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Wang H, Alanis N, Haygood L, Swoboda TK, Hoot N, Phillips D, Knowles H, Stinson SA, Mehta P, Sambamoorthi U. Using natural language processing in emergency medicine health service research: A systematic review and meta-analysis. Acad Emerg Med 2024. [PMID: 38757352 DOI: 10.1111/acem.14937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES Natural language processing (NLP) represents one of the adjunct technologies within artificial intelligence and machine learning, creating structure out of unstructured data. This study aims to assess the performance of employing NLP to identify and categorize unstructured data within the emergency medicine (EM) setting. METHODS We systematically searched publications related to EM research and NLP across databases including MEDLINE, Embase, Scopus, CENTRAL, and ProQuest Dissertations & Theses Global. Independent reviewers screened, reviewed, and evaluated article quality and bias. NLP usage was categorized into syndromic surveillance, radiologic interpretation, and identification of specific diseases/events/syndromes, with respective sensitivity analysis reported. Performance metrics for NLP usage were calculated and the overall area under the summary of receiver operating characteristic curve (SROC) was determined. RESULTS A total of 27 studies underwent meta-analysis. Findings indicated an overall mean sensitivity (recall) of 82%-87%, specificity of 95%, with the area under the SROC at 0.96 (95% CI 0.94-0.98). Optimal performance using NLP was observed in radiologic interpretation, demonstrating an overall mean sensitivity of 93% and specificity of 96%. CONCLUSIONS Our analysis revealed a generally favorable performance accuracy in using NLP within EM research, particularly in the realm of radiologic interpretation. Consequently, we advocate for the adoption of NLP-based research to augment EM health care management.
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Affiliation(s)
- Hao Wang
- Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas, USA
| | - Naomi Alanis
- Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas, USA
| | - Laura Haygood
- Health Sciences Librarian for Public Health, Brown University, Providence, Rhode Island, USA
| | - Thomas K Swoboda
- Department of Emergency Medicine, The Valley Health System, Touro University Nevada School of Osteopathic Medicine, Las Vegas, Nevada, USA
| | - Nathan Hoot
- Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas, USA
| | - Daniel Phillips
- Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas, USA
| | - Heidi Knowles
- Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas, USA
| | - Sara Ann Stinson
- Mary Couts Burnett Library, Burnett School of Medicine at Texas Christian University, Fort Worth, Texas, USA
| | - Prachi Mehta
- Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas, USA
| | - Usha Sambamoorthi
- College of Pharmacy, University of North Texas Health Science Center, Fort Worth, Texas, USA
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Hearn EB, Kehinde G, Sambamoorthi U. Food insecurity and COVID-19 vaccine hesitancy among adults in the United States (US). Vaccine 2024; 42:1723-1730. [PMID: 38355321 DOI: 10.1016/j.vaccine.2024.01.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/14/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Some documented barriers of vaccination behaviors include social determinants of health (SDoH). While there have been many devastations from COVID-19, food security has fluctuated during the pandemic. The purpose of this study is to examine the association with food insecurity and vaccine hesitancy among adults in the U.S. METHODS In response to the COVID-19 pandemic, Federal agencies created the online Household Pulse Survey (HPS) to track social outcomes of the pandemic in the U.S. We performed cross-sectional analysis with data from the HPS collected between March 30, 2022, and April 11, 2022 (Week 44) on adults (N = 6449, weighted N = 37,687,910). Vaccine hesitancy was divided into two groups: 1) probably, not sure, probably not, and definitely not receiving the vaccine, and 2) received the vaccine and definitely will get the vaccine. Food sufficiency was a binary variable (Yes/no) based on the question that best described the food eaten in the household the last 7 days. Chi-square tests and multivariable logistic regressions were conducted using replicate weights with SAS. Logistic regressions adjusted for sex, age, race and ethnicity, income, education, COVID-19 infection, health insurance, food insecurity, children <17 years, remote work, health worker status, functional status, and mental health. RESULTS During HPS Week 44, 11.2 % of represented Americans experienced food insecurity and 13.8 % were vaccine hesitant. The unadjusted odds ratio was 2.41 (95 % CI = 1.30, 4.50), suggesting adults with food insecurity were more likely to be vaccine hesitant than those with food security. After adjusting for age, sex, race and ethnicity, marital status, and COVID-19 history, the statistical significance remained (AOR = 2.14, 95 % CI = 1.15, 3.99). However, after adjusting for education, we no longer observed a significant association (AOR = 1.70, 95 % CI = 0.89, 3.34), and it remained insignificant in the fully adjusted model (AOR = 1.62, 95 % CI = 0.78, 3.34). CONCLUSION Overall, adults with food insecurity were 2.41 times as likely as those with food security to also have vaccine hesitancy. Education mediated the relationship between food insufficiency and vaccine hesitancy. Programs to improve vaccination rates need to also focus on food sufficiency.
