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Trupin L, Schmajuk G, Ying D, Yelin E, Blanc PD. Response. Chest 2022; 162:e288. [PMID: 36344146 DOI: 10.1016/j.chest.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Laura Trupin
- Departments of Medicine at the University of California San Francisco, San Francisco, CA
| | - Gabriela Schmajuk
- Departments of Medicine at the University of California San Francisco, San Francisco, CA; Departments of Medicine San Francisco Veterans Administration Health Care System, San Francisco, CA
| | - David Ying
- Departments of Medicine James A. Haley Veterans' Hospital, Tampa, FL
| | - Edward Yelin
- Departments of Medicine at the University of California San Francisco, San Francisco, CA
| | - Paul D Blanc
- Departments of Medicine at the University of California San Francisco, San Francisco, CA; Departments of Medicine San Francisco Veterans Administration Health Care System, San Francisco, CA.
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Trupin L, Schmajuk G, Ying D, Yelin E, Blanc PD. Military Service and COPD Risk. Chest 2022; 162:792-795. [PMID: 35469853 DOI: 10.1016/j.chest.2022.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- Laura Trupin
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA
| | - Gabriela Schmajuk
- San Francisco Veterans Affairs Health Care System, San Francisco, CA
| | | | - Edward Yelin
- Division of Rheumatology, Department of Medicine, Russell/Engleman Rheumatology Research Center, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | - Paul D Blanc
- San Francisco Veterans Affairs Health Care System, San Francisco, CA; Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA.
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Katz P, Yelin E. Reviewers. ACR Open Rheumatol 2021. [DOI: 10.1002/acr2.11396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Katz P, Pedro S, Trupin L, Yelin E, Michaud K. The Impact of Asthma and Chronic Obstructive Pulmonary Disease (COPD) on Patient-Reported Outcomes in Systemic Lupus Erythematosus (SLE). ACR Open Rheumatol 2021; 3:221-230. [PMID: 33609085 PMCID: PMC8063140 DOI: 10.1002/acr2.11212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022] Open
Abstract
Background Risk of asthma and chronic obstructive pulmonary disease (COPD) may be elevated in systemic lupus erythematosus (SLE), but little research has studied the impact of these conditions on SLE outcomes. We examined prevalence, incidence, and impact of self‐reported asthma and COPD in two US‐based SLE cohorts (FORWARD and Lupus Outcomes Study [LOS]). Methods Prevalence of asthma and COPD were defined as presence of conditions at individuals’ first interviews; incidence was defined as new reports over the next 3 years. Cross‐sectional associations of asthma/COPD with patient‐reported outcomes (PROs) and longitudinal analyses associations with asthma/COPD at entry with PROs 3 years later were examined. Results In FORWARD, 19.8% and 8.3% participants reported asthma and COPD, respectively, at entry. In LOS, 36.0% reported the presence of either (US population comparisons: asthma, 9.7%; COPD, 6.1%). Cross‐sectionally, asthma/COPD was associated with worse PROs, including disease activity. In FORWARD, individuals with asthma experienced greater worsening of fatigue, pain, and global health ratings longitudinally; individuals with COPD experienced greater increases in self‐reported SLE activity. However, no such patterns were noted in the LOS. Conclusion Asthma and COPD appeared to be more common in SLE than in the general US population and were associated with worse status on PROs cross‐sectionally. Asthma was linked to decrements in PROs longitudinally.
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Affiliation(s)
- Patricia Katz
- University of California San Francisco, San Francisco, California
| | - Sofia Pedro
- FORWARD, the National Databank for Rheumatic Diseases, Wichita, Kansas
| | - Laura Trupin
- University of California San Francisco, San Francisco, California
| | - Edward Yelin
- University of California San Francisco, San Francisco, California
| | - Kaleb Michaud
- FORWARD, the National Databank for Rheumatic Diseases, Wichita, Kansas.,University of Nebraska Medical Center, Omaha, Nebraska
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Sullivan JK, Huizinga J, Edwards RR, Hunter DJ, Neogi T, Yelin E, Katz JN, Losina E. Cost-effectiveness of duloxetine for knee OA subjects: the role of pain severity. Osteoarthritis Cartilage 2021; 29:28-38. [PMID: 33171315 PMCID: PMC7814698 DOI: 10.1016/j.joca.2020.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/28/2020] [Accepted: 10/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Establish the impact of pain severity on the cost-effectiveness of generic duloxetine for knee osteoarthritis (OA) in the United States. DESIGN We used a validated computer simulation of knee OA to compare usual care (UC) - intra-articular injections, opioids, and total knee replacement (TKR) - to UC preceded by duloxetine in those no longer achieving pain relief from non-steroidal anti-inflammatory drugs (NSAIDs). Outcomes included quality-adjusted life years (QALYs), lifetime medical costs, and incremental cost-effectiveness ratios (ICERs). We considered cohorts with mean ages 57-75 years and Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain 25-55 (0-100, 100-worst). We derived inputs from published data. We discounted costs and benefits 3% annually. We conducted sensitivity analyses of duloxetine efficacy, duration of pain relief, toxicity, and costs. RESULTS Among younger subjects with severe pain (WOMAC pain = 55), duloxetine led to an additional 9.6 QALYs per 1,000 subjects (ICER = $88,500/QALY). The likelihood of duloxetine being cost-effective at willingness-to-pay (WTP) thresholds of $50,000/QALY and $100,000/QALY was 40% and 54%. Offering duloxetine to older patients with severe pain led to ICERs >$150,000/QALY. Offering duloxetine to subjects with moderate pain (pain = 25) led to ICERs <$50,000/QALY, regardless of age. Among knee OA subjects with severe pain (pain = 55) who are unwilling or unable to undergo TKR, ICERs were <$50,600/QALY, regardless of age. CONCLUSIONS Duloxetine is a cost-effective addition to knee OA UC for subjects with moderate pain or those with severe pain unable or unwilling to undergo TKR. Among younger subjects with severe pain, duloxetine is cost-effective at WTP thresholds >$88,500/QALY.
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Affiliation(s)
- J K Sullivan
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - J Huizinga
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - R R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - D J Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia.
| | - T Neogi
- Boston University School of Medicine, Boston, MA, USA.
| | - E Yelin
- University of California, San Francisco, CA, USA.
| | - J N Katz
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA; Departments of Epidemiology and Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - E Losina
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
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Azizoddin DR, Jolly M, Arora S, Yelin E, Katz P. Longitudinal Study of Fatigue, Stress, and Depression: Role of Reduction in Stress Toward Improvement in Fatigue. Arthritis Care Res (Hoboken) 2020; 72:1440-1448. [PMID: 31421030 PMCID: PMC7024647 DOI: 10.1002/acr.24052] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/13/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Fatigue is common among individuals with systemic lupus erythematosus (SLE), but the causes are not well understood. Our objective was to examine perceived stress and depressive symptoms as predictors of fatigue in SLE. METHODS Data from 2 years of the Lupus Outcomes Study (n = 650 patients), obtained through annual structured interviews, were used. Fatigue was measured with the Short Form 36 (SF-36) vitality scale along with a variety of self-report measures of disease, depression, and stress. Multivariate linear regression models examined predictors of changes in fatigue. Model 1 tested the association of time 1 (T1) depression with time 2 (T2) fatigue; model 2 added T1 perceived stress to model 1, and final models added T1-to-T2 decrease in stress. All analyses controlled for T1 fatigue, age, sex, self-report of fibromyalgia, pain, and SLE duration, activity, and damage. RESULTS Mean ± SD age was 51 ± 12 years, 92% of participants were women, and 68% were white. The mean ± SD SF-36 fatigue score was 55 ± 24. T1 depression significantly predicted T2 fatigue. When T1 stress was added, stress (β = 1.7 [95% confidence interval (95% CI) 1.1, 2.2]; P < 0.0001) significantly predicted T2 fatigue, but depression was no longer significant. The addition of T1-to-T2 decrease in stress was associated with a clinically meaningful decline in fatigue (β = -11.8 [95% CI -15.6, -8.9]; P < 0.0001). CONCLUSION While depressive symptoms initially predicted subsequent fatigue, the effects were mediated by stress. A decrease in stress, in addition, was associated with a clinically meaningful decrease in fatigue. These results suggest that perceived stress plays an important role in SLE fatigue and may be an important focus of interventions for fatigue.
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Affiliation(s)
| | | | | | - Edward Yelin
- Russell/Engleman Research Center in Arthritis and Philip R Lee Institute for Health Policy Studies, University of San Francisco California, San Francisco, CA
| | - Patricia Katz
- Russell/Engleman Research Center in Arthritis and Philip R Lee Institute for Health Policy Studies, University of San Francisco California, San Francisco, CA
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Yelin E, Katz P, Banks C. A Policy to Do Better Next Time: Lessons Learned From the COVID‐19 Pandemic. ACR Open Rheumatol 2020; 2:253-254. [PMID: 32298525 PMCID: PMC7231513 DOI: 10.1002/acr2.11145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Edward Yelin
- University of California, San Francisco, and University of California Berkeley
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Katz P, Yelin E. Reviewers. ACR Open Rheumatol 2019. [DOI: 10.1002/acr2.11104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Schmajuk G, Trupin L, Yelin E, Blanc PD. Prevalence of Arthritis and Rheumatoid Arthritis in Coal Mining Counties of the United States. Arthritis Care Res (Hoboken) 2019; 71:1209-1215. [PMID: 30875457 DOI: 10.1002/acr.23874] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/05/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Exposure to inhaled mineral dust, in particular silica, is associated with increased odds of rheumatoid arthritis (RA) and other autoimmune diseases. We studied the association of RA with work-related coal and silica exposure in the Appalachian region of the US. METHODS We carried out a random-digit dialed telephone survey in selected counties in Appalachia that had elevated coal workers' pneumoconiosis mortality. Our study cohort included men ages ≥50 with any employment history, and we assessed exposure to coal mining employment, other work-related dust, and ergonomic factors. We ascertained self-reported physician diagnosis of any arthritis and of RA with glucocorticoid treatment. We used multivariable logistic regression analysis to estimate the odds ratios (ORs) and associated population attributable fraction (PAF) estimates. RESULTS Among the 973 men who met study entry criteria (mean ± SD ages 66 ± 10 years; 54% ever smokers), 266 (27%) reported coal mining work and 189 (19%) reported other work-related silica exposure. There were 517 men (53%), who reported any arthritis and 112 (12%) whose disease met the study definition of RA. Adjusting for covariates, coal mining was associated with elevated odds of RA (OR 3.6 [95% confidence interval (95% CI) 2.1-6.2]), which accounted for a PAF of 33% (95% CI 26-40%) of the men studied. For any arthritis, the coal mining-associated OR was 2.3 (95% CI 1.6-3.2), with an associated PAF of 20% (95% CI 14-25%). CONCLUSION In this population of older males living in a coal mining region, we estimated that 20% of arthritis and 33% of RA may be attributable to coal mining work.
