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Li J, Gao T, Zhao D, Chai S, Luo J, Wang X, Wang X, Sun J, Li P, Zhou C. Catastrophic health expenditure and health-related quality of life among older adults in Shandong, China: the moderation effect of daily care by adult children. Int J Equity Health 2024; 23:51. [PMID: 38468257 DOI: 10.1186/s12939-023-02057-4] [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] [Received: 09/09/2023] [Accepted: 11/12/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Catastrophic health expenditure (CHE) has a considerable impact on older people in later life, but little is known about the relationship between catastrophic health expenditure and health-related quality of life (HRQOL). The aim of this study was to examine the relationship between catastrophic health expenditure and health-related quality of life in older people, and to explore whether the daily care provided by adult children is a moderator in this relationship. METHODS Data from the sixth National Health Services Survey in Shandong Province, China. The sample consisted of 8599 elderly people (age ≥ 60 years; 51.7% of female). Health-related quality of life was measured by the health utility value of EQ-5D-3 L. Interaction effects were analyzed using Tobit regression models and marginal effects analysis. RESULTS The catastrophic health expenditure prevalence was 60.5% among older people in Shandong, China. catastrophic health expenditure was significantly associated with lower health-related quality of life (β= - 0.142, P < 0.001). We found that adult children providing daily care services to their parents mitigated the effect of catastrophic health expenditure on health-related quality of life among older people (β = 0.027, P = 0.040). CONCLUSIONS Our findings suggested that catastrophic health expenditure was associated with health-related quality of life and the caring role of older adult children moderated this relationship. Reducing the damage caused by catastrophic health expenditure helps to improve health-related quality of life in older people. Adult children should increase intergenerational contact, provide timely financial and emotional support to reduce the negative impact of catastrophic health expenditure on health-related quality of life.
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Affiliation(s)
- Jiayan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Tingting Gao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Dan Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Shujun Chai
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Jingjing Luo
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Xuehong Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Xueqing Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, Jinan, 250012, China
| | - Peilong Li
- Shandong Health Commission Medical Management Service Center, Jinan, 250012, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China.
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University), Jinan, 250012, China.
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Linde S, Egede LE. Catastrophic health expenditures: a disproportionate risk in uninsured ethnic minorities with diabetes. HEALTH ECONOMICS REVIEW 2024; 14:18. [PMID: 38446368 PMCID: PMC10916057 DOI: 10.1186/s13561-024-00486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 02/07/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Chargemaster prices are the list prices that providers and health systems assign to each of their medical services in the US. These charges are often several factors of magnitude higher than those extended to individuals with either private or public insurance, however, these list prices are billed in full to uninsured patients, putting them at increased risk of catastrophic health expenditures (CHE). The objective of this study was to examine the risk of CHE across insurance status, diabetes diagnosis and to examine disparity gaps across race/ethnicity. METHODS We perform a retrospective observational study on a nationally representative cohort of adult patients from the Medical Expenditure Panel Survey for the years 2002-2017. Using logistic regression models we estimate the risk of CHE across insurance status, diabetes diagnosis and explore disparity gaps across race/ethnicity. RESULTS Our fully adjusted results show that the relative odds of having CHE if uninsured is 5.9 (p < 0.01) compared to if insured, and 1.1 (p < 0.01) for patients with a diabetes diagnosis (compared to those without one). We note significant interactions between insurance status and diabetes diagnosis, with uninsured patients with a diabetes diagnosis being 9.5 times (p < 0.01) more likely to experience CHE than insured patients without a diabetes diagnosis. In terms of racial/ethnic disparities, we find that among the uninsured, non-Hispanic blacks are 13% (p < 0.05), and Hispanics 14.2% (p < 0.05), more likely to experience CHE than non-Hispanic whites. Among uninsured patients with diabetes, we further find that Hispanic patients are 39.3% (p < 0.05) more likely to have CHE than non-Hispanic white patients. CONCLUSIONS Our findings indicate that uninsured patients with diabetes are at significantly elevated risks for CHE. These risks are further found to be disproportionately higher among uninsured racial/ethnic minorities, suggesting that CHE may present a channel through which structural economic and health disparities are perpetuated.
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Affiliation(s)
- Sebastian Linde
- Department of Health Policy & Management, Texas A&M School of Public Health, 212 Adriance Lab Rd, College Station, Texas, TX, 77843, USA.
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226-3596, USA
- Center for the Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
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Abegaz TM, Ali AA. Health-Related Quality of Life and Healthcare Events in Patients with Monotherapy of Anti-Diabetes Medications. Healthcare (Basel) 2023; 11:healthcare11040541. [PMID: 36833075 PMCID: PMC9957473 DOI: 10.3390/healthcare11040541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
This study aimed to examine the difference in health-related quality of life (HRQOL) and diabetes-related healthcare events (HCEs) among adults with diabetes who were on metformin, sulfonylurea, insulin, or thiazolidinedione (TZD) monotherapy. The data were sourced from the Medical Expenditure Panel Survey (MEPS). Diabetes patients ≥18 years old who had a complete record of physical component score and mental component scores in round 2 and round 4 of the survey were included. The primary outcome was HRQOL of diabetes patients as measured by the Medical Outcome Study short-form (SF-12v2TM). Multinomial logistic regression and negative binomial regression were conducted to determine associated factors of HRQOL and HCE, respectively. Overall, 5387 patients were included for analysis. Nearly 60% of patients had unchanged HRQOL after the follow-up, whereas almost 15% to 20% of patients showed improvement in HRQOL. The relative risk of declined mental HRQOL was 1.5 times higher relative to unchanged mental HRQOL in patients who were on sulfonylurea 1.55 [1.1-2.17, p = 0.01] than metformin users. The rate of HCE decreased by a factor of 0.79, [95% CI: 0.63-0.99] in patients with no history of hypertension. Patients on sulfonylurea 1.53 [1.20-1.95, <0.01], insulin 2.00 [1.55-2.70, <0.01], and TZD 1.78 [1.23-2.58, <0.01] had increased risk of HCE compared to patients who were on metformin. In general, antidiabetic medications modestly improved HRQOL in patients with diabetes during the follow-up period. Metformin had a lower rate of HCE as compared to other medications. The selection of anti-diabetes medications should focus on HRQOL in addition to controlling glucose level.