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Affiliation(s)
| | - Ganiat Kehinde
- University of North Texas Health Science Center at Fort Worth, USA
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Mitra S, Shen C, Pinnamraju J, Wiener RC, Wang H, Pathak M, Findley PA, Sambamoorthi U. Stress Due to Inflation: Changes over Time, Correlates, and Coping Strategies among Working-Age Adults in the United States. Int J Environ Res Public Health 2024; 21:157. [PMID: 38397647 PMCID: PMC10887512 DOI: 10.3390/ijerph21020157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/13/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, the annual US inflation rate increased from 1.2% in July 2020 to 8% in July 2022. It has since declined to 3.4% (December 2023). This study examined the prevalence of stress due to inflation during a period when it declined from 8.2% in September 2022 to 3% in June 2023 and its association with demographic and social determinants of health (SDOH). METHODS We conducted a cross-sectional analysis of the online Household Pulse Survey (HPS), which surveils the experiences of US households. Beginning September 2022, HPS initiated data collection on "stress due to inflation" through a question on how stressful the increase in prices in the last 2 months has been. Participants could respond: very, moderately, a little, or not stressful. We analyzed data on working-age adults (18-64 years) who responded to the above question of stress due to inflation during 14-26 September 2022 (N = 32,579) and 7-19 June 2023 (N = 36,229). We used replicate weights in chi-squared tests and ordinal logistic regression analyses controlling for gender, age, race and ethnicity, COVID-19, COVID-19 vaccination, health insurance, and SDOH, including education, lost employment income, poverty status, marital status, food affordability, and region. RESULTS The prevalence of stress due to inflation (price increases being very or moderately stressful) significantly increased from 76.9% in September 2022 to 78.9% in June 2023. The odds of stress due to inflation were higher for individuals with the following characteristics: female, transgender, having income below 400% of the federal poverty line, having lost employment income, not being able to afford food, had long or acute COVID-19, and did not have a COVID-19 vaccine. CONCLUSIONS More than three quarters of working-age adults in the US experienced stress due to inflation. Despite a declining national inflation rate in recent months, stress due to inflation has significantly increased among working-age adults. Inflation-related stress warrants further research and policy attention.
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Affiliation(s)
- Sophie Mitra
- Department of Economics, Fordham University, 441 East Fordham Road, Bronx, NY 10458, USA
| | - Chan Shen
- Department of Surgery, Penn State Cancer Institute, Hershey, PA 17033, USA
| | - Jahnavi Pinnamraju
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - R. Constance Wiener
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Dental Public Health and Professional Practice, West Virginia University, Morgantown, WV 26506, USA
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, Fort Worth, TX 76104, USA
| | - Mona Pathak
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | | | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
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Wang H, Pathak M, Takami T, Wiener RC, Shen C, Sambamoorthi U. Ethnic Disparities in Patient-Centered Communication with Healthcare Providers: A Comparison of Non-Hispanic Asians and Non-Hispanic Whites. J Racial Ethn Health Disparities 2024:10.1007/s40615-023-01898-7. [PMID: 38228862 DOI: 10.1007/s40615-023-01898-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/24/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Patient-centered communication (PCC) is an important metric related to patient health outcomes. Non-Hispanic Asian (NHA) individuals reported lower PCC scores with healthcare providers than individuals of other races and ethnicities. We aim to determine the ethnic disparities in PCC and further investigate the association between PCC, individual's confidence in obtaining health-related information (health literacy), and confidence in taking care of themselves (health self-efficacy) among NHA in comparison to the Non-Hispanic White (NHW) population. METHODS This is a cross-sectional study. We used data from the Health Information National Trends Survey 5 (HINTS) cycles 1 and 3. PCC was measured using seven validated survey questions with scores ranging from 7 to 28. Individuals' health literacy and self-efficacy were accessed using two-item survey questions. Multivariable logistic regression analyses were performed to determine the association of independent factors (e.g., self-efficacy, health literacy, and race and ethnicity) with PCC. RESULTS We included 3,831 participants. Fewer NHAs (35.43%) reported high PCC scores compared to NHWs (48.99%, p = 0.0184). In fully adjusted logistic regression model, although NHAs were less likely to have high PCC scores (aOR = 0.78, 95% CI 0.46-1.32) compared to NHWs, the association was not statistically significant (p = 0.350). However, the aOR of confidence in self-efficacy associated with high PCC scores was 2.27 (95% CI 1.68-3.07, p < 0.001) and the aOR of confidence in health literacy with high PCC scores was 2.13 (95% CI 1.64-2.76, p < 0.001). CONCLUSIONS High PCC scores reported by NHA were not significantly different from those of NHW individuals in adjusted comparisons. Individual's confidence in self-efficacy and health literacy was positively associated with high PCC regardless of race and ethnicity.
