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Social Deprivation, Healthcare Access and Diabetic Foot Ulcer: A Narrative Review. J Clin Med 2022; 11:jcm11185431. [PMID: 36143078 PMCID: PMC9501414 DOI: 10.3390/jcm11185431] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
The diabetic foot ulcer (DFU) is a common and serious complication of diabetes. There is also a strong relationship between the environment of the person living with a DFU and the prognosis of the wound. Financial insecurity seems to have a major impact, but this effect can be moderated by social protection systems. Socioeconomic and socio-educational deprivations seem to have a more complex relationship with DFU risk and prognosis. The area of residence is a common scale of analysis for DFU as it highlights the effect of access to care. Yet it is important to understand other levels of analysis because some may lead to over-interpretation of the dynamics between social deprivation and DFU. Social deprivation and DFU are both complex and multifactorial notions. Thus, the strength and characteristics of the correlation between the risk and prognosis of DFU and social deprivation greatly depend not only on the way social deprivation is calculated, but also on the way questions about the social deprivation−DFU relationship are framed. This review examines this complex relationship between DFU and social deprivation at the individual level by considering the social context in which the person lives and his or her access to healthcare.
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Mayer V, Mijanovich T, Egorova N, Flory J, Mushlin A, Calvo M, Deshpande R, Siscovick D. Impact of New York State's Health Home program on access to care among patients with diabetes. BMJ Open Diabetes Res Care 2021; 9:9/Suppl_1/e002204. [PMID: 34933873 PMCID: PMC8679110 DOI: 10.1136/bmjdrc-2021-002204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/04/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Access to care is essential for patients with diabetes to maintain health and prevent complications, and is important for health equity. New York State's Health Homes (HHs) provide care management services to Medicaid-insured patients with chronic conditions, including diabetes, and aim to improve quality of care and outcomes. There is inconsistent evidence on the impact of HHs, and care management programs more broadly, on access to care. RESEARCH DESIGN AND METHODS Using a cohort of patients with diabetes derived from electronic health records from the INSIGHT Clinical Research Network, we analyzed Medicaid data for HH enrollees and a matched comparison group of HH non-enrollees. We estimated HH impacts on several access measures using natural experiment methods. RESULTS We identified and matched 11 646 HH enrollees; patients were largely non-Hispanic Black (29.9%) and Hispanic (48.7%), and had high rates of dual eligibility (33.0%), Supplemental Security Income disability enrollment (49.1%), and multiple comorbidities. In the 12 months following HH enrollment, HH enrollees had one more month of Medicaid coverage (p<0.001) and 4.6 more outpatient visits than expected (p<0.001, evenly distributed between primary and specialty care). There were also positive impacts on the proportions of patients with follow-up visits within 7 days (4 percentage points (pp), p<0.001) and 30 days (6pp, p<0.001) after inpatient care, and on the proportion of patients with follow-up visits within 30 days after emergency department (ED) care (4pp, p<0.001). We did not find meaningful differences in continuity of care. We found small positive impacts on the proportion of patients with an inpatient visit and the proportion with an ED visit. CONCLUSIONS New York State's HH program improved access to care for Medicaid recipients with diabetes. These findings have implications for New York State Medicaid as well as other providers and care management programs.
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Affiliation(s)
- Victoria Mayer
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Tod Mijanovich
- Department of Applied Statistics, Social Sciences, and Humanities, Steinhardt School, New York University, New York City, New York, USA
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - James Flory
- Endocrinology Service, Department of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Alvin Mushlin
- Departments of Population Health Sciences and Medicine, Weill Cornell Medicine, New York City, New York, USA
| | - Michele Calvo
- Research, Evaluation & Policy, New York Academy of Medicine, New York City, New York, USA
| | - Richa Deshpande
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - David Siscovick
- Research, Evaluation & Policy, New York Academy of Medicine, New York City, New York, USA
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Lawrence WR, Hosler AS, Gates Kuliszewski M, Leinung MC, Zhang X, Schymura MJ, Boscoe FP. Impact of preexisting type 2 diabetes mellitus and antidiabetic drugs on all-cause and cause-specific mortality among Medicaid-insured women diagnosed with breast cancer. Cancer Epidemiol 2020; 66:101710. [PMID: 32247208 PMCID: PMC9920233 DOI: 10.1016/j.canep.2020.101710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/12/2020] [Accepted: 03/17/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND We investigated the influence preexisting type 2 diabetes mellitus (T2DM) and antidiabetic drugs have on all-cause and cause-specific mortality among Medicaid-insured women diagnosed with breast cancer. METHODS 9221 women aged <64 years diagnosed with breast cancer and reported to the New York State (NYS) Cancer Registry from 2004 to 2016 were linked with Medicaid claims. Preexisting T2DM was determined by three diagnosis claims for T2DM with at least one claim prior to breast cancer diagnosis and a prescription claim for an antidiabetic drug within three months following breast cancer diagnosis. Estimated menopausal status was determined by age (premenopausal age <50; postmenopausal age ≥50). Hazard ratios (HR) and 95 % confidence intervals (95 %CI) were calculated with Cox proportional hazards regression, adjusting for confounders. RESULTS Women with preexisting T2DM had greater all-cause (HR = 1.40; 95 %CI 1.21, 1.63), cancer-specific (HR = 1.24; 95 %CI 1.04, 1.47), and cardiovascular-specific (HR = 2.46; 95 %CI 1.54, 3.90) mortality hazard compared to nondiabetic women. In subgroup analyses, the association between T2DM and all-cause mortality was found among non-Hispanic White (HR 1.78 95 %CI 1.38, 2.30) and postmenopausal (HR = 1.47; 95 %CI 1.23, 1.77) women, but not among other race/ethnicity groups or premenopausal women. Additionally, compared to women prescribed metformin, all-cause mortality hazard was elevated among women prescribed sulfonylurea (HR = 1.44; 95 %CI 1.06, 1.94) or insulin (HR = 1.54; 95 %CI 1.12, 2.11). CONCLUSION Among Medicaid-insured women with breast cancer, those with preexisting T2DM have an increased mortality hazard, especially when prescribed sulfonylurea or insulin. Further research is warranted to determine the role antidiabetic drugs have on survival among women with breast cancer.