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Linde S, Egede LE. Do Chargemaster Prices Matter?: An Examination of Acute Care Hospital Profitability. Med Care 2022; 60:623-630. [PMID: 35647741 PMCID: PMC9262858 DOI: 10.1097/mlr.0000000000001734] [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: 11/26/2022]
Abstract
BACKGROUND It remains widely debated whether chargemaster price markups are tied to hospital profitability. OBJECTIVE To evaluate the effect of chargemaster markups on hospital profitability in the presence of unobserved hospital-specific (time-invariant) confounders, and cross-sectional dependence due to latent (common) policy shocks. DESIGN We use interactive fixed effects methods to address concerns of unobserved hospital-specific (time-invariant) confounders, and cross-sectional dependence. SETTING US acute care hospitals, 1996 through 2017 (ie, 22 y). PARTICIPANTS Using primarily Medicare cost report data, we construct an unbalanced panel of 3499 acute care hospitals per year, or a total of 76,972 hospital-year observations. MEASUREMENTS Chargemaster markups (above cost), profits per hospital inpatient discharge. RESULTS Between 1996 and 2017, chargemaster markups increased (on average) by 155%, and the SD of the chargemaster markup distribution increased by 324%-indicating growing variability in the average markup strategies pursued by hospitals. Our preferred model specification implies that a unit increase of the hospital chargemaster markup is associated with a $261 ( P <0.01; 95% confidence interval: $232-$291) increase in profits per hospital inpatient discharge. These results are robust to a wide set of model specifications, the use of alternative profitability measurements, and the use of an alternative instrumental variable identification strategy. Additional subsample analysis that controls for a rich set of hospital quality measures and system affiliation information also yields similar results. CONCLUSION We show that higher chargemaster markups are associated with higher hospital profitability. Additional research is needed to understand how chargemaster pricing impact health outcomes and health care disparities.
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Affiliation(s)
- Sebastian Linde
- Medical College of Wisconsin, Department of Medicine,
Division of General Internal Medicine, 8701 Watertown Plank Rd., Milwaukee, WI
53226-3596., USA
- Center for the Advancing Population Sciences, Medical
College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Leonard E. Egede
- Medical College of Wisconsin, Department of Medicine,
Division of General Internal Medicine, 8701 Watertown Plank Rd., Milwaukee, WI
53226-3596., USA
- Center for the Advancing Population Sciences, Medical
College of Wisconsin, Milwaukee, Wisconsin, USA
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Ho HT, Lin SI, Guo NW, Yang YC, Lin MH, Wang CS. Executive function predict the quality of life and negative emotion in older adults with diabetes: A longitudinal study. Prim Care Diabetes 2022; 16:537-542. [PMID: 35659729 DOI: 10.1016/j.pcd.2022.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/01/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
Abstract
AIMS To investigate the influence of executive function (EF) on current and future quality of life (QoL) and negative emotion (NE) in older adults with diabetes. METHODS A total of 128 older adults with diabetes were recruited. Independent variables (demographic information, health and medical conditions, cognitive function, life function) were collected in the first year. Dependent variables (QoL and NE) were collected for 3 years. Pearson's correlation coefficient analysis and stepwise multiple linear regression analysis were performed to identify the predictors of QoL and NE. RESULTS EF was the strongest predictor for overall QoL and NE in all 3 years, and accounted for 23.0-36.2% and 11.1-17.1% of the variance, respectively. The second strongest predictor for overall QoL in all 3 years was pain interference, which accounted for 3.2-5.8% of the variance. Pain interference was also the second strongest predictor for NE in the second year, accounting for 5.5% of the variance. CONCLUSIONS The present study revealed that EF is more predictive than pain for current and future QoL and NE in older adults with diabetes. We recommend that EF be included as an indicator for diabetes surveillance, and that prevention of EF decline be a part of diabetes management plans.
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Affiliation(s)
- Hsiao-Ting Ho
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City 701, Taiwan
| | - Sang-I Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City 701, Taiwan; Department of Physical Therapy, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City 701, Taiwan
| | - Nai-Wen Guo
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City 701, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City 701, Taiwan.
| | - Yi-Ching Yang
- Department of Family Medicine, Tainan Hospital, Ministry of Health and Welfare, 125 Jhongshan Road, West Central District, Tainan City 700, Taiwan; Department of Family Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City 701, Taiwan
| | - Ming-Hsing Lin
- Department of Family Medicine, Tainan Hospital, Ministry of Health and Welfare, 125 Jhongshan Road, West Central District, Tainan City 700, Taiwan
| | - Chong-Shan Wang
- Department of Family Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City 701, Taiwan; Alian Health Clinic, 383 Zhongzheng Road, Alian District, Kaohsiung City 822, Taiwan
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Wang SY, Valero-Elizondo J, Cainzos-Achirica M, Desai NR, Nasir K, Khera R. Measures of Financial Hardship From Health Care Expenses Among Families With a Member With Atherosclerotic Cardiovascular Disease in the US. JAMA HEALTH FORUM 2022; 3:e221962. [PMID: 35977226 PMCID: PMC9308060 DOI: 10.1001/jamahealthforum.2022.1962] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/15/2022] [Indexed: 12/03/2022] Open
Abstract
Importance Patients with atherosclerotic cardiovascular disease (ASCVD) face substantial financial burden from health care costs as assessed by many disparate measures. However, evaluation of the concordance of existing measures and the prevalence of financial burden based on these measures is lacking. Objective To compare subjectively reported and objectively measured financial burden from health care in families of patients with ASCVD. Design Setting and Participants This cross-sectional study used data from the Medical Expenditure Panel Survey, a nationally representative survey of individuals and families in the US, and included all families with 1 or more members with ASCVD from 2014 to 2018. Analyses were conducted from October 2021 to April 2022. Main Outcomes and Measures Using accepted definitions, objective financial hardship represented annual out-of-pocket medical expenses exceeding 20% of annual postsubsistence income, and subjective financial hardship represented self-reported problems paying medical bills or paying them over time. Prevalence of financial hardship was identified based on individual definitions and their concordance was assessed. Factors associated with each type of financial hardship were examined using risk-adjusted survey logistic regression. Multivariable logistic regression was used to model the odds of subjective financial hardship vs objective financial hardship across