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Affiliation(s)
- Gabriela Schmajuk
- University of California, San Francisco and the San Francisco Veterans Affairs Health Care System, San Francisco, California
| | | | | | - Paul D Blanc
- University of California, San Francisco and the San Francisco Veterans Affairs Health Care System, San Francisco, California
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Yelin E, Weinstein S, King T. An update on the burden of musculoskeletal diseases in the U.S. Semin Arthritis Rheum 2019; 49:1-2. [DOI: 10.1016/j.semarthrit.2019.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/29/2019] [Indexed: 11/25/2022]
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Yelin E, Trupin L, Bunde J, Yazdany J. Poverty, Neighborhoods, Persistent Stress, and Systemic Lupus Erythematosus Outcomes: A Qualitative Study of the Patients' Perspective. Arthritis Care Res (Hoboken) 2019; 71:398-405. [PMID: 29781579 DOI: 10.1002/acr.23599] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/15/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To obtain the perspective of individuals with systemic lupus erythematosus (SLE) regarding the role of poverty, neighborhood, and chronic stress in SLE outcomes. METHODS Through annual structured interviews as part of the Lupus Outcomes Study, 723 persons with SLE were followed from 2003 to 2015 in order to establish the effect of combinations of poverty, persistent poverty, residence in an area of concentrated poverty, access to health care, and chronic stress on accumulated damage. We obtained a sample of 28 of the 723 individuals on the basis of household income, geography, and outcomes in their last interview, and administered qualitative interviews to explore their perspectives on the impact of these factors on SLE outcomes. The interviews were recorded, transcribed, and analyzed using a grounded theory approach. RESULTS Persons in poverty frequently reported that poverty necessitated a choice to deal with food, medical care, and housing insecurity on a daily basis and to relegate their management of SLE to occurrences of disease flares. They also reported that exposure to crime in their neighborhoods was a stressor that triggered worse disease activity. Affluent participants reported that neighborhood neither helped nor hindered dealing with SLE, because they relied on networks not tied to neighborhoods to deal with SLE. CONCLUSION Mitigating poverty and reducing exposure to crime through moving to safer neighborhoods are factors identified by individuals with SLE as potentially critical in disease outcomes.
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Affiliation(s)
- Edward Yelin
- University of California, San Francisco and University of California, Berkeley
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Knight AM, Trupin L, Katz P, Yelin E, Lawson EF. Depression Risk in Young Adults With Juvenile- and Adult-Onset Lupus: Twelve Years of Followup. Arthritis Care Res (Hoboken) 2019; 70:475-480. [PMID: 28544568 DOI: 10.1002/acr.23290] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/16/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare major depression risk among young adults with juvenile-onset and adult-onset systemic lupus erythematosus (SLE), and to determine demographic and health-related predictors of depression. METHODS Young adults with SLE ages 18-45 years (n = 546) in the Lupus Outcomes Study completed annual telephone surveys from 2002-2015, including assessment of depression using the Center for Epidemiologic Studies Depression Scale (CES-D), and self-report measures of sociodemographics and health characteristics. Juvenile-onset SLE was defined as age <18 years at diagnosis (n = 115). Repeated-measures analysis was performed to assess the risk for major depression (CES-D ≥24) at any point in study, and logistic regression was used to assess for recurrent (present on ≥2 assessments) major depression. RESULTS Major depression was experienced by 47% of the cohort at least once during the 12-year study period. In adjusted analyses, juvenile-onset SLE patients had an increased risk of having a major depressive episode (odds ratio [OR] 1.7 [95% confidence interval (95% CI) 1.0-2.7]) and recurrent episodes (OR 2.2 [95% CI 1.2-4.3]), compared to participants with adult-onset SLE. Older age, lower educational attainment, and physical function, higher disease activity, and a history of smoking were associated with an increased depression risk. Juvenile-onset SLE patients had a higher risk of major depression across all educational groups. CONCLUSION Young adults with SLE, particularly those with juvenile-onset disease, are at high risk for major depression, which is associated with increased disease activity, poorer physical functioning, and lower educational attainment. Early depression intervention in young adults with SLE has the potential to improve both medical and psychosocial outcomes.
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Affiliation(s)
- Andrea M Knight
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Yelin E, Yazdany J, Trupin L. Relationship Between Poverty and Mortality in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2018; 70:1101-1106. [PMID: 28973834 PMCID: PMC5882599 DOI: 10.1002/acr.23428] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/26/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A prior study established that concurrent poverty, persistent poverty, and exiting poverty were associated with the subsequent extent of damage accumulation in systemic lupus erythematosus (SLE). In this study, we examined whether concurrent poverty affects mortality after taking extent of damage accumulation into account. METHODS Analyses were conducted on 807 persons with SLE participating in the University of California-San Francisco Lupus Outcomes Study in 2009, stratified by whether they lived in households with incomes ≤125% of the federal poverty level in that year. We used Cox proportional hazards regression to estimate the risk of mortality as a function of poverty status, with and without adjustment for demographics; lupus status, including extent of disease damage; overall health status; health behaviors; and health care characteristics. RESULTS Among 807 individuals interviewed in 2009, 71 (8.8%) had died by 2015, 57 (8.3%) among the nonpoor and 14 (12.1%) among the poor (P = 0.18). With adjustment only for age, poverty in 2009 was associated with an increased risk of mortality (hazard ratio [HR] 2.14 [95% confidence interval (95% CI) 1.18-3.88]) through 2015. However, after adjustment for extent of damage and age, poverty was no longer associated with an increased risk of mortality (HR 1.68 [95% CI 0.91-3.10]). Among those who died, those who were poor lived 13.9 fewer years (95% CI 6.9-20.8; P < 0.0001). CONCLUSION The principal way that poverty results in higher mortality in SLE is by increasing the extent of damage accumulation.
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Affiliation(s)
- Edward Yelin
- Philip R. Lee Institute for Health Policy Studies and Rosalind Russell/Ephraim Engleman Rheumatology Research Center, University of California, San Francisco
| | - Jinoos Yazdany
- Rosalind Russell/Ephraim Engleman Rheumatology Research Center, University of California, San Francisco
| | - Laura Trupin
- Philip R. Lee Institute for Health Policy Studies and Rosalind Russell/Ephraim Engleman Rheumatology Research Center, University of California, San Francisco
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Yelin E, Trupin L, Yazdany J. Reply. Arthritis Care Res (Hoboken) 2018; 71:698-699. [PMID: 29609222 DOI: 10.1002/acr.23564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Edward Yelin
- Russell/Engleman Rheumatology Research Center and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | - Laura Trupin
- Russell/Engleman Rheumatology Research Center and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | - Jinoos Yazdany
- Russell/Engleman Rheumatology Research Center, San Francisco, CA
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Yelin E, Trupin L, Yazdany J. A Prospective Study of the Impact of Current Poverty, History of Poverty, and Exiting Poverty on Accumulation of Disease Damage in Systemic Lupus Erythematosus. Arthritis Rheumatol 2017; 69:1612-1622. [PMID: 28480630 PMCID: PMC5529220 DOI: 10.1002/art.40134] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/18/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To estimate the effect of current poverty, number of years in poverty, and exiting poverty on disease damage accumulation in systemic lupus erythematosus (SLE). METHODS For this study, 783 patients with SLE were followed up from 2003 to 2015 through annual structured interviews. Respondents were categorized in each year by whether they had a household income of ≤125% of the US federal poverty level. Linear and logistic regression analyses were used to assess the impact of poverty in 2009, number of years in poverty between 2003 and 2009, and permanent exits from poverty as of 2009 on the extent of disease damage (according to the Brief Index of Lupus Damage [BILD] score) or accumulation of a clinically meaningful increase in disease damage (defined as a minimum 2-point increase in the BILD damage score) by 2015. RESULTS After adjustment for sociodemographic features, health care characteristics, and health behaviors, poverty in 2009 was associated with an increased level of accumulated disease damage in 2015 (mean difference in BILD damage score between poor and non-poor 0.62 points, 95% confidence interval [95% CI] 0.25-0.98) and increased odds of a clinically important increase in damage (odds ratio [OR] 1.67, 95% CI 0.98-2.85). Being poor in every year between 2003 and 2009 was associated with greater damage (mean change in BILD score 2.45, 95% CI 1.88-3.01) than being poor for one-half or more of those years (mean change in BILD score 1.45, 95% CI 0.97-1.93), for fewer than one-half of those years (mean change in BILD score 1.49, 95% CI 1.10-1.88), or for none of those years (mean change in BILD score 1.34, 95% CI 1.20-1.49). Those exiting poverty permanently had similar increases in disease damage (mean change in BILD score 1.30, 95% CI 0.90-1.69) as those who were never in poverty (mean change in BILD score 1.36, 95% CI 1.23-1.50) but much less damage than those who remained in poverty (mean change in BILD score 1.98, 95% CI 1.59-2.38). CONCLUSION The effects of current poverty, "dose" of poverty, and exiting poverty suggest that poverty plays a critical role in the accumulation of damage in patients with SLE.