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Affiliation(s)
- Wayne R Lawrence
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, United States.
| | - Akiko S Hosler
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, United States
| | - Margaret Gates Kuliszewski
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, United States; Bureau of Cancer Epidemiology, New York State Department of Health, 150 Broadway, Suite 361, Albany, NY, United States
| | - Matthew C Leinung
- Division of Endocrinology and Metabolism, Department of Medicine, Albany Medical College, 25 Hackett Boulevard MC-141, Albany, NY, United States
| | - Xiuling Zhang
- Bureau of Cancer Epidemiology, New York State Department of Health, 150 Broadway, Suite 361, Albany, NY, United States
| | - Maria J Schymura
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, United States; Bureau of Cancer Epidemiology, New York State Department of Health, 150 Broadway, Suite 361, Albany, NY, United States
| | - Francis P Boscoe
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, United States; Bureau of Cancer Epidemiology, New York State Department of Health, 150 Broadway, Suite 361, Albany, NY, United States
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Weldegiorgis M, Smith M, Herrington WG, Bankhead C, Woodward M. Socioeconomic disadvantage and the risk of advanced chronic kidney disease: results from a cohort study with 1.4 million participants. Nephrol Dial Transplant 2019; 35:1562-1570. [DOI: 10.1093/ndt/gfz059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/27/2019] [Indexed: 12/11/2022] Open
Abstract
Abstract
Background
Several studies have investigated the effect of socioeconomic deprivation on cardiovascular disease (CVD) and diabetes; less is known about its effect on chronic kidney disease (CKD). We aimed to measure the association between deprivation, CKD Stages 4–5 and end-stage renal disease (ESRD) in a general population sample.
Methods
This observational study examined 1 405 016 participants from the English Clinical Practice Research Datalink (2000–14), linked to hospital discharge data and death certification. Deprivation was assessed according to the participant’s postcode. Cox models were used to estimate hazard ratios (HRs) for CKD Stages 4–5 and ESRD, adjusting for age and sex, and additionally for smoking status, body mass index, diabetes, systolic blood pressure, prior CVD and estimated glomerular filtration rate (eGFR) at baseline.
Results
During 7.5 years of median follow-up, 11 490 individuals developed CKD Stages 4–5 and 1068 initiated ESRD. After adjustment for age and sex, the HRs and confidence interval (CI) comparing those in the 20% most deprived of the population to the 20% least deprived were 1.76 (95% CI 1.68–1.84) and 1.82 (95% CI 1.56–2.12) for CKD Stages 4–5 and ESRD, respectively. Further adjustment for known risk factors and eGFR substantially attenuated these HRs. Adding our results to all known cohort studies produced a pooled relative risk of 1.61 (95% CI 1.42–1.83) for ESRD, for comparisons between highest to lowest categories of deprivation.
Conclusion
Socioeconomic deprivation is independently associated with an increased hazard of CKD Stages 4–5 and ESRD, but in large part may be mediated by known risk factors.
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Affiliation(s)
- Misghina Weldegiorgis
- The George Institute for Global Health, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia
| | - Margaret Smith
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Clare Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mark Woodward
- The George Institute for Global Health, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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Ojeda AS, Widener J, Aston CE, Philp RP. ESRD and ESRD-DM associated with lignite-containing aquifers in the U.S. Gulf Coast region of Arkansas, Louisiana, and Texas. Int J Hyg Environ Health 2018; 221:958-966. [PMID: 29886105 DOI: 10.1016/j.ijheh.2018.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/24/2018] [Accepted: 05/03/2018] [Indexed: 11/19/2022]
Abstract
Balkan endemic nephropathy (BEN) is an irreversible, lethal kidney disease that occurs in regions of the Balkans where residents drink untreated well water. A key factor contributing to the development of BEN may be consumption of dissolved organic matter leached from low-rank coal called lignite. This hypothesis-known as lignite-water hypothesis-was first posed for areas of the Balkans. It is possible that a BEN-like condition exists in the United States (US) Gulf Coast region in parts of the Mississippi Embayment and the Texas Coastal Uplands aquifers -Arkansas, Louisiana, and Texas, for instance-that rely heavily on groundwater from aquifers that contain lignite. This study utilizes a geographic information system (GIS) to map the distributions of end-stage renal disease (ESRD) in relation to water from lignite-containing aquifers in the tri-state region. Regional patterns emerged from geospatial analysis, suggesting that counties that relied on lignite-containing aquifers for their main water source had higher rates of ESRD in comparison to other populations in the region that rely on other water sources, including surface water and groundwater from aquifers not associated with lignite seams. Statewide rates of ESRD and diabetes associated ESRD (ESRD-DM) showed strong correlations to the percent of families at or below poverty level and the percentage of African Americans. These confounding factors somewhat mitigate the association seen between ESRD and lignite-containing regions at the state level. However, at the larger tri-state view, there is a significant (p = 0.002) increase in incidence rates where groundwater is connected to lignite-containing aquifers when considering both race and poverty. Additionally, no relationship was observed between the rate of public water supply withdrawal from lignite-bearing aquifers and rates of ESRD or ESRD-DM at the state or tri-state regions, supporting the observation that the risk associated with water from lignite-containing aquifers is limited to water from untreated domestic supply.
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Affiliation(s)
- Ann S Ojeda
- The University of Oklahoma, Department of Geology and Geophysics, Norman, OK, 73019, United States.
| | - Jeffrey Widener
- The University of Oklahoma, Department of Geography and Environmental Sustainability, Norman, OK, 73019, United States
| | - Christopher E Aston
- The University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, OK, 73104, United States
| | - R Paul Philp
- The University of Oklahoma, Department of Geology and Geophysics, Norman, OK, 73019, United States
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Forssas E, Arffman M, Manderbacka K, Keskimäki I, Ruuth I, Sund R. Multiple complications among people with diabetes from Finland: an 18-year follow-up in 1994-2011. BMJ Open Diabetes Res Care 2016; 4:e000254. [PMID: 27752327 PMCID: PMC5051332 DOI: 10.1136/bmjdrc-2016-000254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/25/2016] [Accepted: 09/16/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE In this study, we examined trends in severe diabetes-related complications (acute myocardial infarction, stroke, lower extremity amputation, and end-stage renal disease) and prevalence of multiple complications in a total population with diabetes in Finland during an 18-year period. RESEARCH DESIGN AND METHODS The total population with diabetes aged 30 years or older in 1994-2011 was obtained from several Finnish health registers. Only the first episode of each end point was included in the analysis. We examined trends in the prevalence of these end points using age-standardization and changes in these end points were analyzed using repeated-measures Poisson regression models. RESULTS The prevalence of single comorbidities decreased during the study period, especially for acute myocardial infarction and stroke. The age-adjusted and diabetes duration-adjusted risk of having one of these end points decreased throughout the study period among persons with type 2 diabetes. Among women, the risk ratio was 0.71 (0.63 to 0.79) in 2006-2011 compared to 1994-1999, and among men, the figure was 0.72 (0.66 to 0.78). In type 1 diabetes, the risk of multiple serious complications increased. We further found increased mortality risk among persons with any of these complications irrespective of diabetes type. CONCLUSIONS Our results concerning the development of risk of complications suggest improvements in the management of diabetes. More attention needs to be paid to the prevention of complications among older persons and those with longer history of diabetes to prevent clustering of complications and to prevent the diabetes epidemic in the population to reduce the public health burden of diabetes.