subgroups. The association between measures of financial hardship and self-reported deferral of care was also assessed. Results Among 10 975 families of patients with ASCVD, representing 22.5 million families nationally (mean [SD] age of index individual, 66 [24] years; estimated 54% men]), 37% experienced either objective or subjective financial hardship. This group included 11% (95% CI, 10%-11%) with objective financial hardship, 21% (95% CI, 20%-22%) with subjective financial hardship, and 5% (95% CI, 5%-6%) with both objective and subjective financial hardship. Mean age was 70 (95% CI, 68-71) years vs 61 (95% CI, 60-62) years for index patients in families reporting objective financial hardship only vs subjective financial hardship only, with no difference in sex (50% [95% CI, 46%-54%] of men vs 49% [95% CI, 47%-52%] of women). In risk-adjusted analyses, among families of patients with ASCVD, patient age of 65 years or older was associated with lower odds of subjective financial hardship than objective financial hardship (odds ratio [OR], 0.39; 95% CI, 0.20-0.76), whereas higher income (OR, 6.08; 95% CI, 3.93-9.42 for an income of >100%-200% of the federal poverty level [FPL] vs ≤100% of the FPL and OR, 20.46; 95% CI, 11.45-36.56 for >200% of FPL vs ≤100% of FPL), public insurance (OR, 6.60; 95% CI, 4.20-10.37), and being uninsured (OR, 5.36; 95% CI, 2.61-10.98) were associated with higher odds of subjective financial hardship than objective financial hardship. Subjective financial hardship alone was associated with significantly higher adjusted odds of self-reporting deferred or forgone care compared with objective financial hardship alone (OR, 2.69; 95% CI, 1.79-4.06). Conclusions and Relevance In this cross-sectional study of US adults, 2 in 5 families of patients with ASCVD experienced health care-related financial hardship, but a focus on objective or subjective measures alone would have captured only half the burden and not identified those deferring health care. The findings suggest that a comprehensive framework that evaluates both objective and subjective measures is essential to monitor financial consequences of health care.
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Affiliation(s)
- Stephen Y. Wang
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Javier Valero-Elizondo
- Center for Outcomes Research, Houston Methodist, Houston, Texas
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist, Houston, Texas
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas
| | - Nihar R. Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist, Houston, Texas
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
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Mathews E, Abraham J, Hense S. Changing social dynamics and older population: A qualitative analysis of the quality of life among older adults in Kerala. JOURNAL OF GERIATRIC MENTAL HEALTH 2022. [DOI: 10.4103/jgmh.jgmh_19_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Anguzu R, Nagavally S, Dawson AZ, Walker RJ, Egede LE. Age and Gender Differences in Trends and Impact of Depression on Quality of Life in the United States, 2008 to 2016. Womens Health Issues 2021; 31:353-365. [PMID: 33810952 DOI: 10.1016/j.whi.2021.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 02/13/2021] [Accepted: 02/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND We aimed to examine age and gender differences in the relationship between depression and quality of life among United States adults. METHODS Medical Expenditure Panel Survey data for 2008 to 2016 on 227,663 adults were analyzed. The dependent variable, quality of life, included physical component summary scores and mental component summary scores from the Short Form Health Survey. The key independent variable, depression, was measured using the two-item Patient Health Questionnaire. General linear regression models examined the relationship between quality of life and depression. Models were adjusted for individual and environmental characteristics, symptom status, functional and biological status, and health perceptions and were stratified by gender and age. RESULTS In adjusted models, mental component summary scores were significantly lower among those with depression compared with those without depression (β = -0.39; 95% confidence interval [CI], 0.38 to -1.16) and lower among women compared with men (β = -0.10; 95% CI, 0.10 to -1.31). Models stratified by gender and age found women with depression ages 40 to 64 (β = -0.07; 95% CI, 0.07 to -0.20) and 65 or older (β = -0.08; 95% CI, 0.08 to -0.24) had significantly lower physical component summary scores compared with those without depression. Among men with depression, those ages 18 to 39 (β = -0.03; 95% CI, 0.03 to -0.10) and 40 to 64 (β = -0.09, 95% CI, 0.08 to -0.26) had lower physical component summary scores compared with those without depression. Women and men of all ages with depression had significantly lower mental component summary scores compared with those without depression. CONCLUSIONS Public health interventions and clinical approaches to address depression in women and men should target functional status in men and perceptions of health in women.
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Affiliation(s)
- Ronald Anguzu
- Division of Epidemiology, Institute of Health and Equity, Graduate School of Biomedical Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sneha Nagavally
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aprill Z Dawson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Campbell JA, Yan A, Walker RE, Weinhardt L, Wang Y, Walker RJ, Egede LE. Quantifying the Influence of Individual, Community, and Health System Factors on Quality of Life Among Inner-City African Americans With Type 2 Diabetes. Sci Diabetes Self Manag Care 2021; 47:124-143. [PMID: 34078179 DOI: 10.1177/0145721721996287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to examine the association of individual, community, and health system factors on quality of life among inner-city African Americans with type 2 diabetes. METHODS Primary data from a cross-sectional study with a community sample of 241 inner-city African Americans with type 2 diabetes were analyzed. Paper-based surveys were administered in which the SF-12 was used to capture the physical component (PCS) and mental component (MCS) of quality of life. Four regression approaches (sequential, stepwise with backward and forward selection, and all possible subsets regression) were used to examine the influence of individual, community, and health system factors on PCS and MCS after adjusting for relevant covariates using a conceptual framework. RESULTS In fully adjusted models, having less than a high school education and having major depression were associated with lower quality-of-life scores for MCS across all 4 regression approaches. Being employed was positively associated with better quality-of-life scores for PCS across all 4 regression approaches. PCS was higher across all 4 regression approaches for those reporting a history of trauma. At the health systems level, usual source of care was associated with better PCS across 3 regression approaches. CONCLUSIONS These results highlight key factors that influence quality of life among inner-city African Americans with type 2 diabetes that could be targets for interventions in this population. However, additional research is needed to understand existing pathways that may be driving many of these relationships.