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Affiliation(s)
- Edward Yelin
- Philip R Lee Institute for Health Policy Studies, UCSF
- Rosalind Russell/Ephraim Engleman Rheumatology Research Center, UCSF
- Institute for Research on Labor and Employment, UC, Berkeley
| | - Laura Trupin
- Philip R Lee Institute for Health Policy Studies, UCSF
- Rosalind Russell/Ephraim Engleman Rheumatology Research Center, UCSF
| | - Jinoos Yazdany
- Rosalind Russell/Ephraim Engleman Rheumatology Research Center, UCSF
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Katz PP, Barton J, Trupin L, Schmajuk G, Yazdany J, Ruiz PJ, Yelin E. Poverty, Depression, or Lost in Translation? Ethnic and Language Variation in Patient-Reported Outcomes in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2017; 68:621-8. [PMID: 26414775 DOI: 10.1002/acr.22748] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 09/02/2015] [Accepted: 09/22/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Despite advances in therapies, disparities in outcomes have been documented for rheumatoid arthritis (RA) patients for both ethnicity and English language proficiency. The goals of these analyses were to compare differences in RA patient-reported outcomes, by both self-identification of ethnicity and English language proficiency, and to identify factors that might explain differences among groups. METHODS Data were collected through structured telephone interviews of a longitudinal cohort with physician-diagnosed RA (n = 438); only women were included (n = 335). Three groups were defined based on self-reported ethnicity and English proficiency: white/English (n = 219), Hispanic/English (n = 39), and Hispanic/Spanish (n = 77). Outcomes examined were patient-reported physical functioning, pain, and presence of moderate or severe fatigue. Multivariate regression analyses compared outcomes among groups, adjusting for sociodemographic characteristics, health and disease factors, and depression. RESULTS Hispanic/Spanish women had worse function, pain, and fatigue than either English-proficient group. Depression was associated with all outcomes (P < 0.0001), and accounted for greater differentials in scores than ethnicity/language proficiency. In interaction analyses, differences between women who were and were not depressed were greater for Hispanic/English than for Hispanic/Spanish. Nondepressed Hispanic/Spanish scores were significantly worse than nondepressed Hispanic/English, i.e., the impact of depression was less for Hispanic/Spanish women because both depressed and nondepressed women in this group reported worse outcomes. After adjustment for sociodemographic factors and depression, language remained significantly associated with outcomes. CONCLUSION Disparities in patient-reported outcomes may be driven less by ethnicity than by sociodemographic or psychological factors. Measurement instruments that are not culturally appropriate and equivalent may also hamper meaningful analyses of disparities.
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Affiliation(s)
| | | | | | | | | | - Pedro J Ruiz
- California Pacific Medical Center, San Francisco, California
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Barton JL, Trupin L, Schillinger D, Evans-Young G, Imboden J, Montori VM, Yelin E. Use of Low-Literacy Decision Aid to Enhance Knowledge and Reduce Decisional Conflict Among a Diverse Population of Adults With Rheumatoid Arthritis: Results of a Pilot Study. Arthritis Care Res (Hoboken) 2017; 68:889-98. [PMID: 26605752 DOI: 10.1002/acr.22801] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 10/23/2015] [Accepted: 11/17/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Despite innovations in treatment of rheumatoid arthritis (RA), adherence is poor and disparities persist. Shared decision making (SDM) promotes patient engagement and enhances adherence; however, few tools support SDM in RA. Our objective was to pilot a low-literacy medication guide and decision aid to facilitate patient-clinician conversations about RA medications. METHODS RA patients were consecutively enrolled into 1 of 3 arms: 1) control; patients received existing medication guide prior to clinic visit, 2) adapted guide prior to visit, and 3) adapted guide prior to plus decision aid during visit. Outcomes were collected immediately postvisit, at 1-week, and at 3- and 6-month interviews. Eligible adults had to have failed at least 1 disease-modifying antirheumatic drug and fulfill 1 of the following: age >65 years, immigrant, non-English speaker, less than high school education, limited health literacy, and racial/ethnic minority. Primary outcomes were knowledge of RA medications, decisional conflict, and acceptability of interventions. RESULTS The majority of 166 patients were immigrants (66%), non-English speakers (54%), and had limited health literacy (71%). Adequate RA knowledge postvisit in arm 3 was higher (78%) than arm 1 (53%; adjusted odds ratio 2.7, 95% confidence interval 1.2, 6.1). Among patients with a medication change, there was lower (better) mean decisional conflict in arms 2 and 3 (P = 0.03). There were no significant differences in acceptability. CONCLUSION A low-literacy medication guide and decision aid was acceptable, improved knowledge, and reduced decisional conflict among vulnerable RA patients. Enhancing knowledge and patient engagement with decision support tools may lead to medication choices better aligned with RA patients' values and preferences.
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Affiliation(s)
- Jennifer L Barton
- VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon
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Yelin E, Yazdany J, Trupin L. Relationship Between Process of Care and a Subsequent Increase in Damage in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2017; 69:927-932. [PMID: 27477567 DOI: 10.1002/acr.22977] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 06/22/2016] [Accepted: 06/28/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate whether low ratings of interactions with providers and health plans in 2013 were associated with increased systemic lupus erythematosus (SLE) damage in 2015. METHODS Data were derived from the Lupus Outcomes Study (LOS) annual surveys and include items from the Consumer Assessment of Health Plans and Interpersonal Processes of Care Scale measuring dimensions of health care interactions. We used ordinary least squares regression to model the change in disease damage over a 2-year period, 2013-2015, as a function of ratings of multiple dimensions of interactions with providers and health plans, with and without adjustment for demographic characteristics, socioeconomic status, and SLE and overall health status, and logistic regression to estimate the effect of the same matrix of variables on the probability of experiencing a minimum clinically important increase in damage. RESULTS There were 566 LOS respondents who were followed from 2013-2015 and who rated their providers and health plans in 2013. After adjustment, persons with SLE rating their providers poorly in patient-provider communication experienced a significantly greater accrual of disease damage (odds ratio [OR] 0.23 [95% confidence interval (95% CI) 0.09-0.38]) and were more likely to experience a minimum clinically important increase in damage (OR 2.35 [95% CI 1.25-4.39]). After adjustment, those rating their health plan poorly on care coordination experienced a significantly greater accrual of disease damage (OR 0.19 [95% CI 0.03-0.35]) and were more likely to experience a minimum clinically important increase in damage (OR 2.20 [95% CI 1.12-4.34]). CONCLUSION Poor patient-provider communication and care coordination may result in increased disease damage.
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Affiliation(s)
- Edward Yelin
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Jinoos Yazdany
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Laura Trupin
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
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Katz PP, Andrews J, Yazdany J, Schmajuk G, Trupin L, Yelin E. Is frailty a relevant concept in SLE? Lupus Sci Med 2017; 4:e000186. [PMID: 28243456 PMCID: PMC5294024 DOI: 10.1136/lupus-2016-000186] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/20/2016] [Accepted: 11/22/2016] [Indexed: 12/29/2022]
Abstract
Objective In geriatric populations, frailty is associated with poor health outcomes, including mortality. Frailty has not been examined in lupus, although components of the phenotype seem relevant. Methods Women with lupus (n=152) participated in research visits in 2008–2009. Frailty was assessed by Fried's frailty phenotype criteria: low weight/unintentional weight loss, slow gait (4-m walk using sex and height criteria), weakness (grip strength using gender and body mass index criteria), exhaustion (2 specific questions) and inactivity (from physical activity questionnaire). Women accumulating 3+ components were classified as ‘frail’, one or two components as ‘prefrail’, and none as ‘robust’. Physical function (36-item Short Form (SF-36) Physical Functioning subscale and Valued Life Activities disability scale), cognitive function (from a 12-test battery) and mortality were examined as outcomes. Mortality was determined as of December 2015. Multiple regression analyses examined concurrent and 2-year function controlling for age, lupus duration, race/ethnicity, glucocorticoid use, obesity, self-reported disease activity and damage and, for longitudinal analyses, baseline function. Mortality analyses controlled for age, lupus duration and baseline disease damage scores. Results Mean age was 48 (±12) years, mean lupus duration was 16 (±9) years. 20% of the sample was classified as frail and 50% as prefrail. Frail women had significantly worse physical functioning than both robust and prefrail women and were more likely to have cognitive impairment. Frail women were also more likely to experience declines in functioning and onset of cognitive impairment. Mortality rates were significantly higher in the frail group (frail 19.4%; prefrail 3.9%; robust 2.3%). Odds (95% CI) of death for frail women were elevated, even after adjusting for age, lupus duration and baseline disease damage (5.9 (0.6 to 57.1)). Conclusions Prevalence of frailty in this sample of women with lupus was higher than in samples of older adults. Frailty was associated with poor physical and cognitive function, functional declines and mortality.
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Affiliation(s)
- Patricia P Katz
- University of California San Francisco , San Francisco, California , USA
| | - James Andrews
- University of Washington , Seattle, Washington , USA
| | - Jinoos Yazdany
- University of California San Francisco , San Francisco, California , USA
| | - Gabriela Schmajuk
- University of California San Francisco , San Francisco, California , USA
| | - Laura Trupin
- University of California San Francisco , San Francisco, California , USA
| | - Edward Yelin
- University of California San Francisco , San Francisco, California , USA
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Wysham KD, Murray SG, Hills N, Yelin E, Gensler LS. Cervical Spinal Fracture and Other Diagnoses Associated With Mortality in Hospitalized Ankylosing Spondylitis Patients. Arthritis Care Res (Hoboken) 2017; 69:271-277. [PMID: 27159625 PMCID: PMC5102813 DOI: 10.1002/acr.22934] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/15/2016] [Accepted: 04/26/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Little data exist regarding mortality in ankylosing spondylitis (AS). We assessed diagnoses associated with in-hospital mortality in AS using a population-based inpatient data set. METHODS Data were abstracted from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample between 2007 and 2011. We identified AS admissions using International Classification of Diseases, Ninth Revision, Clinical Modification code 720.0. In-hospital mortality was the primary outcome. Logistic regression was used to evaluate the association between top diagnoses and in-hospital mortality. We performed a secondary analysis from the same years in all patients (with and without AS) with cervical spine (C-spine) fracture to determine whether AS was an independent risk factor for mortality. RESULTS Between 2007 and 2011, we identified 12,484 admissions and 267 deaths in AS patients. C-spine fracture with spinal cord injury and sepsis had the highest odds of death, with odds ratios (ORs) of 13.43 (95% confidence interval [95% CI] 8.00-22.55, P < 0.0001) and 7.63 (95% CI 5.62-10.36, P < 0.0001), respectively. In the same time period, there were 53,606 C-spine fracture admissions, of which 408 were coded with AS. Among all C-spine fracture hospitalizations, an AS diagnosis was associated with inpatient death (OR 1.61 [95% CI 1.16-2.22], P = 0.004). CONCLUSION In AS patients admitted to the hospital, C-spine fracture is a leading cause of in-hospital mortality. Other diagnoses associated with mortality include sepsis, pneumonia, cardiovascular disease, and comorbid illnesses. Among all hospitalizations with C-spine fracture, AS was associated with increased odds of death. C-spine fracture-associated mortality warrants further study to elucidate risk factors in order to prevent such devastating fractures in AS patients.