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Affiliation(s)
- Erja Forssas
- Service System Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Martti Arffman
- Service System Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Kristiina Manderbacka
- Service System Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Ilmo Keskimäki
- Service System Research Unit, National Institute for Health and Welfare, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Iiris Ruuth
- Service System Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Reijo Sund
- Centre for Research Methods, University of Helsinki, Helsinki, Finland
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Manderbacka K, Arffman M, Lumme S, Lehikoinen M, Winell K, Keskimäki I. Regional trends in avoidable hospitalisations due to complications among population with diabetes in Finland in 1996-2011: a register-based cohort study. BMJ Open 2016; 6:e011620. [PMID: 27550651 PMCID: PMC5013371 DOI: 10.1136/bmjopen-2016-011620] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/28/2016] [Accepted: 08/02/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Diabetes requires continuous medical care including prevention of acute complications and risk reduction for long-term complications. Diabetic complications impose a substantial burden on public health and care delivery. We examined trends in regional differences in hospitalisations due to diabetes-related complications among the total diabetes population in Finland. RESEARCH DESIGN A longitudinal register-based cohort study 1996-2011 among a total population with diabetes in Finland. PARTICIPANTS All persons with diabetes identified from several administrative registers in Finland in 1964-2011 and alive on 1 January 1996. OUTCOME MEASURES We examined hospitalisations due to diabetes-related short-term and long-term complications, uncomplicated diabetes, myocardial infarction, stroke, lower extremity amputation and end-stage renal disease (ESRD). We calculated annual age-adjusted rates per 10 000 person years and the systematic component of variation. Multilevel models were used for studying time trends in regional variation. RESULTS There was a steep decline in complication-related hospitalisation rates during the study period. The decline was relatively small in ESRD (30%), whereas rates of hospitalisations for short-term and long-term complications as well as uncomplicated diabetes diminished by about 80%. The overall correlation between hospital district intercepts and slopes in time was -0.72 (p<0.001) among men and -0.99 (p<0.001) among women indicating diminishing variation. Diminishing variation was found in each of the complications studied. The variation was mainly distributed at the health centre level. CONCLUSIONS Our study suggests that the prevention of complications among persons with diabetes has improved in Finland between 1996 and 2011. The results further suggest that the prevention of complications has become more uniform throughout the country.
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Affiliation(s)
- Kristiina Manderbacka
- Service System Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Martti Arffman
- Service System Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Sonja Lumme
- Service System Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Markku Lehikoinen
- Department of Social Services and Health Care, Health Centre of City of Helsinki, Helsinki, Finland
- Department of General Practice and Primary Health Care, Network of Academic Health Centres, University of Helsinki, Helsinki, Finland
| | - Klas Winell
- Conmedic, Espoo, Finland
- Health Monitoring Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Ilmo Keskimäki
- Service System Research Unit, National Institute for Health and Welfare, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
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Vart P, Gansevoort RT, Crews DC, Reijneveld SA, Bültmann U. Mediators of the association between low socioeconomic status and chronic kidney disease in the United States. Am J Epidemiol 2015; 181:385-96. [PMID: 25731886 DOI: 10.1093/aje/kwu316] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Using data collected from 9,823 participants in the 2007-2008 and 2009-2010 cycles of the National Health and Nutrition Examination Survey, we formally investigated potentially modifiable factors linking low socioeconomic status (SES) to chronic kidney disease (CKD) for their presence and magnitude of mediation. SES was defined using the poverty income ratio. The main outcome was CKD, defined as estimated glomerular filtration rate <60 mL/minute/1.73 m(2) (using the Chronic Kidney Disease Epidemiology Collaboration equation) and/or urinary albumin:creatinine ratio ≥30 mg/g. In mediation analyses, we tested the contributions of health-related behaviors (smoking, alcohol intake, diet, physical activity, and sedentary time), comorbid conditions (diabetes, hypertension, obesity, abdominal obesity, and hypercholesterolemia), and access to health care (health insurance and routine health-care visits) to this association. Except for sedentary time and diet, all examined health-related behaviors, comorbid conditions, and factors related to health-care access mediated the low SES-CKD association and contributed 20%, 32%, and 11%, respectively, to this association. In race/ethnicity-specific analyses, identified mediators tended to explain more of the association between low SES and CKD in non-Hispanic blacks than in other racial/ethnic groups. In conclusion, potentially modifiable factors like health-related behaviors, comorbid conditions, and health-care access contribute substantially to the association between low SES and CKD in the United States, especially among non-Hispanic blacks.
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Williams AW. Health policy, disparities, and the kidney. Adv Chronic Kidney Dis 2015; 22:54-9. [PMID: 25573513 DOI: 10.1053/j.ackd.2014.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 05/23/2014] [Accepted: 06/03/2014] [Indexed: 11/11/2022]
Abstract
Kidney care and public policy have been linked for 40 years, with various consequences to outcomes. The 1972 Social Security Amendment, Section 2991, expanded Medicare coverage for all modalities of dialysis and transplant services and non-kidney-related care to those with end-stage renal disease (ESRD) regardless of age. This first and only disease-specific entitlement program was a step toward decreasing disparities in access to care. Despite this, disparities in kidney disease outcomes continue as they are based on many factors. Over the last 4 decades, policies have been enacted to understand and improve the delivery of ESRD care. More recent policies include novel shared-risk payment models to ensure quality and decrease costs. This article discusses the impact or potential impact of selected policies on health disparities in advanced chronic kidney disease and ESRD. Although it is too early to know the consequences of newer policies (Affordable Care Act, ESRD Prospective Payment System, Quality Incentive Program, Accountable Care Organizations), their goal of improving access to timely patient-centered appropriate affordable and quality care should lessen the disparity gap. The Nephrology community must leverage this dynamic state of care-delivery model redesign to decrease kidney-related health disparities.
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Gatwood J, Bailey JE. Improving medication adherence in hypercholesterolemia: challenges and solutions. Vasc Health Risk Manag 2014; 10:615-25. [PMID: 25395859 PMCID: PMC4226449 DOI: 10.2147/vhrm.s56056] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Medication nonadherence is a prevalent public health issue that contributes to significant medical costs and detrimental health outcomes. This is especially true in patients with hypercholesterolemia, a condition affecting millions of American adults and one that is associated with increased risk for coronary and cerebrovascular events. Considering the magnitude of outcomes related to this disease, the medical community has placed significant emphasis on addressing the treatment for high cholesterol, and progress has been made in recent years. However, poor adherence to therapy continues to plague health outcomes and more must be understood and done to address suboptimal medication taking. Here we provide an overview of the reasons for poor medication adherence in patients with hypercholesterolemia and describe recent efforts to curb nonadherence. Suggested approaches for improving medication taking in patients with high cholesterol are also provided to guide practitioners, patients, and payers.