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Affiliation(s)
- Jennifer A Campbell
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alice Yan
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Renee E Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lance Weinhardt
- Joseph Zilber School of Public Health, University of Wisconsin, Milwaukee, Milwaukee, Wisconsin
| | - Yang Wang
- Joseph Zilber School of Public Health, University of Wisconsin, Milwaukee, Milwaukee, Wisconsin
| | - Rebekah J Walker
- Joseph Zilber School of Public Health, University of Wisconsin, Milwaukee, Milwaukee, Wisconsin
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
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Chen G, Delcher C, Xiao H, Roussos-Ross D, Huo J, Chen X. Factors associated with opioid prescriptions among women proximal to pregnancy in the United States. Res Social Adm Pharm 2020; 17:1483-1488. [PMID: 33234451 DOI: 10.1016/j.sapharm.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/08/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pregnant women are a vulnerable population exposed to opioids in the United States. OBJECTIVE To examine trends and factors associated with opioid prescribing to women proximal to pregnancy. METHODS The 2011 to 2015 Medical Expenditure Panel Survey (MEPS) was used to identify participants (n = 3020) with self-reported pregnancy or pregnancy-relevant events aged between 18 and 44 years old. To investigate factors associated with opioid prescriptions, we categorized participants into two subgroups: having one or more opioid prescription or having none during the observational period. We used survey multivariable logistic regression to identify factors associated with opioid prescribing accounting for the complex survey design in MEPS. RESULTS From 2011 to 2015, the prevalence of opioid prescribing among study participants was 31%. Opioids were more likely to be prescribed to women who had psychiatric conditions (odds ratio, 1,76, 95%CI: 1.27-2.44, p < 0.001). Other significant factors included being non-Hispanic white or black, living in the South, active tobacco users, and those with lower Physical Component Summary Scores. CONCLUSION Receipt of an opioid prescription in the perinatal period is associated with maternal psychiatric disorders in the United States. Study findings add new data to the literature on opioid use among pregnant women and provide evidence for healthcare providers and policy makers to tailor treatment and educational programs to avoid opioid overuse among pregnant women.
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Affiliation(s)
- Guanming Chen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Chris Delcher
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Hong Xiao
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, New Jersey, USA
| | - Dikea Roussos-Ross
- Department of Obstetrics & Gynecology and Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jinhai Huo
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, New Jersey, USA
| | - Xinguang Chen
- Department of Epidemiology, College of Public Health, University of Florida, Gainesville, FL, USA.
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Smyth LJ, Patterson CC, Swan EJ, Maxwell AP, McKnight AJ. DNA Methylation Associated With Diabetic Kidney Disease in Blood-Derived DNA. Front Cell Dev Biol 2020; 8:561907. [PMID: 33178681 PMCID: PMC7593403 DOI: 10.3389/fcell.2020.561907] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/15/2020] [Indexed: 12/23/2022] Open
Abstract
A subset of individuals with type 1 diabetes will develop diabetic kidney disease (DKD). DKD is heritable and large-scale genome-wide association studies have begun to identify genetic factors that influence DKD. Complementary to genetic factors, we know that a person’s epigenetic profile is also altered with DKD. This study reports analysis of DNA methylation, a major epigenetic feature, evaluating methylome-wide loci for association with DKD. Unique features (n = 485,577; 482,421 CpG probes) were evaluated in blood-derived DNA from carefully phenotyped White European individuals diagnosed with type 1 diabetes with (cases) or without (controls) DKD (n = 677 samples). Explicitly, 150 cases were compared to 100 controls using the 450K array, with subsequent analysis using data previously generated for a further 96 cases and 96 controls on the 27K array, and de novo methylation data generated for replication in 139 cases and 96 controls. Following stringent quality control, raw data were quantile normalized and beta values calculated to reflect the methylation status at each site. The difference in methylation status was evaluated between cases and controls; resultant P-values for array-based data were adjusted for multiple testing. Genes with significantly increased (hypermethylated) and/or decreased (hypomethylated) levels of DNA methylation were considered for biological relevance by functional enrichment analysis using KEGG pathways. Twenty-two loci demonstrated statistically significant fold changes associated with DKD and additional support for these associated loci was sought using independent samples derived from patients recruited with similar inclusion criteria. Markers associated with CCNL1 and ZNF187 genes are supported as differentially regulated loci (P < 10–8), with evidence also presented for AFF3, which has been identified from a meta-analysis and subsequent replication of genome-wide association studies. Further supporting evidence for differential gene expression in CCNL1 and ZNF187 is presented from kidney biopsy and blood-derived RNA in people with and without kidney disease from NephroSeq. Evidence confirming that methylation sites influence the development of DKD may aid risk prediction tools and stimulate research to identify epigenomic therapies which might be clinically useful for this disease.
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Affiliation(s)
- Laura J Smyth
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | | | - Elizabeth J Swan
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Alexander P Maxwell
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.,Regional Nephrology Unit, Belfast City Hospital, Belfast, United Kingdom
| | - Amy Jayne McKnight
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
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12
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Kharat AA, Muzumdar J, Hwang M, Wu W. Assessing trends in medical expenditures and measuring the impact of health-related quality of life on medical expenditures for U.S. adults with diabetes associated chronic kidney disease using 2002–2016 medical expenditure panel survey data. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2020. [DOI: 10.1111/jphs.12378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Background
Chronic Kidney Disease (CKD) is one of the most expensive comorbidities of diabetes. The changes in medical expenditures over the years and the latest economic burden of CKD among diabetes are unknown.
Objectives
(1) To examine the trend and estimate the differences in medical expenditures between adults with diabetes-associated CKD and diabetes-no CKD from 2002 to 2016 using Medical Expenditure Panel Survey data (2) To study the impact of health-related quality of life (HRQOL) on medical expenditure for adults with diabetes-associated CKD.