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Affiliation(s)
- Katherine D. Wysham
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, CA, USA
| | - Sara G. Murray
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, CA, USA
| | - Nancy Hills
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine San Francisco, CA, USA
| | - Edward Yelin
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, CA, USA
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Lianne S. Gensler
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, CA, USA
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Abstract
The purpose of this study was to estimate the increment in medical care expenditures and wage losses associated with disability in the adult population after taking into account other characteristics of adults with disabilities. The authors used the 1997 Medical Expenditures Panel Survey Household Component (MEPS), a national probability sample of the noninstitutionalized population, to tabulate all medical care expenditures of the adult MEPS respondents, stratified by disability status. They then used regression techniques to estimate the increment of health care expenditures attributable to disability. They used the same methods to estimate the magnitude of the earnings losses sustained by persons with disabilities. Adults with disabilities incurred mean total medical care expenditures of $8,035, for a total of $182.6 billion. The mean increment in medical care expenditures specifically attributable to disability among those 18 and older was $2,953, for a total of about $65.9 billion. Persons with disabilities ages 18 through 64 earned $10,191 less, on average, than other persons these ages, for a total of $115.3 billion. The average increment in earnings losses attributable to disability was $13,160, for a total of $148.9 billion. A large proportion of the total medical care expenditures of adults with disabilities would occur in the absence of the disability, but persons with disability actually earned more than would be expected on the basis of their other characteristics.
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Affiliation(s)
- Edward Yelin
- Department of Medicine and Institute for Health Policy Studies, University of California, San Francisco,
| | | | - Laura Trupin
- Department of Medicine and Institute for Health Policy Studies, University of California, San Francisco
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Yelin E. Book Review: Berkowitz, Monroe, editor (1990). Forging Linkages: Modifying Disability Benefit Programs to Encourage Employment. New York: Rehabilitation International. 192 pp. Journal of Disability Policy Studies 2016. [DOI: 10.1177/104420739000100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Andrews J, Wahl E, Schmajuk G, Yelin E, Katz P. THU0096 Serum Inflammation Identifies Increased Risk of Frailty in Rheumatoid Arthritis: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Yelin E, Trupin L, Yazdany J. FRI0556 Does Leaving Poverty Reduce Newly Accumulated Damage in SLE?: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Katz P, Margaretten M, Trupin L, Schmajuk G, Yazdany J, Yelin E. Role of Sleep Disturbance, Depression, Obesity, and Physical Inactivity in Fatigue in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016; 68:81-90. [PMID: 25779719 DOI: 10.1002/acr.22577] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 01/17/2015] [Accepted: 03/03/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Fatigue is a major concern for individuals with rheumatoid arthritis (RA). However, in order to treat fatigue adequately, its sources need to be identified. METHODS Data were collected during a single home visit (number of participants = 158). All participants had physician-diagnosed RA. Assessments of self-reported sleep quality, depression, physical activity, RA disease activity, muscle strength, functional limitations, and body composition were made. Information on demographics, medications, and smoking was collected. The Fatigue Severity Inventory (FSI; measuring average fatigue over the past 7 days) was used as the primary outcome. Analyses were first conducted to evaluate bivariate relationships with fatigue. Correlations among risk factors were examined. Multivariate analyses identified independent predictors of fatigue. RESULTS The mean ± SD age was 59 ± 11 years, the mean ± SD disease duration was 21 ± 13 years, and 85% of subjects were female. The mean ± SD FSI rating was 3.8 ± 2.0 (range 0-10). In multivariate analyses, self-reported disease activity, poor sleep, depression, and obesity were independently associated with fatigue. Physical inactivity was correlated with poor sleep, depression, and obesity. Mediation analyses indicated that physical inactivity had an indirect association with fatigue, mediated by poor sleep, depression, and obesity. CONCLUSION This cross-sectional study suggests that fatigue may not be solely a result of RA disease activity, but may result from a constellation of factors that includes RA disease activity or pain, but also includes inactivity, depression, obesity, and poor sleep. The results suggest new avenues for interventions to improve fatigue in individuals with RA, such as increasing physical activity or addressing depression or obesity.
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Losina E, Michl G, Collins JE, Hunter DJ, Jordan JM, Yelin E, Paltiel AD, Katz JN. Model-based evaluation of cost-effectiveness of nerve growth factor inhibitors in knee osteoarthritis: impact of drug cost, toxicity, and means of administration. Osteoarthritis Cartilage 2016; 24:776-85. [PMID: 26746146 PMCID: PMC4838505 DOI: 10.1016/j.joca.2015.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 12/03/2015] [Accepted: 12/16/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Studies suggest nerve growth factor inhibitors (NGFi) relieve pain but may accelerate disease progression in some patients with osteoarthritis (OA). We sought cost and toxicity thresholds that would make NGFi a cost-effective treatment for moderate-to-severe knee OA. DESIGN We used the Osteoarthritis Policy (OAPol) model to estimate the cost-effectiveness of NGFi compared to standard of care (SOC) in OA, using Tanezumab as an example. Efficacy and rates of accelerated OA progression were based on published studies. We varied the price/dose from $200 to $1000. We considered self-administered subcutaneous (SC) injections (no administration cost) vs provider-administered intravenous (IV) infusion ($69-$433/dose). Strategies were defined as cost-effective if their incremental cost-effectiveness ratio (ICER) was less than $100,000/quality-adjusted life year (QALY). In sensitivity analyses we varied efficacy, toxicity, and costs. RESULTS SOC in patients with high levels of pain led to an average discounted quality-adjusted life expectancy of 11.15 QALYs, a lifetime risk of total knee replacement surgery (TKR) of 74%, and cumulative discounted direct medical costs of $148,700. Adding Tanezumab increased QALYs to 11.42, reduced primary TKR utilization to 63%, and increased costs to between $155,400 and $199,500. In the base-case analysis, Tanezumab at $600/dose was cost-effective when delivered outside of a hospital. At $1000/dose, Tanezumab was not cost-effective in all but the most optimistic scenario. Only at rates of accelerated OA progression of 10% or more (10-fold higher than reported values) did Tanezumab decrease QALYs and fail to represent a viable option. CONCLUSIONS At $100,000/QALY, Tanezumab would be cost effective if priced ≤$400/dose in all settings except IV hospital delivery.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Anti-Inflammatory Agents, Non-Steroidal/economics
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/economics
- Antibodies, Monoclonal, Humanized/therapeutic use
- Cost-Benefit Analysis
- Disease Progression
- Drug Costs/statistics & numerical data
- Female
- Health Care Costs
- Health Services Research/methods
- Humans
- Infusions, Intravenous
- Injections, Subcutaneous
- Male
- Middle Aged
- Models, Econometric
- Nerve Growth Factor/antagonists & inhibitors
- Osteoarthritis, Knee/drug therapy
- Osteoarthritis, Knee/economics
- Pain Measurement/methods
- Quality-Adjusted Life Years
- Self Administration/economics
- United States
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Affiliation(s)
- E Losina
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - G Michl
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - J E Collins
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - D J Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia.
| | - J M Jordan
- Thurston Arthritis Research Center and the Division of Rheumatology, Allergy and Immunology, University of North Carolina, Chapel Hill, USA.
| | - E Yelin
- University of California, San Francisco, San Francisco, CA, USA.
| | - A D Paltiel
- Yale School of Public Health, New Haven, CT, USA.
| | - J N Katz
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Katz JN, Smith SR, Collins JE, Solomon DH, Jordan JM, Hunter DJ, Suter LG, Yelin E, Paltiel AD, Losina E. Cost-effectiveness of nonsteroidal anti-inflammatory drugs and opioids in the treatment of knee osteoarthritis in older patients with multiple comorbidities. Osteoarthritis Cartilage 2016; 24:409-18. [PMID: 26525846 PMCID: PMC4761310 DOI: 10.1016/j.joca.2015.10.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 09/16/2015] [Accepted: 10/13/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate long-term clinical and economic outcomes of naproxen, ibuprofen, celecoxib or tramadol for OA patients with cardiovascular disease (CVD) and diabetes. DESIGN We used the Osteoarthritis Policy Model to examine treatment with these analgesics after standard of care (SOC) - acetaminophen and corticosteroid injections - failed to control pain. NSAID regimens were evaluated with and without proton pump inhibitors (PPIs). We evaluated over-the-counter (OTC) regimens where available. Estimates of treatment efficacy (pain reduction, occurring in ∼57% of patients on all regimens) and toxicity (major cardiac or gastrointestinal toxicity or fractures, risk ranging from 1.09% with celecoxib to 5.62% with tramadol) were derived from published literature. Annual costs came from Red Book Online(®). Outcomes were discounted at 3%/year and included costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios (ICERs). Key input parameters were varied in sensitivity analyses. RESULTS Adding ibuprofen to SOC was cost saving, increasing QALYs by 0.07 while decreasing cost by $800. Incorporating OTC naproxen rather than ibuprofen added 0.01 QALYs and increased costs by $300, resulting in an ICER of $54,800/QALY. Using prescription naproxen with OTC PPIs led to an ICER of $76,700/QALY, while use of prescription naproxen with prescription PPIs resulted in an ICER of $252,300/QALY. Regimens including tramadol or celecoxib cost more but added fewer QALYs and thus were dominated by several of the naproxen-containing regimens. CONCLUSIONS In patients with multiple comorbidities, naproxen- and ibuprofen-containing regimens are more effective and cost-effective in managing OA pain than opioids, celecoxib or SOC.
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Ferguson S, Trupin L, Yazdany J, Yelin E, Barton J, Katz P. Who receives contraception counseling when starting new lupus medications? The potential roles of race, ethnicity, disease activity, and quality of communication. Lupus 2015; 25:12-7. [PMID: 26190169 DOI: 10.1177/0961203315596079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/17/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Family planning discussions are an important aspect of medical care for women with systemic lupus erythematosus (SLE) as active disease is a risk factor for poor pregnancy outcomes, and the medications used for treatment can be harmful to the fetus when used during conception and pregnancy. Our objective was to examine the impact of patient perception of quality and type of communication on receiving contraception counseling. METHODS Data were derived from patients enrolled in the University of California, San Francisco Lupus Outcomes Study. Individuals participate in a yearly structured telephone interview that includes assessment of contraception counseling when starting new medications, and measures of communication and decision making. Logistic regression was performed to identify predictors of not receiving contraception counseling. RESULTS Of the 68 women included in this analysis, one-third did not receive contraception counseling when starting new medications. Older age, white race, depressive symptoms, and higher SLE disease activity were independently associated with not receiving contraception counseling. Participants who did not receive contraception counseling rated their physicians lower in shared decision-making (SDM) communication. CONCLUSIONS This study demonstrates a gap in family planning counseling among women with SLE starting new medications. Future studies to address these potential areas of intervention, including education about the need for contraception through menopause, and mechanisms to engage in SDM surrounding contraception are needed to improve quality of care for women with lupus.