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Affiliation(s)
- Hao Wang
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA.
| | - Mona Pathak
- Department of Pharmacotherapy, College of Pharmacy, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Trevor Takami
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - R Constance Wiener
- Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | - Chan Shen
- Department of Health Services Research, Penn State College of Medicine, Hershey, PA, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, TX, USA
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Neba RA, Wang H, Kolala M, Sambamoorthi U. Multimorbidity and chronic pain management with opioids and other therapies among adults in the United States: A cross-sectional study. J Multimorb Comorb 2024; 14:26335565241237889. [PMID: 38454920 PMCID: PMC10919125 DOI: 10.1177/26335565241237889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
Background Multimorbidity, defined as the concurrent presence of ≥ 2 chronic conditions, and chronic pain (i.e., pain lasting ≥3 months) often co-exist. Multimodal pain management that includes non-pharmacologic treatment and non-opioid therapy is recommended to prevent serious risks associated with opioids. Purpose Estimate the prevalence of types of pain treatment and analyze their associations with multimorbidity using a nationally representative survey in the United States (US). Methods Data was collected from the 2020 National Health Interview Survey among adults with chronic pain and chronic conditions (N= 12,028). Chronic pain management was grouped into four categories: opioid therapy; non-opioid multimodal pain treatment; pain treatment with monotherapy; and no pain treatment. Chi-square tests and multivariable multinomial logistic regressions were used to analyze the association of multimorbidity with types of pain treatment after controlling for age, sex, social determinants of health (SDoH), and lifestyle characteristics. Results Among NHIS respondents, 68% had multimorbidity. In adjusted multinomial logistic regressions with "pain management with monotherapy" as the reference group, those with multimorbidity were more likely to utilize opioids (AOR=1.63, 95% CI=1.23, 2.17). Those with severe pain were also more likely to use opioid therapy (AOR=19.36, 95% CI=13.35, 28.06) than those with little pain. Those with low income and education were less likely to have multimodal pain management without opioids. Conclusion Seven in 10 adults had multimorbidity. Those with multimorbidity reported severe pain and relied on opioids for pain control. Regardless of multimorbidity status, SDoH was associated with types of chronic pain management.
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Affiliation(s)
- Rolake A Neba
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, Fort Worth, TX, USA
| | - Misozi Kolala
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
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Kirk BO, Khan R, Davidov D, Sambamoorthi U, Misra R. Exploring facilitators and barriers to patient-provider communication regarding diabetes self-management. PEC Innov 2023; 3:100188. [PMID: 37457669 PMCID: PMC10339241 DOI: 10.1016/j.pecinn.2023.100188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
Objective Long-term type 2 diabetes management requires open communication between a patient and their provider for self-care adherence. This study explored facilitators and barriers to diabetes-specific communication in West Virginia, a medically underserved state with the highest prevalence of diabetes (16.2%) in the U.S. Methods A secondary qualitative analysis was conducted using data from semi-structured interviews (n = 34) and 4 focus groups (n = 23) with participants of a diabetes education program. Transcripts were analyzed using thematic analysis. Results Three facilitators to patient-provider communication emerged: "Patient-Provider Partnership", "Provider Accessibility", and "Empowerment Through Education". Partnership with providers, especially those who were accessible outside of scheduled appointments, and empowerment obtained through diabetes education facilitated diabetes-specific patient-provider communication. However, barriers included "Providers' Focus on 'Numbers' Rather than Patient Concerns", "Patient Lack of Preparation for Appointments", and "Providers 'Talking Down to' Patients". Conclusion The findings highlight patient- and provider-related factors that impact diabetes-specific communication. Innovation Previous interventions have trained providers in communication skills. Despite some success, challenges in implementation remain considering providers' limited time and overwhelming demands. This study suggests that diabetes education programs incorporating communication and self-advocacy skills could be a promising alternative as they can empower patients to communicate their diabetes-specific needs/preferences with providers.