Methods
This is a retrospective cross-sectional study. Descriptive statistics were used for studying the trend in medical expenditures from 2002 to 2016. HRQOL was measured using physical and mental component summary (PCS, MCS). Two-part model was utilized for estimating the incremental medical expenditure for diabetes patients by CKD status.
Key findings
A total of 35,112 diabetic adults were identified in the Medical Expenditure Panel Survey dataset. Among these, 3,489 individuals had CKD. The pooled mean expenditure for diabetes-associated CKD was $25,953 which was almost double of $12,170 for patients with diabetes and no CKD. Individuals with diabetes CKD had $12,109 higher adjusted direct incremental medical expenditure as compared to diabetes-no CKD. With respect to HRQOL, individuals in the highest quartile of PCS and MCS spent $18,076 and $10,307 lesser than those in the lowest quartile respectively.
Conclusions
Medical expenditures associated with CKD are a significant contributor to the financial burden among diabetes adults. Improvements in HRQOL also lead to lower healthcare costs in diabetes-associated CKD patients.
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Affiliation(s)
- Aditi A Kharat
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
| | - Jagannath Muzumdar
- College of Pharmacy and Health Sciences, St. John's University, Jamaica, NY, USA
| | - Monica Hwang
- College of Pharmacy and Health Sciences, St. John's University, Jamaica, NY, USA
| | - Wenchen Wu
- College of Pharmacy and Health Sciences, St. John's University, Jamaica, NY, USA
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13
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Contemporary relationship between medical expenditures and quality of life among adults with epilepsy in the United States. Epilepsy Behav 2020; 112:107430. [PMID: 32956943 DOI: 10.1016/j.yebeh.2020.107430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 11/22/2022]
Abstract
AIMS Epilepsy exacts substantial adverse economic and quality of life (QoL) costs. Clarifying the quantitative and qualitative relationships between total and out-of-pocket (OOP) healthcare expenditures and QoL could shed insights into how they influence each other, and have done so over recent times. METHODS We used the Medical Expenditure Household Components 2003-2014 to identify a total of 2450 adults with epilepsy, representing a weighted population of 1,942,413. Quality of life was assessed using the Physical Component Summary (PCS) and the Mental Component Summary (MCS) derived from the Short-form 12 Version 2 (SF-12 V2), converted into quartiles of equal distribution, with higher quartiles indicating a better QoL. We computed unadjusted mean and adjusted (through a generalized linear model (GLM)) total and OOP healthcare expenditures by QoL categories among adults with epilepsy (reported as dollars in 2016). RESULTS The pooled estimates of total healthcare expenditures decreased as PCS and MCS quartiles of QoL increased [PCS: costs for quartile 1 = $21,792 (95% confidence interval (CI): $18,416-$25,168 vs. costs for quartile 4 = $6057 (95% CI: $4648-$7466) and MCS: costs for quartile 1 = $19,040 (95% CI: $15,544-$22,535) vs. quartile 4 = $12,939 (95% CI: $8450-$17,429)]. Similarly, the pooled estimates of OOP healthcare expenditures and QoL were inversely related [PCS: costs for quartile 1 = $1849 (95% CI: $1583-$2114) vs. costs for quartile 4 = $948 ($709-$1187) and MCS: costs for quartile 1 = 1812 (95% CI: $1483-2141) vs. quartile 4 = $1317 (95% CI: $982-$1652)]. The association between QoL and total and OOP healthcare expenditures was unchanged after adjusting for socioeconomic and healthcare system related confounders in the GLM. Overall, healthcare expenditures were stable across years independently of the QoL; only OOP expenditures decreased between 2003-2006 and 2011-2014 for quartile 1 of PCS and MCS. CONCLUSION Quality of life and OOP health expenditures are independently and inversely related to each other among adults with epilepsy. Over the decade studied in the United States, there was a decrease in OOP health expenditures among those patients with epilepsy with the lowest QoL, possibly reflecting a rise in insurance coverage after the Affordable Care Act.
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14
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Burgermaster M, Son JH, Davidson PG, Smaldone AM, Kuperman G, Feller DJ, Burt KG, Levine ME, Albers DJ, Weng C, Mamykina L. A new approach to integrating patient-generated data with expert knowledge for personalized goal setting: A pilot study. Int J Med Inform 2020; 139:104158. [PMID: 32388157 PMCID: PMC7332366 DOI: 10.1016/j.ijmedinf.2020.104158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/19/2020] [Accepted: 04/23/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Self-monitoring technologies produce patient-generated data that could be leveraged to personalize nutritional goal setting to improve population health; however, most computational approaches are limited when applied to individual-level personalization with sparse and irregular self-monitoring data. We applied informatics methods from expert suggestion systems to a challenging clinical problem: generating personalized nutrition goals from patient-generated diet and blood glucose data. MATERIALS AND METHODS We applied qualitative process coding and decision tree modeling to understand how registered dietitians translate patient-generated data into recommendations for dietary self-management of diabetes (i.e., knowledge model). We encoded this process in a set of functions that take diet and blood glucose data as an input and output diet recommendations (i.e., inference engine). Dietitians assessed face validity. Using four patient datasets, we compared our inference engine's output to clinical narratives and gold standards developed by expert clinicians. RESULTS To dietitians, the knowledge model represented how recommendations from patient data are made. Inference engine recommendations were 63 % consistent with the gold standard (range = 42 %-75 %) and 74 % consistent with narrative clinical observations (range = 63 %-83 %). DISCUSSION Qualitative modeling and automating how dietitians reason over patient data resulted in a knowledge model representing clinical knowledge. However, our knowledge model was less consistent with gold standard than narrative clinical recommendations, raising questions about how best to evaluate approaches that integrate patient-generated data with expert knowledge. CONCLUSION New informatics approaches that integrate data-driven methods with expert decision making for personalized goal setting, such as the knowledge base and inference engine presented here, demonstrate the potential to extend the reach of patient-generated data by synthesizing it with clinical knowledge. However, important questions remain about the strengths and weaknesses of computer algorithms developed to discern signal from patient-generated data compared to human experts.