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Affiliation(s)
- Justin Gatwood
- University of Tennessee Health Science Center, College of Pharmacy, Center for Health System Improvement, Memphis, TN, USA
| | - James E Bailey
- University of Tennessee Health Science Center, Center for Health System Improvement, Memphis, TN, USA
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Assogba FGA, Couchoud C, Hannedouche T, Villar E, Frimat L, Fagot-Campagna A, Jacquelinet C, Stengel B. Trends in the epidemiology and care of diabetes mellitus-related end-stage renal disease in France, 2007-2011. Diabetologia 2014; 57:718-28. [PMID: 24496924 DOI: 10.1007/s00125-014-3160-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/13/2013] [Indexed: 01/13/2023]
Abstract
AIMS/HYPOTHESIS The aim was to study geographic variations and recent trends in the incidence of end-stage renal disease (ESRD) by diabetes status and type, and in patient condition and modalities of care at initiation of renal replacement therapy. METHODS Data from the French population-based dialysis and transplantation registry of all ESRD patients were used to study geographic variations in 5,857 patients without diabetes mellitus, 227 with type 1 diabetes mellitus, and 3,410 with type 2. Trends in incidence and patient care from 2007 to 2011 were estimated. RESULTS Age- and sex-adjusted incidence rates were higher in the overseas territories than in continental France for ESRD unrelated to diabetes and related to type 2 diabetes, but quite similar for type 1 diabetes-related ESRD. ESRD incidence decreased significantly over time for patients with type 1 diabetes (-10% annually) and not significantly for non-diabetic patients (0.2%), but increased significantly for patients with type 2 diabetes (+7% annually until 2009 and seemingly stabilised thereafter). In type 2 diabetes, the net change in the absolute number was +21%, of which +3% can be attributed to population ageing, +2% to population growth and +16% to the residual effect of the disease. Patients with type 2 diabetes more often started dialysis as an emergency (32%) than those with type 1 (20%) or no diabetes. CONCLUSIONS/INTERPRETATION The major impact of diabetes on ESRD incidence is due to type 2 diabetes mellitus. Our data demonstrate the need to reinforce strategies for optimal management of patients with diabetes to improve prevention, or delay the onset, of diabetic nephropathy, ESRD and cardiovascular comorbidities, and to reduce the rate of emergency dialysis.
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Affiliation(s)
- Frank G A Assogba
- The French REIN Registry, Biomedicine Agency, Saint Denis La Plaine, France,
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Abdul-Sattar AB, Abou El Magd S. Association of perceived neighborhood characteristics, socioeconomic status and rural residency with health outcomes in Egyptian patients with systemic lupus erythematosus: one center study. Int J Rheum Dis 2014; 20:2045-2052. [DOI: 10.1111/1756-185x.12331] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Amal B. Abdul-Sattar
- Department of Rheumatology and Rehabilitation; Zagazig University; Zagazig Egypt
| | - Sahar Abou El Magd
- Department of Community, Environmental and Occupational Medicine; Zagazig University; Zagazig Egypt
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Fatehi F, Martin-Khan M, Gray LC, Russell AW. Design of a randomized, non-inferiority trial to evaluate the reliability of videoconferencing for remote consultation of diabetes. BMC Med Inform Decis Mak 2014; 14:11. [PMID: 24528569 PMCID: PMC3925960 DOI: 10.1186/1472-6947-14-11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 02/07/2014] [Indexed: 11/26/2022] Open
Abstract
Background An estimated 366 million people are living with diabetes worldwide and it is predicted that its prevalence will increase to 552 million by 2030. Management of this disease and its complications is a challenge for many countries. Optimal glycaemic control is necessary to minimize complications, but less than 70% of diabetic patients achieve target levels of blood glucose, partly due to poor access to qualified health care providers. Telemedicine has the potential to improve access to health care, especially for rural and remote residents. Video teleconsultation, a real-time (or synchronous) mode of telemedicine, is gaining more popularity around the world through recent improvements in digital telecommunications. If video consultation is to be offered as an alternative to face-to-face consultation in diabetes assessment and management, then it is important to demonstrate that this can be achieved without loss of clinical fidelity. This paper describes the protocol of a randomised controlled trail for assessing the reliability of remote video consultation for people with diabetes. Methods/Design A total of 160 people with diabetes will be randomised into either a Telemedicine or a Reference group. Participants in the Reference group will receive two sequential face-to-face consultations whereas in the Telemedicine group one consultation will be conducted face-to-face and the other via videoconference. The primary outcome measure will be a change in the patient’s medication. Secondary outcome measures will be findings in physical examination, detecting complications, and patient satisfaction. A difference of less than 20% in the aggregated level of agreement between the two study groups will be used to identify if videoconference is non-inferior to traditional mode of clinical care (face-to-face). Discussion Despite rapid growth in application of telemedicine in a variety of medical specialities, little is known about the reliability of videoconferencing for remote consultation of people with diabetes. Results of this proposed study will provide evidence of the reliability of specialist consultation offered by videoconference for people with diabetes. Trial registration number Australian New Zealand Clinical Trials Registry ACTRN12612000315819.
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Affiliation(s)
- Farhad Fatehi
- Centre for Online Health, The University of Queensland, Brisbane, Australia.
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14
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Pons-Estel GJ, Saurit V, Alarcón GS, Hachuel L, Boggio G, Wojdyla D, Alfaro-Lozano JL, de la Torre IG, Massardo L, Esteva-Spinetti MH, Guibert-Toledano M, Gómez LAR, Costallat LTL, Del Pozo MJS, Silveira LH, Cavalcanti F, Pons-Estel BA. The impact of rural residency on the expression and outcome of systemic lupus erythematosus: data from a multiethnic Latin American cohort. Lupus 2012; 21:1397-404. [PMID: 22941567 DOI: 10.1177/0961203312458465] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this paper is to examine the role of place of residency in the expression and outcomes of systemic lupus erythematosus (SLE) in a multi-ethnic Latin American cohort. PATIENTS AND METHODS SLE patients (< two years of diagnosis) from 34 centers constitute this cohort. Residency was dichotomized into rural and urban, cut-off: 10,000 inhabitants. Socio-demographic, clinical/laboratory and mortality rates were compared between them using descriptive tests. The influence of place of residency on disease activity at diagnosis and renal disease was examined by multivariable regression analyses. RESULTS Of 1426 patients, 122 (8.6%) were rural residents. Their median ages (onset, diagnosis) were 23.5 and 25.5 years; 85 (69.7%) patients were Mestizos, 28 (22.9%) Caucasians and 9 (7.4%) were African-Latin Americans. Rural residents were more frequently younger at diagnosis, Mestizo and uninsured; they also had fewer years of education and lower socioeconomic status, exhibited hypertension and renal disease more frequently, and had higher levels of disease activity at diagnosis; they used methotrexate, cyclophosphamide pulses and hemodialysis more frequently than urban patients. Disease activity over time, renal damage, overall damage and the proportion of deceased patients were comparable in rural and urban patients. In multivariable analyses, rural residency was associated with high levels of disease activity at diagnosis (OR 1.65, 95% CI 1.06-2.57) and renal disease occurrence (OR 1.77, 95% CI 1.00-3.11). CONCLUSIONS Rural residency associates with Mestizo ethnicity, lower socioeconomic status and renal disease occurrence. It also plays a role in disease activity at diagnosis and kidney involvement but not on the other end-points examined.
