s)
- Viktor V Chirikov
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Fadia T Shaya
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA.,b 2 University of Maryland School of Medicine, Baltimore, MD, USA
| | - C Daniel Mullins
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Susan dosReis
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Ebere Onukwugha
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Charles D Howell
- c 3 Department of Medicine, Howard University College of Medicine, 2041 Georgia Ave. Suite 5C02, Washington, DC 20060, USA
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