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Affiliation(s)
- S Ferguson
- University of California, San Francisco, Division of Rheumatology, San Francisco, CA, USA
| | - L Trupin
- University of California, San Francisco, Division of Rheumatology, San Francisco, CA, USA
| | - J Yazdany
- University of California, San Francisco, Division of Rheumatology, San Francisco, CA, USA
| | - E Yelin
- University of California, San Francisco, Division of Rheumatology, San Francisco, CA, USA
| | - J Barton
- Portland Veterans Affairs Medical Center, Division of Hospital & Specialty Medicine, Portland, OR, USA
| | - P Katz
- University of California, San Francisco, Division of Rheumatology, San Francisco, CA, USA
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Losina E, Paltiel AD, Weinstein AM, Yelin E, Hunter DJ, Chen SP, Klara K, Suter LG, Solomon DH, Burbine SA, Walensky RP, Katz JN. Lifetime medical costs of knee osteoarthritis management in the United States: impact of extending indications for total knee arthroplasty. Arthritis Care Res (Hoboken) 2015; 67:203-15. [PMID: 25048053 DOI: 10.1002/acr.22412] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 07/15/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The impact of increasing utilization of total knee arthroplasty (TKA) on lifetime costs in persons with knee osteoarthritis (OA) is understudied. METHODS We used the Osteoarthritis Policy Model to estimate total lifetime costs and TKA utilization under a range of TKA eligibility criteria among US persons with symptomatic knee OA. Current TKA utilization was estimated from the Multicenter Osteoarthritis Study and calibrated to Health Care Cost and Utilization Project data. OA treatment efficacy and toxicity were drawn from published literature. Costs in 2013 dollars were derived from Medicare reimbursement schedules and Red Book Online. Time costs were derived from published literature and the US Bureau of Labor Statistics. RESULTS Estimated average discounted (3% per year) lifetime costs for persons diagnosed with knee OA were $140,300. Direct medical costs were $129,600, with $12,400 (10%) attributable to knee OA over 28 years. OA patients spent a mean ± SD of 13 ± 10 years waiting for TKA after failing nonsurgical regimens. Under current TKA eligibility criteria, 54% of knee OA patients underwent TKA over their lifetimes. Estimated OA-related discounted lifetime direct medical costs ranged from $12,400 (54% TKA uptake) when TKA eligibility was limited to Kellgren/Lawrence grades 3 or 4 to $16,000 (70% TKA uptake) when eligibility was expanded to include symptomatic OA with a lesser degree of structural damage. CONCLUSION Because of low efficacy of nonsurgical regimens, knee OA treatment-attributable costs are low, representing a small portion of all costs for OA patients. Expanding TKA eligibility increases OA-related costs substantially for the population, underscoring the need for more effective nonoperative therapies.
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Affiliation(s)
- Elena Losina
- Harvard Medical School, Brigham and Women's Hospital, and Boston University School of Public Health, Boston, Massachusetts
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Yelin E, Yazdany J, Tonner C, Trupin L, Criswell LA, Katz P, Schmajuk G. Interactions between patients, providers, and health systems and technical quality of care. Arthritis Care Res (Hoboken) 2015; 67:417-24. [PMID: 25132660 PMCID: PMC4320034 DOI: 10.1002/acr.22427] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/29/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Prior studies have established disparities by race/ethnicity and socioeconomic status (SES) in the kind, quantity, and technical quality of systemic lupus erythematosus (SLE) care and outcomes. In this study we evaluate whether disparities exist in assessments of interactions with health care providers and health plans and whether such interactions affect the technical quality of SLE care. METHODS Data derive from the Lupus Outcomes Study (LOS). Principal data collection is an annual structured phone interview including items from the Consumer Assessment of Health Plans and Interpersonal Processes of Care Scale measuring dimensions of health care interactions. We use general estimating equations to assess whether disparities exist by race/ethnicity and SES in being in the lowest quartile of ratings of such interactions and whether ratings in the lowest quartile of interactions are associated with technical quality of care after adjustment for sociodemographic and disease characteristics. RESULTS In the 2012 LOS interview, there were 793 respondents, of whom 640 had ≥1 visit to their principal SLE provider. Nonwhite race/ethnicity and education were not associated with low ratings on any dimension of provider or system interaction; poverty was associated only with low ratings of health plan interactions. After adjustment for demographics, SLE status, and health care variables, ratings in the lowest quartile on all dimensions were associated with significantly lower technical quality of care. CONCLUSION Ratings in the lowest quartile on all dimensions of interactions with providers and the health care system were associated with lower technical quality of care, potentially resulting in poorer SLE outcomes.
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Affiliation(s)
- Edward Yelin
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
- Philip R. Lee Institute for Health Policy Studies, UCSF
| | - Jinoos Yazdany
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
| | - Chris Tonner
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
- Philip R. Lee Institute for Health Policy Studies, UCSF
| | - Laura Trupin
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
- Philip R. Lee Institute for Health Policy Studies, UCSF
| | | | - Patricia Katz
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
- Philip R. Lee Institute for Health Policy Studies, UCSF
| | - Gabriela Schmajuk
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
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Barton JL, Trupin L, Tonner C, Imboden J, Katz P, Schillinger D, Yelin E. English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis. J Rheumatol 2015; 41:1290-7. [PMID: 24931952 DOI: 10.3899/jrheum.131350] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Treat-to-target guidelines promote shared decision making (SDM) in rheumatoid arthritis (RA). Also, because of high cost and potential toxicity of therapies, SDM is central to patient safety. Our objective was to examine patterns of perceived communication around decision making in 2 cohorts of adults with RA. METHODS Data were derived from patients enrolled in 1 of 2 longitudinal, observational cohorts [University of California, San Francisco (UCSF) RA Cohort and RA Panel Cohort]. Subjects completed a telephone interview in their preferred language that included a measure of patient-provider communication, including items about decision making. Measures of trust in physician, education, and language proficiency were also asked. Logistic regression was performed to identify correlates of suboptimal SDM communication. Analyses were performed on each sample separately. RESULTS Of 509 patients across 2 cohorts, 30% and 32% reported suboptimal SDM communication. Low trust in physician was independently associated with suboptimal SDM communication in both cohorts. Older age and limited English proficiency were independently associated with suboptimal SDM in the UCSF RA Cohort, as was limited health literacy in the RA Panel Cohort. CONCLUSION This study of over 500 adults with RA from 2 demographically distinct cohorts found that nearly one-third of subjects report suboptimal SDM communication with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts, as was limited English language proficiency and older age in the UCSF RA Cohort and limited health literacy in the RA Panel Cohort. These findings underscore the need to examine the influence of SDM on health outcomes in RA.
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Affiliation(s)
- Jennifer L Barton
- From the University of California, San Francisco (UCSF) and UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, USA.J.L. Barton, MD; L. Trupin, MPH; C. Tonner, MPH; J. Imboden, MD; P. Katz, PhD, University of California, San Francisco; D. Schillinger, MD, University of California, San Francisco and UCSF Center for Vulnerable Populations, San Francisco General Hospital; E.H. Yelin, PhD, University of California, San Francisco
| | - Laura Trupin
- From the University of California, San Francisco (UCSF) and UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, USA.J.L. Barton, MD; L. Trupin, MPH; C. Tonner, MPH; J. Imboden, MD; P. Katz, PhD, University of California, San Francisco; D. Schillinger, MD, University of California, San Francisco and UCSF Center for Vulnerable Populations, San Francisco General Hospital; E.H. Yelin, PhD, University of California, San Francisco
| | - Chris Tonner
- From the University of California, San Francisco (UCSF) and UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, USA.J.L. Barton, MD; L. Trupin, MPH; C. Tonner, MPH; J. Imboden, MD; P. Katz, PhD, University of California, San Francisco; D. Schillinger, MD, University of California, San Francisco and UCSF Center for Vulnerable Populations, San Francisco General Hospital; E.H. Yelin, PhD, University of California, San Francisco
| | - John Imboden
- From the University of California, San Francisco (UCSF) and UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, USA.J.L. Barton, MD; L. Trupin, MPH; C. Tonner, MPH; J. Imboden, MD; P. Katz, PhD, University of California, San Francisco; D. Schillinger, MD, University of California, San Francisco and UCSF Center for Vulnerable Populations, San Francisco General Hospital; E.H. Yelin, PhD, University of California, San Francisco
| | - Patricia Katz
- From the University of California, San Francisco (UCSF) and UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, USA.J.L. Barton, MD; L. Trupin, MPH; C. Tonner, MPH; J. Imboden, MD; P. Katz, PhD, University of California, San Francisco; D. Schillinger, MD, University of California, San Francisco and UCSF Center for Vulnerable Populations, San Francisco General Hospital; E.H. Yelin, PhD, University of California, San Francisco
| | - Dean Schillinger
- From the University of California, San Francisco (UCSF) and UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, USA.J.L. Barton, MD; L. Trupin, MPH; C. Tonner, MPH; J. Imboden, MD; P. Katz, PhD, University of California, San Francisco; D. Schillinger, MD, University of California, San Francisco and UCSF Center for Vulnerable Populations, San Francisco General Hospital; E.H. Yelin, PhD, University of California, San Francisco
| | - Edward Yelin
- From the University of California, San Francisco (UCSF) and UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, USA.J.L. Barton, MD; L. Trupin, MPH; C. Tonner, MPH; J. Imboden, MD; P. Katz, PhD, University of California, San Francisco; D. Schillinger, MD, University of California, San Francisco and UCSF Center for Vulnerable Populations, San Francisco General Hospital; E.H. Yelin, PhD, University of California, San Francisco
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Polinski JM, Brookhart MA, Ayanian JZ, Katz JN, Kim SC, Lii J, Tonner C, Yelin E, Solomon DH. Relationships between driving distance, rheumatoid arthritis diagnosis, and disease-modifying antirheumatic drug receipt. Arthritis Care Res (Hoboken) 2014; 66:1634-43. [PMID: 24664991 DOI: 10.1002/acr.22333] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 03/18/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Disease-modifying antirheumatic drugs (DMARDs) are recommended for all patients with rheumatoid arthritis (RA). Some estimate that approximately one-half of patients with RA do not receive DMARDs. We hypothesized that patients with RA living farther from rheumatologists would be less likely to receive RA diagnoses and to receive DMARDs. METHODS US-based Medicare patients ages >65 years were study eligible. We calculated driving distance from patients' homes to the nearest rheumatologist. Using multivariable logistic regression, we assessed relationships between driving distance and RA diagnosis and between driving distance and DMARD receipt. In one set of analyses, distance was divided into quartiles: 0-2, 2.1-5, 5.1-15.9, and ≥16 miles. In a second set of analyses, we used predefined categories: 0-15, 15.1-30, 30.1-60, and >60 miles. RESULTS Among 59,426 Medicare beneficiaries, 918 had diagnosed RA. Compared to the first quartile, increased distance was associated with decreased odds of RA diagnosis (odds ratio [OR] 0.96 [95% confidence interval (95% CI) 0.80-1.16] in second quartile, OR 0.88 [95% CI 0.72-1.07] in third quartile, and OR 0.72 [95% CI 0.56-0.93] in fourth quartile; P < 0.01 for trend). Similar results were observed using predefined categories. Among those with RA, increased distance was associated with increased odds of DMARD receipt across quartiles (OR 1.15 [95% CI 1.06-1.25] in second quartile, OR 1.41 [95% CI 1.29-1.54] in third quartile, and OR 1.32 [95% CI 1.18-1.46] in fourth quartile; P = 0.001 for trend). There was no relationship between predefined categories and DMARD receipt (P = 0.45 for trend). CONCLUSION Increased driving distance to rheumatologists was associated with decreased odds of RA diagnosis. Among those with diagnosed RA, the odds of DMARD receipt rose as distance increased from <2 to 16 miles, but not beyond. Urban residents living closer to rheumatologists may have barriers to DMARD use besides geographic access.