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Affiliation(s)
- Marissa Burgermaster
- Nutritional Sciences & Population Health, University of Texas at Austin, Austin, TX, USA; Biomedical Informatics, Columbia University, New York, NY, USA.
| | - Jung H Son
- Biomedical Informatics, Columbia University, New York, NY, USA
| | | | - Arlene M Smaldone
- School of Nursing & College of Dental Medicine, Columbia University, New York, NY, USA
| | - Gilad Kuperman
- Biomedical Informatics, Columbia University, New York, NY, USA; Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel J Feller
- Biomedical Informatics, Columbia University, New York, NY, USA
| | | | | | - David J Albers
- Biomedical Informatics, Columbia University, New York, NY, USA; Pediatrics & Informatics, University of Colorado, Aurora, CO, USA
| | - Chunhua Weng
- Biomedical Informatics, Columbia University, New York, NY, USA
| | - Lena Mamykina
- Biomedical Informatics, Columbia University, New York, NY, USA
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Mahato SKS, Apidechkul T, Sriwongpan P, Hada R, Sharma GN, Nayak SK, Mahato RK. Factors associated with quality of life among chronic kidney disease patients in Nepal: a cross-sectional study. Health Qual Life Outcomes 2020; 18:207. [PMID: 32600360 PMCID: PMC7325283 DOI: 10.1186/s12955-020-01458-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/19/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) leads to decreased quality of life (QOL) by increasing the risk of death during the progression of its pathogenesis. However, many factors can be improved to support QOL. This study aimed to assess QOL among CKD patients in Nepal and to determine the factors associated with their QOL. METHOD A cross-sectional study was used for data collection. CKD cases receiving medical attention in the Bir Hospital in Mahaboudh, Kathmandu; Tribhuvan University Teaching Hospital in Maharajgunj, Kathmandu; Sumeru Hospital in Dhapakhel, Lalitpur; and Shahid Dharma Bhakta National Transplant Centre in Bhaktapur between August and October 2019 were invited to participate in the study. A validated questionnaire and the kidney disease quality of life short form (KDQOL-SF™ 1.3) were used to assess QOL. A questionnaire was completed by the researcher in face-to-face interviews. Logistic regression was used to detect the associations between variables at the significance level of α = 0.05. RESULTS A total of 440 participants were recruited into the study: 56.59% were males, 74.32% were aged between 31 and 70 years, 25.68% were illiterate, and 82.95% were unemployed. The prevalence of good QOL among CKD in the domains of the physical component summary (PCS), mental component summary (MCS), and kidney disease component summary (KDCS) with and without hemodialysis were 53.64, 22.05, 21.28, and 13.19%, respectively. After controlling for all potential confounding factors, eight variables were found to be associated with good QOL in the domain of PCS: age, education, stage of CKD, hemodialysis, transporting oneself to a hospital, health insurance, medical expenses, and perceived lack of difficulty in handling medical expenses. Six variables were associated with good QOL in the domain of MCS after controlling for all potential confounding factors: residence, stage of CKD, transporting oneself to a hospital, health insurance, medical expenses, and perceived lack of difficulty in handling medical expenses. CONCLUSIONS Public health interventions should be developed and implemented to improve QOL among CKD patients in Nepal by focusing on older female patients who have low education, live in rural areas and no health insurance.
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Affiliation(s)
- Shambhu Kumar Saxena Mahato
- School of Health Science, Mae Fah Luang University, Muang Chiang Rai, Chiang Rai Province Thailand
- Epidemiology and Disease Control Division, Department of Health Services, Teku, Kathmandu, Nepal
| | - Tawatchai Apidechkul
- School of Health Science, Mae Fah Luang University, Muang Chiang Rai, Chiang Rai Province Thailand
- Center of Excellence for the Hill tribe Health Research, Mae Fah Luang University, Muang Chiang Rai, Chiang Rai Province Thailand
| | - Pamornsri Sriwongpan
- School of Health Science, Mae Fah Luang University, Muang Chiang Rai, Chiang Rai Province Thailand
| | - Rajani Hada
- Department of Nephrology, National Academy of Health Sciences, Bir Hospital, Mahaboudh, Kathmandu, Nepal
| | | | | | - Ram Kumar Mahato
- Ministry of Health and Population, Ramshah Path, Kathmandu, Nepal
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16
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Wang J, Shi L. Prediction of medical expenditures of diagnosed diabetics and the assessment of its related factors using a random forest model, MEPS 2000-2015. Int J Qual Health Care 2020; 32:99-112. [PMID: 32159759 DOI: 10.1093/intqhc/mzz135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/14/2019] [Accepted: 12/18/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To predict the medical expenditures of individual diabetics and assess the related factors of it. DESIGN AND SETTING Cross-sectional study. SETTING AND PARTICIPANTS Data were collected from the US household component of the medical expenditure panel survey, 2000-2015. MAIN OUTCOME MEASURE Random forest (RF) model was performed with the programs of randomForest in R software. Spearman correlation coefficients (rs), mean absolute error (MAE) and mean-related error (MRE) was computed to assess the prediction of all the models. RESULTS Total medical expenditure was increased from $105 Billion in 2000 to $318 Billion in 2015. rs, MAE and MRE between the predicted and actual values of medical expenditures in RF model were 0.644, $0.363 and 0.043%. Top one factor in prediction was being treated by the insulin, followed by type of insurance, employment status, age and economical level. The latter four variables had no impact in predicting of medical expenditure by being treated by the insulin. Further, after the sub-analysis of gender and age-groups, the evaluating indicators of prediction were almost identical to each other. Top five variables of total medical expenditure among male were same as those among all the diabetics. Expenses for doctor visits, hospital stay and drugs were also predicted with RF model well. Treatment with insulin was the top one factor of total medical expenditure among female, 18-, 25- and 65-age-groups. Additionally, it indicated that RF model was little superior to traditional regression model. CONCLUSIONS RF model could be used in prediction of medical expenditure of diabetics and assessment of its related factors well.