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Affiliation(s)
- Brenna O. Kirk
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, 64 Medical Center Dr., Morgantown, WV 26506-9190, United States of America
| | - Raihan Khan
- Department of Health Sciences, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA 22807, United States of America
| | - Danielle Davidov
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, 64 Medical Center Dr., Morgantown, WV 26506-9190, United States of America
| | - Usha Sambamoorthi
- College of Pharmacy, University of North Texas Health Science System, Fort Worth, TX, United States of America
| | - Ranjita Misra
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, 64 Medical Center Dr., Morgantown, WV 26506-9190, United States of America
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Vishwanatha JK, Christian A, Sambamoorthi U, Thompson EL, Stinson K, Syed TA. Community perspectives on AI/ML and health equity: AIM-AHEAD nationwide stakeholder listening sessions. PLOS Digit Health 2023; 2:e0000288. [PMID: 37390116 DOI: 10.1371/journal.pdig.0000288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/30/2023] [Indexed: 07/02/2023]
Abstract
Artificial intelligence and machine learning (AI/ML) tools have the potential to improve health equity. However, many historically underrepresented communities have not been engaged in AI/ML training, research, and infrastructure development. Therefore, AIM-AHEAD (Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity) seeks to increase participation and engagement of researchers and communities through mutually beneficial partnerships. The purpose of this paper is to summarize feedback from listening sessions conducted by the AIM-AHEAD Coordinating Center in February 2022, titled the "AIM-AHEAD Community Building Convention (ACBC)." A total of six listening sessions were held over three days. A total of 977 people registered with AIM-AHEAD to attend ACBC and 557 individuals attended the listening sessions across stakeholder groups. Facilitators led the conversation based on a series of guiding questions, and responses were captured through voice and chat via the Slido platform. A professional third-party provider transcribed the audio. Qualitative analysis included data from transcripts and chat logs. Thematic analysis was then used to identify common and unique themes across all transcripts. Six main themes arose from the sessions. Attendees felt that storytelling would be a powerful tool in communicating the impact of AI/ML in promoting health equity, trust building is vital and can be fostered through existing trusted relationships, and diverse communities should be involved every step of the way. Attendees shared a wealth of information that will guide AIM-AHEAD's future activities. The sessions highlighted the need for researchers to translate AI/ML concepts into vignettes that are digestible to the larger public, the importance of diversity, and how open-science platforms can be used to encourage multi-disciplinary collaboration. While the sessions confirmed some of the existing barriers in applying AI/ML for health equity, they also offered new insights that were captured in the six themes.
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Affiliation(s)
- Jamboor K Vishwanatha
- Institute for Health Disparities, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Allison Christian
- Institute for Health Disparities, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Usha Sambamoorthi
- College of Pharmacy, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Erika L Thompson
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Katie Stinson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Toufeeq Ahmed Syed
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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Khalid S, Innes K, Umer A, Lilly C, Gross D, Sambamoorthi U. Assessment of Joint and Interactive Effects of Multimorbidity and Chronic Pain on ADRD Risk in the Elder Population. Res Sq 2023:rs.3.rs-2743755. [PMID: 37090532 PMCID: PMC10120756 DOI: 10.21203/rs.3.rs-2743755/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Objective Multimorbidity and non-cancer chronic pain conditions (NCPC) are independently linked to elevated risk for cognitive impairment and incident Alzheimer's Disease and Related Dementias (ADRD)-both - We present the study of potential joint and interactive effects of these conditions on the risk of incident ADRD in older population. Methods This retrospective-cohort study drew baseline and 2-year follow-up data from linked Medicare claims and Medicare Current Beneficiary Survey (MCBS). Baseline multimorbidity and NCPC were ascertained using claims data. ADRD was ascertained at baseline and follow-up. Results NCPC accompanied by multimorbidity (vs. absence of NCPC or multimorbidity) had a significant and upward association with incident ADRD (adjusted odds ratio (AOR): 1.72, 95% CI 1.38, 2.13, p < 0.0001). Secondary analysis by number of comorbid conditions suggested that the joint effects of NCPC and multimorbidity on ADRD risk may increase with rising number contributing chronic conditions. Interaction analyses indicated significantly elevated excess risk for incident ADRD.