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Affiliation(s)
- Jennifer M Polinski
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Yelin E, Tonner C, Kim SC, Katz JN, Ayanian JZ, Brookhart MA, Solomon DH. Sociodemographic, disease, health system, and contextual factors affecting the initiation of biologic agents in rheumatoid arthritis: a longitudinal study. Arthritis Care Res (Hoboken) 2014; 66:980-9. [PMID: 24339352 DOI: 10.1002/acr.22244] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/26/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To analyze the effect of sociodemographic, disease, and health system characteristics and contextual features about the community of residence on the subsequent initiation of treatment with biologic agents for rheumatoid arthritis (RA). METHODS We analyzed data from the University of California, San Francisco Rheumatoid Arthritis Panel Study for the years 1999-2011. Principal data collection was by a structured annual phone survey. We estimated Kaplan-Meier curves of the time until initiation of biologic agents, stratified by age and income. We also used Cox regression to estimate the effect of individual-level sociodemographic and medical factors, contextual-level socioeconomic status measures, and density of health providers in the local community on the probability of initiating therapy with biologic agents for RA. RESULTS In total, 527 persons were included in the panel in 1999, and 229 persons (44%) had initiated therapy with biologic agents by 2011. In multivariable Cox regression models, age <70 years (hazard ratio [HR] for ages 19-54 years 1.89 [95% confidence interval (95% CI) 1.24-2.87] and HR for ages 55-69 years 1.25 [95% CI 0.84-1.87]), Hispanic ethnicity (HR 2.02 [95% CI 1.05-3.86]), household income ≥$30,000/year (HR 1.61 [95% CI 1.12-2.32]), being married or with a partner (HR 1.39 [95% CI 1.00-1.92]), and residence in rural environments (HR 1.96 [95% CI 1.28-2.99]) were associated with a higher probability of initiating biologic agents. Having no (HR 0.18 [95% CI 0.08-0.40]) or only 1-4 rheumatology visits in the year prior to interview (HR 0.60 [95% CI 0.45-0.81]) and living in an area with ≥1 federally qualified health centers (HR 0.63 [95% CI 0.41-0.96]) were associated with a lower probability. CONCLUSION The probability of initiating therapy with biologic agents is affected by sociodemographic and health system characteristics as well as the nature of the community of residence, resulting in disparities in access to these medications.
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Yelin E, Yazdany J, Trupin L. THU0445 Are Patient Ratings of Providers and Health Plans Associated with Technical Quality of Care in Sle? Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yelin E, Trupin L, Yazdany J. Are patient ratings of interactions with providers and health plans associated with technical quality of care in systemic lupus erythematosus? Arthritis Res Ther 2014. [PMCID: PMC4179542 DOI: 10.1186/ar4619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bernatsky S, Ramsey-Goldman R, Joseph L, Boivin JF, Costenbader KH, Urowitz MB, Gladman DD, Fortin PR, Nived O, Petri MA, Jacobsen S, Manzi S, Ginzler EM, Isenberg D, Rahman A, Gordon C, Ruiz-Irastorza G, Yelin E, Bae SC, Wallace DJ, Peschken CA, Dooley MA, Edworthy SM, Aranow C, Kamen DL, Romero-Diaz J, Askanase A, Witte T, Barr SG, Criswell LA, Sturfelt GK, Blanco I, Feldman CH, Dreyer L, Patel NM, Pierre YS, Clarke AE. Lymphoma risk in systemic lupus: effects of disease activity versus treatment. Ann Rheum Dis 2014; 73:138-42. [PMID: 23303389 PMCID: PMC3855611 DOI: 10.1136/annrheumdis-2012-202099] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To examine disease activity versus treatment as lymphoma risk factors in systemic lupus erythematosus (SLE). METHODS We performed case-cohort analyses within a multisite SLE cohort. Cancers were ascertained by regional registry linkages. Adjusted HRs for lymphoma were generated in regression models, for time-dependent exposures to immunomodulators (cyclophosphamide, azathioprine, methotrexate, mycophenolate, antimalarial drugs, glucocorticoids) demographics, calendar year, Sjogren's syndrome, SLE duration and disease activity. We used adjusted mean SLE Disease Activity Index scores (SLEDAI-2K) over time, and drugs were treated both categorically (ever/never) and as estimated cumulative doses. RESULTS We studied 75 patients with lymphoma (72 non-Hodgkin, three Hodgkin) and 4961 cancer-free controls. Most lymphomas were of B-cell origin. As is seen in the general population, lymphoma risk in SLE was higher in male than female patients and increased with age. Lymphomas occurred a mean of 12.4 years (median 10.9) after SLE diagnosis. Unadjusted and adjusted analyses failed to show a clear association of disease activity with lymphoma risk. There was a suggestion of greater exposure to cyclophosphamide and to higher cumulative steroids in lymphoma cases than the cancer-free controls. CONCLUSIONS In this large SLE sample, there was a suggestion of higher lymphoma risk with exposure to cyclophosphamide and high cumulative steroids. Disease activity itself was not clearly associated with lymphoma risk. Further work will focus on genetic profiles that might interact with medication exposure to influence lymphoma risk in SLE.
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Affiliation(s)
- Sasha Bernatsky
- Medicine, Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rosalind Ramsey-Goldman
- Department of Medicine/Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lawrence Joseph
- Medicine, Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Karen H Costenbader
- Medicine, Division of Rheumatology, Immunolog, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Murray B Urowitz
- Department of Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Department of Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Paul R Fortin
- Infectiologie et immunologie, Université de Laval, Quebec, Quebec, Canada
| | - Ola Nived
- Division of Rheumatology, Lund University Hospital, Lund, Sweden
| | - Michelle A Petri
- Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Soren Jacobsen
- Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susan Manzi
- Department of Medicine, West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA
| | - Ellen M Ginzler
- Division of Rheumatology, Downstate Medical Centre, State University New York, Brooklyn, New York, USA
| | - David Isenberg
- Centre for Rheumatology Research, University College London, London, UK
| | - Anisur Rahman
- Centre for Rheumatology Research, University College London, London, UK
| | - Caroline Gordon
- Rheumatology Research Group, University of Birmingham, Birmingham, UK
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Hospital Universitario Cruces, University of the Basque Country, Bizkaia, Spain
| | - Edward Yelin
- Medicine, Division of Rheumatology, University of California, San Francisco, California, USA
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Daniel J Wallace
- Department of Medicine, Cedars-Sinai Medical Center/David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Christine A Peschken
- Medicine, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary Anne Dooley
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steven M Edworthy
- Division of Rheumatology, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia Aranow
- Center for Autoimmune and Musculoskeletal, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Diane L Kamen
- Division of Immunology and Rheumatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Juanita Romero-Diaz
- Division of Rheumatology and Immunology, Instituto Nacional de Cs Medicas y Nutricion, Mexico City, Mexico
| | - Anca Askanase
- Department of Medicine, Hospital for Joint Diseases, New York University, New York, New York, USA
| | - Torsten Witte
- Division of Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
| | - Susan G Barr
- Division of Rheumatology, University of Calgary, Calgary, Alberta, Canada
| | - Lindsey A Criswell
- Rosalind Russell Medical Research Center for Arthritis, Department of Medicine, University of California, San Francisco, California, USA
| | | | - Irene Blanco
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Candace H Feldman
- Medicine, Division of Rheumatology, Immunolog, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Lene Dreyer
- Department of Rheumatology, Rigshospitalet and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Neha M Patel
- Division of Rheumatology, Downstate Medical Centre, State University New York, Brooklyn, New York, USA
| | - Yvan St Pierre
- Medicine, Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ann E Clarke
- Medicine, Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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Margaretten ME, Katz P, Schmajuk G, Yelin E. Missed opportunities for depression screening in patients with arthritis in the United States. J Gen Intern Med 2013; 28:1637-42. [PMID: 23897128 PMCID: PMC3832729 DOI: 10.1007/s11606-013-2541-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/03/2013] [Accepted: 06/03/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Arthritis affects 20 % of the adult US population and is associated with comorbid depression. Depression screening guidelines have been endorsed for high-risk groups, including persons with arthritis, in the hopes that screening will increase recognition and use of appropriate interventions. OBJECTIVE To examine national rates of depression and depression screening for patients with arthritis between 2006 and 2010. PARTICIPANTS AND DESIGN We used nationally representative cross-sections of ambulatory visits in the United States from the National Ambulatory Medical Care Survey from 2006 to 2010, which included 18,507 visits with a diagnosis of arthritis. When weighted to the US population, this total represents approximately 644 million visits. MEASUREMENTS Visits where arthritis was listed among diagnoses. Outcomes were survey-weighted estimates of depression and prevalence of depression screening among patients with arthritis across patient and physician characteristics. KEY RESULTS Of the 644,419,374 visits with arthritis listed, 83,574,127 (13 %) were associated with a comorbid diagnosis of depression. The odds ratio for comorbid depression with arthritis was 1.42 (95 % CI 1.3, 1.5). Depression screening occurred at 3,835,000 (1 %) visits associated with arthritis. When examining the rates of depression screening between ambulatory visits with and without arthritis listed, there was no difference in depression screening rates; both were approximately 1 %. There was no difference in screening rates by provider type. Compared to visits with other common, chronic conditions, the prevalence of depression at arthritis visits was high (13 per 100 visits), although the prevalence of depression screening at arthritis visits was low (0.68 per 100 visits). CONCLUSIONS Despite the high prevalence of depression with arthritis, screening for depression was performed at few arthritis visits, representing missed opportunities to detect a common, serious comorbidity. Improved depression screening by providers would identify affected patients, and may lead to appropriate interventions such as mental health referrals and/or treatment with anti-depressants.