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Affiliation(s)
- Jing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan road, Shushan district, Hefei city,230032, P.R. China
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-1999, USA
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-1999, USA
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17
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Simmons M, Bishu KG, Williams JS, Walker RJ, Dawson AZ, Egede LE. Racial and Ethnic Differences in Out-of-Pocket Expenses among Adults with Diabetes. J Natl Med Assoc 2019; 111:28-36. [PMID: 30129486 PMCID: PMC7995684 DOI: 10.1016/j.jnma.2018.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 04/17/2018] [Accepted: 04/25/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Racial and ethnic minority groups have a higher prevalence of diabetes, increased risk for adverse complications, and worse health outcomes compared to Non-Hispanic Whites. Evidence suggests they also have higher healthcare expenses associated with diabetes care. Therefore, the objective of this study was to assess racial and ethnic differences in out-of-pocket (OOP) costs among a nationally representative sample of adults with diabetes. METHODS Cross-sectional study of 17,702 adults (aged ≥18 years) with diabetes from years 2002-2011 in the Medical Expenditure Panel Survey Household Component. The outcome was OOP expenditures, and the primary predictor was race/ethnicity. Descriptive statistics summarized the sample population. Unadjusted mean values were computed to compare OOP expenses over time. A two-part model was used to estimate adjusted incremental OOP expenses. RESULTS For the overall sample, OOP expenditures decreased significantly over time. In addition, compared to NHWs, racial and ethnic minority groups had significantly lower OOP costs per year when adjusted for sociodemographic characteristics, comorbid conditions, and time. NHBs paid $481 less than NHWs; Hispanics paid $591 less than NHWs; and individuals in the 'Other' racial/ethnic category paid nearly $645 less compared to NHWs (p < 0.001). CONCLUSIONS Racial/ethnic minority patients with diabetes had significantly less OOP expenses compared to NHWs, possibly due to differences in healthcare utilization. OOP expenses decreased significantly over time for all racial and ethnic groups. Additional research is needed to understand the factors associated with differences in OOP expenditures among racial groups.
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Affiliation(s)
- Makiera Simmons
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kinfe G Bishu
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Joni S Williams
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Room H3165, Milwaukee, WI 53226, USA
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Room H3165, Milwaukee, WI 53226, USA
| | - Aprill Z Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Room H3165, Milwaukee, WI 53226, USA
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226, USA; Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Room H3165, Milwaukee, WI 53226, USA.
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18
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Kaewput W, Thongprayoon C, Mungthin M, Jindarat S, Varothai N, Suwannahitatorn P, Rangsin R, Mao MA, Cheungpasitporn W. Temporal trends in optimal diabetic care and complications of elderly type 2 diabetes patients in Thailand: A nationwide study. J Evid Based Med 2019; 12:22-28. [PMID: 30398014 DOI: 10.1111/jebm.12318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/01/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND This study aimed to assess the nationwide trends in optimal diabetic care and complications of elderly type 2 diabetes mellitus (T2DM) patients over a 6-year period in Thailand. METHODS T2DM patients aged 65 years or older who received medical care at public hospitals in Thailand from 2010 to 2015 were included. The optimal T2DM care in elderly patients was defined as (1) blood pressure (BP) < 140/90, (2) hemoglobin A1C (HbA1c) < 7%, (3) low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL, (4) use of antiplatelet medications, and (5) use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) in hypertensive patients. T2DM treatment-related complications included hospital admissions due to dysglycemia. RESULTS A total of 54 295 elderly T2DM patients were enrolled in this study. From 2010 to 2015, there was an increasing trend in the achievement of BP control and use of antiplatelet medications (P for trend < 0.01), whereas there was a decreasing trend in the achievement of HbA1c and LDL-C control among elderly T2DM patients (P for trend < 0.001). There was an increasing trend in the use of ACEI/ARB among elderly T2DM patients with hypertension (P for trend < 0.001). Hospital admissions due to dysglycemia decreased over the study period (P for trend < 0.001). CONCLUSION There has been a trend change for diabetic care among elderly T2DM patients in Thailand. Further studies are needed to assess the impact on patient outcomes.
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Affiliation(s)
- Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Charat Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, New York City, New York, USA
| | - Mathirut Mungthin
- Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Sarawut Jindarat
- Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Narittaya Varothai
- Medicine, Geriatric Unit, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Michael A Mao
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology/Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Kang SH, Ju YJ, Yoon HJ, Lee SA, Kim W, Park EC. The relationship between catastrophic health expenditure and health-related quality of life. Int J Equity Health 2018; 17:166. [PMID: 30428892 PMCID: PMC6237009 DOI: 10.1186/s12939-018-0883-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/30/2018] [Indexed: 01/21/2023] Open
Abstract
Objectives The objective of our study was to investigate the relationship between catastrophic health expenditure (CHE) and health-related quality of life (HRQoL) in general population. Methods We used Korean Health Panel Survey data from 2011 to 2013, which included data from 8850 baseline participants of 19 years of age or older. We defined CHE as total annual out-of-pocket health payment that was 40% greater than the household’s capacity to pay. HRQoL was measured using the EuroQol-visual analogue scale (EQ-VAS). We used generalized estimating equations to perform a longitudinal regression analysis. Results A total of 4.5% of the participants (n = 398) experienced CHE. Those with CHE tended to have a lower EQ-VAS index score compared with those without CHE (β: − 1.34, p = 0.013). A subgroup analysis revealed that individuals experiencing CHE had significant decreases as the number of chronic diseases increased (three or more, β: − 1.85, p = 0.014). Conclusions Catastrophic health expenditure influences HRQoL, which was more pronounced in patient with chronic disease. The efforts should focus on people who suffer from excessive health expenditures and chronic diseases.