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Affiliation(s)
- G J Pons-Estel
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Spain.
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15
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Grace BS, Clayton P, Cass A, McDonald SP. Socio-economic status and incidence of renal replacement therapy: a registry study of Australian patients. Nephrol Dial Transplant 2012; 27:4173-80. [DOI: 10.1093/ndt/gfs361] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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16
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Otiniano M, Wood RC. Exploring the importance of identifying geographic variation to improve diabetes treatment. J Diabetes Complications 2012; 26:255-6. [PMID: 22673567 DOI: 10.1016/j.jdiacomp.2012.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Patzer RE, McClellan WM. Influence of race, ethnicity and socioeconomic status on kidney disease. Nat Rev Nephrol 2012; 8:533-41. [PMID: 22735764 DOI: 10.1038/nrneph.2012.117] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Low socioeconomic status (SES) influences disease incidence and contributes to poor health outcomes throughout an individual's life course across a wide range of populations. Low SES is associated with increased incidence of chronic kidney disease, progression to end-stage renal disease, inadequate dialysis treatment, reduced access to kidney transplantation, and poor health outcomes. Similarly, racial and ethnic disparities, which in the USA are strongly associated with lower SES, are independently associated with poor health outcomes. In this Review, we discuss individual-level and group-level SES factors, and the concomitant role of race and ethnicity that are associated with and mediate the development of chronic kidney disease, progression to end-stage renal disease and access to treatment.
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Affiliation(s)
- Rachel E Patzer
- Emory University School of Medicine, Department of Surgery, Emory Transplant Center, 101 Woodruff Circle, 5125 WMB, Atlanta, GA 30322, USA
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18
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Agrawal V, Jaar BG, Frisby XY, Chen SC, Qiu Y, Li S, Whaley-Connell AT, McCullough PA, Bomback AS. Access to health care among adults evaluated for CKD: findings from the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 2012; 59:S5-15. [PMID: 22339901 DOI: 10.1053/j.ajkd.2011.10.043] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 10/07/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Data are scant regarding access to health care in patients with chronic kidney disease (CKD). We performed descriptive analyses using data from the National Kidney Foundation's Kidney Early Evaluation Program (KEEP), a nationwide health screening program for adults at high risk of CKD. METHODS From 2000-2010, a total of 122,502 adults without end-stage renal disease completed KEEP screenings; 27,927 (22.8%) met criteria for CKD (10,082, stages 1-2; 16,684, stage 3; and 1,161, stages 4-5). CKD awareness, self-rated health status, frequency of physician visits, difficulty obtaining medical care, types of caregivers, insurance status, and medication coverage and estimated costs were assessed. RESULTS Participants with CKD were more likely to report fair/poor health status than those without CKD. Health care utilization increased at later CKD stages; ~95% of participants at stages 3-5 had visited a physician during the preceding year compared with 83.7% of participants without CKD. More Hispanic and African American than white participants at all CKD stages reported not having a physician. Approximately 40% of participants younger than 65 years reported fair/poor health status at stages 4-5 compared with ~30% who were 65 years and older. Younger participants at all stages were more likely to report extreme or somewhat/moderate difficulty obtaining medical care. Comorbid conditions (diabetes, hypertension, and prior cardiovascular events) were associated with increased utilization of care. Utilization of nephrology care was poor at all CKD stages; <6% of participants at stage 3 and <30% at stages 4-5 reported ever seeing a nephrologist. CONCLUSIONS Lack of health insurance and perceived difficulty obtaining medical care with lower health care utilization, both of which are consistent with inadequate access to health care, are more likely for KEEP participants who are younger than 65 years, nonwhite, and without previously diagnosed comorbid conditions. Nephrology care is infrequent in elderly participants with advanced CKD who are nonwhite, have comorbid disease, and have high-risk states for cardiovascular disease.
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Affiliation(s)
- Varun Agrawal
- Division of Nephrology and Hypertension, Fletcher Allen Health Care, Burlington, VT 05401, USA.
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Shah A, Fried LF, Chen SC, Qiu Y, Li S, Cavanaugh KL, Norris KC, Whaley-Connell AT, McCullough PA, Mehrotra R. Associations between access to care and awareness of CKD. Am J Kidney Dis 2012; 59:S16-23. [PMID: 22339898 PMCID: PMC3644220 DOI: 10.1053/j.ajkd.2011.10.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 10/22/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Most individuals with chronic kidney disease (CKD) in the United States are unaware of their condition, creating challenges in implementing early interventions to delay disease progression. Whether characteristics expected to enhance health care access are associated with greater CKD awareness has not been studied adequately. METHOD Data from volunteer participants in the National Kidney Foundation's Kidney Early Evaluation Program (KEEP), 2000-2010, with presumed CKD (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m(2) or albumin-creatinine ratio >30 mg/g) were analyzed. Given that the diagnosis of CKD was based on a single measurement of kidney function, the diagnosis is presumed, but not confirmed. Associations of CKD awareness with measures of access to care (health insurance coverage, type of health insurance, prescription drug coverage, and self-reported level of difficulty obtaining care) were examined using logistic regression. RESULTS Of 29,144 participants with CKD, 6,751 (23%) reported CKD awareness. No significant association was found between availability of health insurance or prescription drug coverage and CKD awareness; results did not vary by diabetic status or in analyses restricted to participants with eGFR <60 mL/min/1.73 m(2). Participants reporting extreme or some difficulty obtaining medical care were more likely than those reporting no difficulty to be aware of CKD (adjusted OR, 1.25; 95% CI, 1.05-1.50). CONCLUSIONS Most KEEP participants with CKD are unaware of the condition, results that are not modified by the availability of health insurance or prescription drug coverage. The mechanisms underlying the association of perceived difficulty in access to care with greater CKD awareness require further study.
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Affiliation(s)
- Anuja Shah
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA
| | | | - Shu-Cheng Chen
- Chronic Kidney Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Yang Qiu
- Chronic Kidney Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Suying Li
- Chronic Kidney Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN
| | | | - Keith C. Norris
- Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Adam T. Whaley-Connell
- Harry S Truman VA Medical Center and the Department of Internal Medicine, Division of Nephrology and Hypertension, University of Missouri-Columbia School of Medicine, Columbia, MO
| | - Peter A. McCullough
- St. John Providence Health System, Providence Park Heart Institute, Novi, MI
| | - Rajnish Mehrotra
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA
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Whaley-Connell AT, Vassalotti JA, Collins AJ, Chen SC, McCullough PA. National Kidney Foundation's Kidney Early Evaluation Program (KEEP) annual data report 2011: executive summary. Am J Kidney Dis 2012; 59:S1-4. [PMID: 22339897 PMCID: PMC3285421 DOI: 10.1053/j.ajkd.2011.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 11/16/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Adam T Whaley-Connell
- Harry S Truman VA Medical Center and the Department of Internal Medicine, Division of Nephrology and Hypertension, University of Missouri-Columbia School of Medicine, Columbia, MO 65212, USA.