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Affiliation(s)
- Mary E Margaretten
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA,
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Lu M, Bernatsky S, Ramsey-Goldman R, Petri M, Manzi S, Urowitz MB, Gladman D, Fortin PR, Ginzler EM, Yelin E, Bae SC, Wallace DJ, Jacobsen S, Dooley MA, Peschken CA, Alarcón GS, Nived O, Gottesman L, Criswell LA, Sturfelt G, Dreyer L, Lee JL, Clarke AE. Non-lymphoma hematological malignancies in systemic lupus erythematosus. Oncology 2013; 85:235-40. [PMID: 24107608 PMCID: PMC3880772 DOI: 10.1159/000350165] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 02/21/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe non-lymphoma hematological malignancies in systemic lupus erythematosus (SLE). METHODS A large SLE cohort was linked to cancer registries. We examined the types of non-lymphoma hematological cancers. RESULTS In 16,409 patients, 115 hematological cancers [including myelodysplastic syndrome (MDS)] occurred. Among these, 33 were non-lymphoma. Of the 33 non-lymphoma cases, 13 were of lymphoid lineage: multiple myeloma (n = 5), plasmacytoma (n = 3), B cell chronic lymphocytic leukemia (B-CLL; n = 3), precursor cell lymphoblastic leukemia (n = 1) and unspecified lymphoid leukemia (n = 1). The remaining 20 cases were of myeloid lineage: MDS (n = 7), acute myeloid leukemia (AML; n = 7), chronic myeloid leukemia (CML; n = 2) and 4 unspecified leukemias. Most of these malignancies occurred in female Caucasians, except for plasma cell neoplasms (4/5 multiple myeloma and 1/3 plasmacytoma cases occurred in blacks). CONCLUSIONS In this large SLE cohort, the most common non-lymphoma hematological malignancies were myeloid types (MDS and AML). This is in contrast to the general population, where lymphoid types are 1.7 times more common than myeloid non-lymphoma hematological malignancies. Most (80%) multiple myeloma cases occurred in blacks; this requires further investigation.
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Affiliation(s)
- Mary Lu
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sasha Bernatsky
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Rosalind Ramsey-Goldman
- Department of Medicine/Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Manzi
- Department of Medicine, West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA
| | - Murray B. Urowitz
- Department of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Dafna Gladman
- Department of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Paul R. Fortin
- Division of Rheumatology, CHU de Québec and Université Laval, Quebec City, Quebec, Canada
| | - Ellen M. Ginzler
- Division of Rheumatology, Downstate Medical Center, State University of New York, Brooklyn, NY, USA
| | - Edward Yelin
- Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Sang-Cheol Bae
- The Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea
| | - Daniel J. Wallace
- Cedars-Sinai Medical Center/David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Soren Jacobsen
- Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mary Anne Dooley
- Department of Rheumatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Graciela S. Alarcón
- Department of Rheumatology, The University of Alabama, Birmingham, Alabama, USA
| | - Ola Nived
- Department of Rheumatology, Lund University Hospital, Lund, Sweden
| | - Lena Gottesman
- Division of Rheumatology, Downstate Medical Center, State University of New York, Brooklyn, NY, USA
| | - Lindsey A. Criswell
- Rosalind Russell Medical Research Center for Arthritis, Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Gunnar Sturfelt
- Department of Rheumatology, Lund University Hospital, Lund, Sweden
| | - Lene Dreyer
- Department of Rheumatology, Rigshospitalet and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark”
| | - Jennifer L. Lee
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ann E. Clarke
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
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Tessier Cloutier B, Clarke AE, Ramsey-Goldman R, Wang Y, Foulkes W, Gordon C, Hansen JE, Yelin E, Urowitz MB, Gladman D, Fortin PR, Wallace DJ, Petri M, Manzi S, Ginzler EM, Labrecque J, Edworthy S, Dooley MA, Senécal JL, Peschken CA, Bae SC, Isenberg D, Rahman A, Ruiz-Irastorza G, Hanly JG, Jacobsen S, Nived O, Witte T, Criswell LA, Barr SG, Dreyer L, Sturfelt G, Bernatsky S. Breast cancer in systemic lupus erythematosus. Oncology 2013; 85:117-21. [PMID: 23887245 DOI: 10.1159/000353138] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 05/14/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Evidence points to a decreased breast cancer risk in systemic lupus erythematosus (SLE). We analyzed data from a large multisite SLE cohort, linked to cancer registries. METHODS Information on age, SLE duration, cancer date, and histology was available. We analyzed information on histological type and performed multivariate logistic regression analyses of histological types according to age, SLE duration, and calendar year. RESULTS We studied 180 breast cancers in the SLE cohort. Of the 155 cases with histology information, 11 were referred to simply as 'carcinoma not otherwise specified'. In the remaining 144 breast cancers, the most common histological type was ductal carcinoma (n = 95; 66%) followed by lobular adenocarcinoma (n = 11; 8%), 15 cancers were of mixed histology, and the remaining ones were special types. In our regression analyses, the independent risk factors for lobular versus ductal carcinoma was age [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.01-1.14] and for the 'special' subtypes it was age (OR 1.06, 95% CI 1.01-1.10) and SLE duration (OR 1.05, 95% CI 1.00-1.11). CONCLUSIONS Generally, up to 80% of breast cancers are ductal carcinomas. Though our results are not definitive, in the breast cancers that occur in SLE, there may be a slight decrease in the ductal histological type. In our analyses, age and SLE duration were independent predictors of histological status.
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Affiliation(s)
- B Tessier Cloutier
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Que., Canada
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Abstract
OBJECTIVES To determine whether pain predicts future activity of daily living (ADL) disability or death in individuals aged 60 and older. DESIGN Prospective cohort study. SETTING The 1998 to 2008 Health and Retirement Study (HRS), a nationally representative study of older community-living individuals. PARTICIPANTS Twelve thousand six hundred thirty-one participants in the 1998 HRS aged 60 and older who did not need help in any ADL. MEASUREMENTS Participants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of ADL disability or death over 10 yrs, assessed at five successive 2-year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2-year interval using only participants who started the interval with no ADL disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations (ADL difficulty and difficulty with five measures of mobility). RESULTS At baseline, 2,283 (18%) participants had significant pain. Participants with pain were more likely (all P < .001) to be female (65% vs 54%), have ADL difficulty (e.g., transferring 12% vs 2%, toileting 11% vs 2%), have difficulty walking several blocks (60% vs 21%), and have difficulty climbing one flight of stairs (40% vs 12%). Over 10 years, participants with pain were more likely to develop ADL disability or death (58% vs 43%, unadjusted hazard ratio (HR) = 1.67, 95% confidence interval (CI) = 1.57-1.79), although after adjustment for confounders, participants with pain were not at greater risk for ADL disability or death (HR = 0.98, 95% CI = 0.91-1.07). Adjustment for functional status almost entirely explained the difference between the unadjusted and adjusted results. CONCLUSION Although there are strong cross-sectional relationships between pain and functional limitations, individuals with pain are not at higher risk of subsequent disability or death after accounting for functional limitations. Like many geriatric syndromes, pain and disability may represent interrelated phenomena that occur simultaneously and require unified treatment paradigms.
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Affiliation(s)
- James S Andrews
- School of Medicine, Division of Geriatrics, University of California at San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
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Murphy LB, Yelin E. Introduction to special issue of best practices in rheumatology: health economics of musculoskeletal diseases. Best Pract Res Clin Rheumatol 2013; 26:559-60. [PMID: 23218422 DOI: 10.1016/j.berh.2012.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2012] [Indexed: 10/27/2022]
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Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterised by variable and unpredictable manifestations that can severely affect a person's physical and mental well-being, social life and ability to acquire and maintain gainful employment. Damage to vital organs may ensue as a result of the disease itself or as a consequence of treatment, and patients often consume substantial health-care resources and incur considerable health-care costs. Furthermore, SLE tends to affect women in young and middle adulthood, at a time in their lives when they are usually most actively engaged in the workforce, and can have important consequences with respect to acquiring and maintaining employment and advancing in one's career. A number of studies have attempted to assess the health-care costs (direct costs) associated with SLE, the effects of SLE on employment and the associated costs due to decreases in work productivity (indirect costs). In this article, we review a number of recent studies that have added to our current understanding of the economic burden of SLE.
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Affiliation(s)
- Pantelis Panopalis
- McGill University Health Centre (Montreal General Hospital), 1650 Cedar Avenue, Montreal, Quebec, Canada H3G 1A4.