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Affiliation(s)
- Seung Hyun Kang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Yeong Jun Ju
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Hyo Jung Yoon
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Sang Ah Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Woorim Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea. .,Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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Abstract
An estimated 30.2 million Americans have diabetes, and this number is expected to increase based on trends over recent decades and compounded by an aging U.S. POPULATION As reviewed in this article, type 2 diabetes mellitus (T2DM) is associated with impaired health-related quality of life (HRQoL) and with a substantial socioeconomic burden. Compared with individuals without T2DM, those with T2DM have worse HRQoL, greater decrements in HRQoL over time, and possibly greater depressive symptomology. Diabetes-related complications and comorbidities (e.g., obesity and cardiovascular disease) are associated with worse HRQoL. Hypoglycemic episodes are associated with reduced HRQoL and greater levels of depression; they can also interfere with social and occupational activities. In turn, low HRQoL can be a driver for poor glycemic control. In 2012, the total estimated cost associated with diagnosed diabetes in the United States was $245 billion. Factors contributing to increased health care resource utilization and costs in patients with T2DM include medical comorbidities, diabetes-related complications, inadequate glycemic control, and hypoglycemic episodes. Readmission is a key driver of hospital-related costs and is more common among elderly patients with T2DM. Elderly patients with T2DM represent a particularly vulnerable population given that these patients may have varying degrees of physical and mental comorbidities that can increase their risk of hypoglycemia, falls, and depression. This review demonstrates that T2DM imposes a considerable burden on both the individual and society. Treatment strategies should consider the effects of treatment on HRQoL and on outcomes (e.g., complications and hypoglycemia) that affect both HRQoL and costs. Management strategies that maximize HRQoL while minimizing the risk of hypoglycemia and other treatment-related complications are particularly critical in the elderly. DISCLOSURES This supplement was funded by Novo Nordisk. Cannon reports speaker fees and owns stock in Novo Nordisk. Handelsman reports research grants from Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Grifols, Janssen, Lexicon, Merck, Novo Nordisk, Regeneron, and Sanofi; speaker fees from Amarin, Amgen, AstraZeneca, Boehringer Ingelheim-Lilly, Janssen, Merck, Novo Nordisk, Regeneron, and Sanofi; and has served in advisory capacity to Amarin, Amgen, AstraZeneca, Boehringer Ingelheim, Eisai, Intarcia, Janssen, Lilly, Merck, Merck-Pfizer, Novo Nordisk, Regeneron, and Sanofi. Heile reports speaker fees from and has served as advisor to Novo Nordisk. Shannon reports consultant and speaker fees from Novo Nordisk and Boehringer Ingelheim-Lilly Alliance.
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Zorland JL, Gilmore D, Johnson JA, Borgman R, Emshoff J, Akin J, Seale JP, Shellenberger S, Kuperminc GP. Effects of substance use screening and brief intervention on health-related quality of life. Qual Life Res 2018; 27:2329-2336. [PMID: 29869747 DOI: 10.1007/s11136-018-1899-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Screening, brief intervention, and referral to treatment interventions have been shown to positively impact alcohol use. These programs utilize motivational interviewing techniques in an effort to reduce risky substance use among those at elevated risk of developing a disorder. However, there is a dearth of research assessing positive impacts above and beyond changes in alcohol use. This study examines potential benefits of brief interventions, utilizing motivation interviewing, on mental and physical quality of life. METHODS The present quasi-experimental study examined changes in health-related quality of life among individuals presenting at urban emergency departments. The analyses included the use of propensity score matching to minimize potential biases resulting from differences between groups at baseline. RESULTS The results indicated that the intervention group experienced significant increases in perceptions of mental health over those of the comparison group, regardless of changes in substance use. CONCLUSIONS These findings have implications for practice, as they suggest that brief substance abuse interventions delivered in the emergency department settings may have effects beyond those targeted by the intervention. Specifically, brief substance abuse interventions may positively impact mental health, thus enhancing the quality of life among targets of the intervention.
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Affiliation(s)
- J L Zorland
- Department of Psychology, Georgia State University, Atlanta, GA, 30302, USA.
| | - D Gilmore
- Department of Psychology, Georgia State University, Atlanta, GA, 30302, USA
| | - J A Johnson
- Institute of Public & Preventive Health, Georgia Regents University, Augusta, GA, 30912, USA
| | - R Borgman
- Department of Psychology, Georgia State University, Atlanta, GA, 30302, USA
| | - J Emshoff
- Department of Psychology, Georgia State University, Atlanta, GA, 30302, USA
| | - J Akin
- Department of Psychology, Georgia State University, Atlanta, GA, 30302, USA
| | - J P Seale
- Department of Family Medicine, NavicentHealth and Mercer University School of Medicine, Macon, GA, 31206, USA
| | | | - G P Kuperminc
- Department of Psychology, Georgia State University, Atlanta, GA, 30302, USA
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Lekoubou A, Bishu KG, Ovbiagele B. Nationwide Healthcare Expenditures among Hypertensive Individuals with Stroke: 2003-2014. J Stroke Cerebrovasc Dis 2018. [PMID: 29530460 DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Of all the various clinical entities, hypertension is arguably most strongly linked to the occurrence of stroke. However, the impact of stroke on health-care expenditures in patients with hypertension has not been previously evaluated. METHODS We analyzed data from the Medical Expenditure Panel Survey Household Component, 2003-2014 data. Adults aged 18 years or greater were included in this analysis. We used a 2-part model (adjusting for demographic, comorbidity, and time) to estimate the incremental health-care expenditures incurred by stroke among individuals with hypertension. RESULTS On average, $4057 more dollars (adjusted incremental health-care expenditure) was spent on individuals with hypertension plus stroke versus no history of stroke. Overall unadjusted mean medical expenditure in those with a comorbid diagnosis of stroke was twice as high as in those without a diagnosis of stroke ($16,668 versus 8374; P < .001). Inpatient expenditures (37.4%), outpatient expenditures, and prescription expenditures (nearly 23% each) accounted for almost 80% of the total mean unadjusted direct expenditures. Annual average unadjusted aggregate costs among individuals with hypertension and stroke were $98.3 billion, while annual adjusted aggregate incremental costs were higher by $24 billion among patients with stroke versus those without stroke. CONCLUSION Among individuals with hypertension in the United States, those who have experienced a stroke incur tens of billions of dollars in higher health-care expenditures compared with those without known stroke. Greater emphasis on stroke prevention strategies and cost control initiatives (wherever appropriate) are warranted.
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Affiliation(s)
- Alain Lekoubou
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina.
| | - Kinfe G Bishu
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; Section of Health Systems Research and Policy, Medical University of South Carolina, Charleston, South Carolina
| | - Bruce Ovbiagele
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
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