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21
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Hossain MP, Palmer D, Goyder E, El Nahas AM. Association of deprivation with worse outcomes in chronic kidney disease: findings from a hospital-based cohort in the United Kingdom. Nephron Clin Pract 2012; 120:c59-70. [PMID: 22269817 DOI: 10.1159/000334998] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 11/09/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) prevalence and complications are known to be associated with deprivation, but there is limited understanding of the underlying reasons for inequalities. AIMS To evaluate the association of both individual and area level socioeconomic status (SES) with heavy proteinuria at presentation, progression of CKD, end-stage renal disease (ESRD) and death. METHODS A retrospective study of 918 CKD patients using integral multivariate logistic regression to adjust for known clinical and demographic explanatory variables. RESULTS During 3 years of median follow-up, 34% of the study population had progression of their CKD and of these, 32% experienced rapid progression. 23% presented with heavy proteinuria (urine protein:creatinine ratio ≥300 mg/mmol), 4% developed ESRD requiring renal replacement therapy and 10% died. Area level deprivation was independently associated with heavy proteinuria, progression and rapid progression of CKD. People living in the most deprived areas were more likely to develop ESRD. Unskilled professionals were more likely to experience a higher mortality rate. CONCLUSION Area level SES is inversely associated with both heavy proteinuria on presentation and progression as well as rapid progression of CKD. In contrast, individual level SES, unskilled professionals found to have a marginally significant association with increased risk of mortality. People living in more deprived areas presenting with CKD are likely to be at increased risk of poor outcomes and may need more active management and earlier referral.
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Affiliation(s)
- M P Hossain
- Sheffield Kidney Institute, University of Sheffield, Sheffield, UK
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22
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Margolis DJ, Hoffstad O, Nafash J, Leonard CE, Freeman CP, Hennessy S, Wiebe DJ. Location, location, location: geographic clustering of lower-extremity amputation among Medicare beneficiaries with diabetes. Diabetes Care 2011; 34:2363-7. [PMID: 21933906 PMCID: PMC3198303 DOI: 10.2337/dc11-0807] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Lower-extremity amputation (LEA) is common among persons with diabetes. The goal of this study was to identify geographic variation and the influence of location on the incidence of LEA among U.S. Medicare beneficiaries with diabetes. RESEARCH DESIGN AND METHODS We conducted a cohort study of beneficiaries of Medicare. The geographic unit of analysis was hospital referral regions (HRRs). Tests of spatial autocorrelation and geographically weighted regression were used to evaluate the incidence of LEA by HRRs as a function of geographic location in the U.S. Evaluated covariates covered sociodemographic factors, risk factors for LEA, diabetes severity, provider access, and cost of care. RESULTS Among persons with diabetes, the annual incidence per 1,000 of LEA was 5.0 in 2006, 4.6 in 2007, and 4.5 in 2008 and varied by the HRR. The incidence of LEA was highly concentrated in neighboring HRRs. High rates of LEA clustered in contiguous portions of Texas, Oklahoma, Louisiana, Arkansas, and Mississippi. Accounting for geographic location greatly improved our ability to understand the variability in LEA. Additionally, covariates associated with LEA per HRR included socioeconomic status, prevalence of African Americans, age, diabetes, and mortality rate associated with having a foot ulcer. CONCLUSIONS There is profound "region-correlated" variation in the rate of LEA among Medicare beneficiaries with diabetes. In other words, location matters and whereas the likelihood of an amputation varies dramatically across the U.S. overall, neighboring locations have unexpectedly similar amputation rates, some being uniformly high and others uniformly low.
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Affiliation(s)
- David J Margolis
- Department of Biostatistics and Epidemiology and the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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23
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Böger CA, Gorski M, Li M, Hoffmann MM, Huang C, Yang Q, Teumer A, Krane V, O'Seaghdha CM, Kutalik Z, Wichmann HE, Haak T, Boes E, Coassin S, Coresh J, Kollerits B, Haun M, Paulweber B, Köttgen A, Li G, Shlipak MG, Powe N, Hwang SJ, Dehghan A, Rivadeneira F, Uitterlinden A, Hofman A, Beckmann JS, Krämer BK, Witteman J, Bochud M, Siscovick D, Rettig R, Kronenberg F, Wanner C, Thadhani RI, Heid IM, Fox CS, Kao WH. Association of eGFR-Related Loci Identified by GWAS with Incident CKD and ESRD. PLoS Genet 2011; 7:e1002292. [PMID: 21980298 PMCID: PMC3183079 DOI: 10.1371/journal.pgen.1002292] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 07/22/2011] [Indexed: 01/23/2023] Open
Abstract
Family studies suggest a genetic component to the etiology of chronic kidney disease (CKD) and end stage renal disease (ESRD). Previously, we identified 16 loci for eGFR in genome-wide association studies, but the associations of these single nucleotide polymorphisms (SNPs) for incident CKD or ESRD are unknown. We thus investigated the association of these loci with incident CKD in 26,308 individuals of European ancestry free of CKD at baseline drawn from eight population-based cohorts followed for a median of 7.2 years (including 2,122 incident CKD cases defined as eGFR <60ml/min/1.73m2 at follow-up) and with ESRD in four case-control studies in subjects of European ancestry (3,775 cases, 4,577 controls). SNPs at 11 of the 16 loci (UMOD, PRKAG2, ANXA9, DAB2, SHROOM3, DACH1, STC1, SLC34A1, ALMS1/NAT8, UBE2Q2, and GCKR) were associated with incident CKD; p-values ranged from p = 4.1e-9 in UMOD to p = 0.03 in GCKR. After adjusting for baseline eGFR, six of these loci remained significantly associated with incident CKD (UMOD, PRKAG2, ANXA9, DAB2, DACH1, and STC1). SNPs in UMOD (OR = 0.92, p = 0.04) and GCKR (OR = 0.93, p = 0.03) were nominally associated with ESRD. In summary, the majority of eGFR-related loci are either associated or show a strong trend towards association with incident CKD, but have modest associations with ESRD in individuals of European descent. Additional work is required to characterize the association of genetic determinants of CKD and ESRD at different stages of disease progression. Chronic kidney disease (CKD) affects about 6%–11% of the general population, and progression to end stage renal disease (ESRD) has a significant public health impact. Family studies suggest that the risk for CKD and ESRD is heritable. Unraveling the genetic underpinning of risk for these diseases may lead to the identification of novel mechanisms and thus diagnostic and therapeutic tools. We have previously identified 16 genetic markers in association with kidney function and prevalent CKD in general population studies. However, little is known about the relevance of these SNPs to the initial development of CKD or to ESRD risk. Therefore, we have now analyzed the association of these markers with the initiation of CKD in more than 26,000 individuals from the general population using serial estimations of kidney function, and with ESRD in four case-control studies in subjects of European ancestry (3,775 cases, 4,577 controls). We show that many of the 16 markers are also associated or show a strong trend towards association with initiation of CKD, while only 2 markers are nominally associated with ESRD. Further work is required to characterize the association of genetic determinants of different stages of CKD progression.