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Solomon DH, Yelin E, Katz JN, Lu B, Shaykevich T, Ayanian JZ. Treatment of rheumatoid arthritis in the Medicare Current Beneficiary Survey. Arthritis Res Ther 2013; 15:R43. [PMID: 23506671 PMCID: PMC3672709 DOI: 10.1186/ar4201] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 02/14/2013] [Indexed: 01/12/2023] Open
Abstract
Introduction Numerous studies across different health systems have documented that many patients with rheumatoid arthritis (RA) do not receive disease-modifying anti-rheumatic drugs (DMARDs). Relatively little is known about correlates of DMARD use and whether there are socioeconomic and demographic disparities. We examined DMARD use during 2001 to 2006 in the Medicare Current Beneficiary Survey (MCBS), a longitudinal US survey of randomly selected Medicare beneficiaries. Methods Participants in MCBS with RA were included in the analyses, and DMARD use was based on an in-home assessment of all medications. Variables included as potential correlates of DMARD use in weighted regression models included race/ethnicity, insurance, income, education, rheumatology visit, region, age, gender, comorbidity index, and calendar year. Results The cohort consisted of 509 MCBS participants with a diagnosis code for RA. Their median age was 70 years, 72% were female, and 24% saw a rheumatologist. Rates of DMARD use ranged from 37% among those <75 years of age to 25% of those age 75 to 84 and 4% of those age 85 and older. The multivariable adjusted predictors of DMARD use include: visit with a rheumatologist in the prior year (odds ratio, OR, 7.74, 95% CI, 5.37, 11.1) and older patient age (compared with <75 years, ages 75 to 84, OR 0.58, 95% CI 0.37, 0.92, and 85 and over, OR 0.09, 95% CI 0.02, 0.31). In those without a rheumatology visit, lower income and older age were associated with a significantly reduced probability of DMARD use; no association of DMARD use with income or age was observed for subjects seen by rheumatologists. Race and ethnicity were not significantly associated with receipt of DMARDs. Conclusions Among individuals not seeing rheumatologists, lower income and older age were associated with a reduced probability of DMARD use.
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Yazdany J, Schmajuk G, Robbins M, Daikh D, Beall A, Yelin E, Barton J, Carlson A, Margaretten M, Zell J, Gensler LS, Kelly V, Saag K, King C. Choosing wisely: the American College of Rheumatology's Top 5 list of things physicians and patients should question. Arthritis Care Res (Hoboken) 2013; 65:329-39. [PMID: 23436818 PMCID: PMC4106486 DOI: 10.1002/acr.21930] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 12/10/2012] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We sought to develop a list of 5 tests, treatments, or services commonly used in rheumatology practice whose necessity or value should be questioned and discussed by physicians and patients. METHODS We used a multistage process combining consensus methodology and literature reviews to arrive at the American College of Rheumatology's (ACR) Top 5 list. Rheumatologists from diverse practice settings generated items using the Delphi method. Items with high content agreement and perceived high prevalence advanced to a survey of ACR members, who comprise >90% of the US rheumatology workforce. To increase the response rate, a nested random sample of 390 rheumatologists received more intensive survey followup. The samples were combined and weighting procedures were applied to ensure generalizability. Items with high ratings underwent literature review. Final items were then selected and formulated by the task force. RESULTS One hundred five unique items were proposed and narrowed down to 22 items during the Delphi rounds. A total of 1,052 rheumatologists (17% of those contacted) participated in the member-wide survey, whereas 33% of those in the nested random sample participated; respondent characteristics were similar in both samples. Based on survey results and available scientific evidence, 5 items (relating to antinuclear antibodies, Lyme disease, magnetic resonance imaging, bone absorptiometry, and biologic therapy for rheumatoid arthritis) were selected for inclusion. CONCLUSION The ACR Top 5 list is intended to promote discussions between physicians and patients about health care practices in rheumatology whose use should be questioned and to assist rheumatologists in providing high-value care.
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Affiliation(s)
- Jinoos Yazdany
- Division of Rheumatology, University of California, San Francisco, Box 0920, San Francisco, CA 94143-0920, USA.
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Bernatsky S, Ramsey-Goldman R, Labrecque J, Joseph L, Boivin JF, Petri M, Zoma A, Manzi S, Urowitz MB, Gladman D, Fortin PR, Ginzler E, Yelin E, Bae SC, Wallace DJ, Edworthy S, Jacobsen S, Gordon C, Dooley MA, Peschken CA, Hanly JG, Alarcón GS, Nived O, Ruiz-Irastorza G, Isenberg D, Rahman A, Witte T, Aranow C, Kamen DL, Steinsson K, Askanase A, Barr S, Criswell LA, Sturfelt G, Patel NM, Senécal JL, Zummer M, Pope JE, Ensworth S, El-Gabalawy H, McCarthy T, Dreyer L, Sibley J, St Pierre Y, Clarke AE. Cancer risk in systemic lupus: an updated international multi-centre cohort study. J Autoimmun 2013; 42:130-5. [PMID: 23410586 DOI: 10.1016/j.jaut.2012.12.009] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 11/23/2012] [Accepted: 12/13/2012] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To update estimates of cancer risk in SLE relative to the general population. METHODS A multisite international SLE cohort was linked with regional tumor registries. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers. RESULTS Across 30 centres, 16,409 patients were observed for 121,283 (average 7.4) person-years. In total, 644 cancers occurred. Some cancers, notably hematologic malignancies, were substantially increased (SIR 3.02, 95% confidence interval, CI, 2.48, 3.63), particularly non-Hodgkin's lymphoma, NHL (SIR 4.39, 95% CI 3.46, 5.49) and leukemia. In addition, increased risks of cancer of the vulva (SIR 3.78, 95% CI 1.52, 7.78), lung (SIR 1.30, 95% CI 1.04, 1.60), thyroid (SIR 1.76, 95% CI 1.13, 2.61) and possibly liver (SIR 1.87, 95% CI 0.97, 3.27) were suggested. However, a decreased risk was estimated for breast (SIR 0.73, 95% CI 0.61-0.88), endometrial (SIR 0.44, 95% CI 0.23-0.77), and possibly ovarian cancers (0.64, 95% CI 0.34-1.10). The variability of comparative rates across different cancers meant that only a small increased risk was estimated across all cancers (SIR 1.14, 95% CI 1.05, 1.23). CONCLUSION These data estimate only a small increased risk in SLE (versus the general population) for cancer over-all. However, there is clearly an increased risk of NHL, and cancers of the vulva, lung, thyroid, and possibly liver. It remains unclear to what extent the association with NHL is mediated by innate versus exogenous factors. Similarly, the etiology of the decreased breast, endometrial, and possibly ovarian cancer risk is uncertain, though investigations are ongoing.
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Affiliation(s)
- Sasha Bernatsky
- McGill University Health Centre, 687 Pine Avenue, V Building, Montreal, Quebec H3A 1A1, Canada.
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Richman IB, Taylor KE, Chung SA, Trupin L, Petri M, Yelin E, Graham RR, Lee A, Behrens TW, Gregersen PK, Seldin MF, Criswell LA. European genetic ancestry is associated with a decreased risk of lupus nephritis. ACTA ACUST UNITED AC 2013; 64:3374-82. [PMID: 23023776 DOI: 10.1002/art.34567] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE African Americans, East Asians, and Hispanics with systemic lupus erythematosus (SLE) are more likely to develop renal disease than are SLE patients of European descent. This study was undertaken to investigate whether European genetic ancestry protects against the development of lupus nephritis, with the aim of exploring the genetic and socioeconomic factors that might explain this effect. METHODS This was a cross-sectional study of SLE patients from a multiethnic case collection. Participants were genotyped for 126 single-nucleotide polymorphisms (SNPs) informative for ancestry. A subset of participants was also genotyped for 80 SNPs in 14 candidate genes for renal disease in SLE. Logistic regression was used to test the association between European ancestry and renal disease. Analyses were adjusted for continental ancestries, socioeconomic status (SES), and candidate genes. RESULTS Participants (n = 1,906) had, on average, 62.4% European, 15.8% African, 11.5% East Asian, 6.5% Amerindian, and 3.8% South Asian ancestry. Among the participants, 656 (34%) had renal disease. A 10% increase in the proportion of European ancestry estimated in each participant was associated with a 15% reduction in the odds of having renal disease, after adjustment for disease duration and sex (odds ratio 0.85, 95% confidence interval 0.82-0.87; P = 1.9 × 10(-30) ). Adjustment for other genetic ancestries, measures of SES, or SNPs in the genes most associated with renal disease (IRF5 [rs4728142], BLK [rs2736340], STAT4 [rs3024912], and HLA-DRB1*0301 and DRB1*1501) did not substantively alter this relationship. CONCLUSION European ancestry is protective against the development of renal disease in SLE, an effect that is independent of other genetic ancestries, candidate risk alleles, and socioeconomic factors.
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Murphy LB, Yelin E, Theis KA. Compromised access to prescriptions and medical care because of cost among US adults with arthritis. Best Pract Res Clin Rheumatol 2012; 26:677-94. [PMID: 23218431 DOI: 10.1016/j.berh.2012.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Study objectives were to: 1) determine the magnitude of three outcomes (prescription unaffordable, care delayed and needed care not obtained) related to cost-attributable compromised medical care access among US adults ≥18 years with and without arthritis and 2) identify US adults with arthritis with the highest levels of these outcomes. MATERIALS AND METHODS We analysed 2009-2011 US National Health Interview Survey data and estimated prevalence of outcomes by arthritis status and, among people with arthritis, by socio-demographic, medical care access and health status characteristics. Unadjusted and multivariable (MV) adjusted (prevalence ratios) PRs quantified associations between each outcome and arthritis status, and, among people with arthritis, selected characteristics. Number and proportion of adults with arthritis without health insurance coverage were estimated. RESULTS Outcomes were more prevalent (statistically-significant) among those with arthritis than those without: prescription unaffordable = 14% (9%), care delayed = 14% (11%) and needed care not obtained = 11% (8%). Outcomes were marginally more likely (statistically significant) among adults with arthritis than those without (range MV PRs = 1.2-1.3). Among those with arthritis, the uninsured had the highest prevalence of, and were most likely to have, each outcome (MV PRs: prescription unaffordable = 3.6 (95% confidence interval [CI] = 3.6-4.4), delayed care = 4.7 (95% CI = 3.9-5.7) and needed care not obtained = 5.9 (95% CI = 4.7-7.5) (referent: those with both public and private coverage)). An estimated 4.5 million adults with arthritis were uninsured. CONCLUSIONS Cost-attributable compromised access is common among US adults with arthritis; they are also slightly more likely than those without arthritis to have compromised care. Compromised access is highest among the uninsured. For those with limited access, convenient, inexpensive and proven community-based strategies that improve physical and psychosocial health may be especially practical.
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Affiliation(s)
- Louise B Murphy
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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