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Affiliation(s)
- Carsten A. Böger
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Mathias Gorski
- Department of Epidemiology and Preventive Medicine, University Hospital Regensburg, Regensburg, Germany
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Man Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Michael M. Hoffmann
- Clinical Chemistry, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Chunmei Huang
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Qiong Yang
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Alexander Teumer
- Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
| | - Vera Krane
- University of Würzburg, Department of Medicine 1, Division of Nephrology, University Hospital Würzburg, Würzburg, Germany
| | - Conall M. O'Seaghdha
- Division of Nephrology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- NHLBI's Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts, United States of America
| | - Zoltán Kutalik
- Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - H.-Erich Wichmann
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
- Klinikum Großhadern, Munich, Germany
| | - Thomas Haak
- Diabetes Klinik Bad Mergentheim, Bad Mergentheim, Germany
| | - Eva Boes
- Innsbruck Medical University, Division of Genetic Epidemiology, Innsbruck, Austria
| | - Stefan Coassin
- Innsbruck Medical University, Division of Genetic Epidemiology, Innsbruck, Austria
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Barbara Kollerits
- Innsbruck Medical University, Division of Genetic Epidemiology, Innsbruck, Austria
| | - Margot Haun
- Innsbruck Medical University, Division of Genetic Epidemiology, Innsbruck, Austria
| | - Bernhard Paulweber
- First Department of Internal Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Anna Köttgen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Renal Division, University Hospital of Freiburg, Freiburg, Germany
| | - Guo Li
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Michael G. Shlipak
- Division of General Internal Medicine, San Francisco VA Medical Center, San Francisco, California, United States of America
- Department of Medicine, Epidemiology, and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Neil Powe
- Department of Medicine, San Francisco General Hospital and University of California San Francisco, San Francisco, California, United States of America
| | - Shih-Jen Hwang
- NHLBI's Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts, United States of America
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Member of Netherlands Consortium for Healthy Aging (NCHA), Netherlands Genomics Initiative (NGI), Leiden, The Netherlands
| | - Fernando Rivadeneira
- Member of Netherlands Consortium for Healthy Aging (NCHA), Netherlands Genomics Initiative (NGI), Leiden, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - André Uitterlinden
- Member of Netherlands Consortium for Healthy Aging (NCHA), Netherlands Genomics Initiative (NGI), Leiden, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Member of Netherlands Consortium for Healthy Aging (NCHA), Netherlands Genomics Initiative (NGI), Leiden, The Netherlands
| | - Jacques S. Beckmann
- Service of Medical Genetics, Centre Hospitalier Universitaire Vaudois and Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland
| | - Bernhard K. Krämer
- University Medical Centre Mannheim, 5th Department of Medicine, Mannheim, Germany
| | - Jacqueline Witteman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Member of Netherlands Consortium for Healthy Aging (NCHA), Netherlands Genomics Initiative (NGI), Leiden, The Netherlands
| | - Murielle Bochud
- University Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - David Siscovick
- Cardiovascular Health Research Unit, Departments of Epidemiology and Medicine, University of Washington, Seattle, Washington, United States of America
| | - Rainer Rettig
- Institute of Physiology, University of Greifswald, Greifswald, Germany
| | - Florian Kronenberg
- Innsbruck Medical University, Division of Genetic Epidemiology, Innsbruck, Austria
| | - Christoph Wanner
- University of Würzburg, Department of Medicine 1, Division of Nephrology, University Hospital Würzburg, Würzburg, Germany
| | - Ravi I. Thadhani
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Iris M. Heid
- Department of Epidemiology and Preventive Medicine, University Hospital Regensburg, Regensburg, Germany
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Caroline S. Fox
- NHLBI's Framingham Heart Study and the Center for Population Studies, Framingham, Massachusetts, United States of America
- Division of Endocrinology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail: (CSF); (WHK)
| | - W. H. Kao
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail: (CSF); (WHK)
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Toobert DJ, Strycker LA, Barrera M, Osuna D, King DK, Glasgow RE. Outcomes from a multiple risk factor diabetes self-management trial for Latinas: ¡Viva Bien! Ann Behav Med 2011; 41:310-23. [PMID: 21213091 DOI: 10.1007/s12160-010-9256-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Culturally appropriate interventions are needed to assist Latinas in making multiple healthful lifestyle changes. PURPOSE The purpose of this study was to test a cultural adaptation of a successful multiple health behavior change program, ¡Viva Bien! METHODS Random assignment of 280 Latinas with type 2 diabetes to usual care only or to usual care + ¡Viva Bien!, which included group meetings for building skills to promote the Mediterranean diet, physical activity, stress management, supportive resources, and smoking cessation. RESULTS ¡Viva Bien! participants compared to usual care significantly improved psychosocial and behavioral outcomes (fat intake, stress management practice, physical activity, and social-environmental support) at 6 months, and some improvements were maintained at 12 months. Biological improvements included hemoglobin A1c and heart disease risk factors. CONCLUSIONS The ¡Viva Bien! multiple lifestyle behavior program was effective in improving psychosocial, behavioral, and biological/quality of life outcomes related to heart health for Latinas with type 2 diabetes.
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Toobert DJ, Strycker LA, King DK, Barrera M, Osuna D, Glasgow RE. Long-term outcomes from a multiple-risk-factor diabetes trial for Latinas: ¡Viva Bien! Transl Behav Med 2011; 1:416-426. [PMID: 22022345 PMCID: PMC3196590 DOI: 10.1007/s13142-010-0011-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Latinas with type 2 diabetes are in need of culturally sensitive interventions to make recommended longterm lifestyle changes and reduce heart disease risk. To test the longer-term (24-month) effects of a previously successful, culturally adapted, multiple-healthbehavior- change program, ¡Viva Bien!, 280 Latinas were randomly assigned to usual care or ¡Viva Bien!. Treatment included group meetings to promote a culturally adapted Mediterranean diet, physical activity, supportive resources, problem solving, stress-management practices, and smoking cessation. ¡Viva Bien! participants achieved and maintained some lifestyle improvements from baseline through 24 months, including significant improvements for psychosocial outcomes, fat intake, social-environmental support, body mass index, and hemoglobin A1c. Effects tended to diminish over time. The ¡Viva Bien! multiple-behavior program was effective in improving and maintaining some psychosocial, behavioral, and biological outcomes related to heart health across 24 months for Latinas with type 2 diabetes, a high-risk, underserved population (ClinicalTrials.gov number, NCT00233259).
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Affiliation(s)
- Deborah J Toobert
- />Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403-1983 USA
| | - Lisa A Strycker
- />Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403-1983 USA
| | - Diane K King
- />Institute for Health Research Address Kaiser Permanente Colorado, P.O. Box 378066, Denver, CO 80237-8066 USA
| | - Manuel Barrera
- />Psychology Department, Arizona State University, Box 871104, Tempe, AZ 85287-1104 USA
| | - Diego Osuna
- />University of Colorado Health Sciences Center, Institute for Health Research, Kaiser Permanente Colorado, P.O. Box 378066, Denver, CO 80237-8066 USA
| | - Russell E Glasgow
- />Dissemination and Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd., Room 6144, Rockville, MD 20852 USA
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Wolf G, Busch M, Müller N, Müller UA. Association between socioeconomic status and renal function in a population of German patients with diabetic nephropathy treated at a tertiary centre. Nephrol Dial Transplant 2011; 26:4017-23. [PMID: 21493815 DOI: 10.1093/ndt/gfr185] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Diabetic nephropathy is the most common disease leading to end-stage renal disease (ESRD) in many countries including Germany. Some previous studies, mainly from the US, suggest that low socioeconomic status (SES) may increase the risk of ESRD. No data are available whether the SES influences the development of diabetic nephropathy in patients with diabetes mellitus in Germany. METHODS This cross-sectional study was performed on patients treated at a large university outpatient department for endocrinology and metabolic diseases. A total of 174 patients with type 1 and 651 patients with type 2 diabetes and chronic preterminal diabetic nephropathy were studied [mainly chronic kidney disease (CKD) Stages 2 and 3]. Only very few CKD Stage 5 patients were included. Patients with acute kidney injury or abnormal urinary sediment were excluded. Patients were asked about their social status using a questionnaire. Social status was determined by three components: education, highest professional position achieved and household net income. Each component was assessed by a score with 1 to 7 points to generate a total score with a minimum of 3 up to maximum of 21 points. Smoking habits were also assessed by questionnaire. HbA1c, systolic and diastolic blood pressure and body mass index from the last observation were recorded. Estimated glomerular filtration rate (eGFR) was calculated according to the modified equation 7 MDRD formula. Patients were grouped into the CKD stages according to eGFR and presence of albuminuria. Multivariate analysis was used for data analysis. RESULTS Patients were grouped in tertiles according to their social status (Tertile 1: 307, Tertile 2: 269, Tertile 3: 269 patients). The majority of type 1 (50.9%) and type 2 (64.9%) patients were in CKD Stages 2 and 3. Multivariate analysis revealed that SES is an independent predictor of renal function in all patients as well as in type 2 diabetic patients with diabetic nephropathy. This relationship was independent of smoking behaviour, duration of diabetes and HbA1c values. There was no association between renal function and SES in type 1 diabetic patients, but a type 2 error caused by low patient number cannot be excluded. Furthermore, no significant association between SES and albuminuria (defined ≥20 mg/L) existed. There was no significant difference in the number of visits to the clinic in regard to SES excluding referral bias. CONCLUSIONS A lower SES was associated with the presence of diabetic nephropathy in patients with type 2 diabetes in a German population. The causes for this association are likely multiple.
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Affiliation(s)
- Gunter Wolf
- Department of Internal Medicine III, University of Jena, Jena, Germany.
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Young BA. The interaction of race, poverty, and CKD. Am J Kidney Dis 2010; 55:977-80. [PMID: 20497834 PMCID: PMC3465978 DOI: 10.1053/j.ajkd.2010.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 04/13/2010] [Indexed: 11/11/2022]
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JOLLY MEENAKSHI, MIKOLAITIS RACHELA, SHAKOOR NAJIA, FOGG LOUISF, BLOCK JOELA. Education, Zip Code-based Annualized Household Income, and Health Outcomes in Patients with Systemic Lupus Erythematosus. J Rheumatol 2010; 37:1150-7. [DOI: 10.3899/jrheum.090862] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective.To determine the association of socioeconomic status [SES; education and zip code-based annual household income (Z-AHI)] and ethnicity with health-related quality of life (HRQOL) among patients with systemic lupus erythematosus (SLE).Methods.Data on 211 subjects from a cross-sectional study (LupusPRO©) using the Medical Outcomes Study Short Form-36 questionnaire to evaluate physical health scores (PCS) and mental health scores were used to obtain education and zip code. The 2000 US Census was used to obtain each zip code’s median annual household income.Results.Education and Z-AHI correlated with PCS (education standardized β = 0.17, 95% CI 0.47, 3.65, p = 0.01, r2 = 0.03; Z-AHI standardized β = 0.15, 95% CI 0.57, 8.30, p = 0.02, r2 = 0.02) on regression analysis. Z-AHI was linked to PCS, independent of education. Ethnicity was associated with PCS through disease activity and SES.Conclusion.SES is associated with HRQOL in SLE. Z-AHI and education are equally predictive surrogates of SES; however, Z-AHI, independent of education, was predictive of HRQOL. Z-AHI has less subject bias and is easily obtainable, therefore its use for future HRQOL studies is suggested.
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Cisternas MG, Yelin E, Katz JN, Solomon DH, Wright EA, Losina E. Ambulatory visit utilization in a national, population-based sample of adults with osteoarthritis. ARTHRITIS AND RHEUMATISM 2009; 61:1694-703. [PMID: 19950315 PMCID: PMC2836231 DOI: 10.1002/art.24897] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To estimate the proportion of adults with osteoarthritis (OA) seeing various medical providers and ascertain factors affecting the likelihood of a patient seeing an OA specialist. METHODS We used data from the Medical Expenditures Panel Survey, a stratified random sample of the noninstitutionalized civilian population. We classified adults as having symptomatic OA if their medical conditions included at least 1 occurrence of the International Classification of Diseases, Ninth Revision Clinical Modification, codes 715, 716, or 719, and if they reported joint pain, swelling, or stiffness during the previous 12 months. For the purpose of our analysis, we defined rheumatologists, orthopedists, and physical therapists as OA specialists. We first estimated the proportion of OA individuals seen by OA specialists and other health care providers in a 1-year period. We then used logistic regression to estimate the impact of demographic and clinical factors on the likelihood of an individual seeing an OA specialist. RESULTS A total of 9,933 persons met the definition of OA, representing 22.5 million adults in the US. Of these persons, 92% see physicians during the year, 34% see at least 1 OA specialist, 25% see an orthopedist, 11% see a physical therapist, and 6% see a rheumatologist. Higher educational attainment, having more comorbidities, and residing in the northeastern US are significant positive predictors for a patient seeing an OA specialist. Significant negative predictors for seeing an OA specialist are being unmarried but previously married and having no health insurance. CONCLUSION Most adults with OA do not visit OA specialists. Those without insurance and with lower levels of education are less likely to see these specialists.
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