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Ghani F, Wang H, Manning SE, Sambamoorthi U. Interactive association of chronic illness and food insecurity with emergency department utilization among school-age children in the United States: A cross-sectional study. Health Sci Rep 2023; 6:e1123. [PMID: 36814967 PMCID: PMC9940462 DOI: 10.1002/hsr2.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/29/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/23/2023] Open
Abstract
Background and Aims Food insecurity combined with chronic disease conditions is a risk factor for Emergency Department (ED) utilization, an indicator of poor quality of care. However, such an association is not certain among school-age children with chronic conditions. Therefore, we aim to determine the association of food insecurity, chronic conditions, and ED utilization among school-age children in the United States. Methods We analyzed the data from the 2017 Medical expenditure panel survey (MEPS) among children aged 6-17 years (N = 5518). MEPS data was released electronically by the Agency for Healthcare Research and Quality (AHRQ). We identified four groups of school-age children based on the presence of food security and chronic conditions: 1) with food insecurity and chronic conditions; 2) no food insecurity and chronic conditions; 3) with food insecurity and no chronic conditions; and 4) no food insecurity and no chronic conditions. We compared ED utilization among these four groups using incidence rate ratios (IRR) after adjusting children's age, sex, race and ethnicity, household income, insurance coverage, obesity, and geographic region using count data model, specifically multivariable Poison regression. We used SAS 9.4 and STATA 14.2 for all the data analyses. Results There were unweighted 5518 school-age children who represented weighted 50,479,419 school-age children in the final analysis. Overall, 6.0% had food insecurity with chronic conditions. These children had higher ED utilization (19.7%) than the other three groups (13.3%, 8.8%, and 7.2%, p < 0.001). The adjusted IRR of ED utilization among school-age children with food insecurity and chronic conditions was 1.90 (95% confidence interval 1.20-3.01, p = 0.007) compared with those with food security and chronic conditions. Conclusion One in 16 school-age children has both food insecurity and chronic conditions. Food insecurity was positively associated with frequent ED visits in the presence of chronic conditions. Therefore, addressing food insecurity may reduce the risk of ED visits.
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Affiliation(s)
- Farheen Ghani
- Department of Pharmacotherapy, College of PharmacyUniversity of North Texas Health Science CenterFort WorthTexasUSA
| | - Hao Wang
- Department of Emergency MedicineJPS Health NetworkFort WorthTexasUSA
| | | | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of PharmacyUniversity of North Texas Health Science CenterFort WorthTexasUSA
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Findley PA, Wiener RC, Mitra S, Wang H, Shen C, Sambamoorthi U. Whole Health in Parts: Omissions from National Data Sets. Popul Health Manag 2023; 26:22-28. [PMID: 36799933 PMCID: PMC10081708 DOI: 10.1089/pop.2022.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/18/2023] Open
Abstract
Background: The Whole Health model is a holistic approach to facilitate whole health practices by addressing (1) the physical, mental, and social health of individuals and (2) associated support systems. Several national organizations such as the Institute for Healthcare Improvement's (IHI) Age-Friendly Health Systems (AFHS) movement and, the U.S. Department of Veterans Affairs have implemented whole health frameworks with many common elements and promoted whole health practice and skills. However, implementing a Whole Health model across communities and health systems will require evidence of effectiveness. Generating evidence on the effectiveness of the Whole Health model's effect on health outcomes requires data-driven intelligence. Methods: We identified the national public-use data sets that are most often used in health research with a machine-assisted literature search of PubMed and Scopus for peer-reviewed journal articles published from 2010 through the end of 2021, including preprints, using Python [3.7]. We then assessed if the 8 most commonly used datasets include variables associated with whole health. Results: The number of publications examining whole health has increased annually in the last decade, with more than 2800 publications in 2020 alone. Since 2010, 24,811 articles have been published using 1 of these data sets. However, we also found a lack of data (ie, data set includes all of the whole health variables) to examine whole health in national data sets. Conclusions: We support a call to expand data collection and standardization of critical measures of whole health.
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Affiliation(s)
| | - R. Constance Wiener
- Department of Dental Public Health and Professional Practice, West Virginia University, Morgantown, West Virginia, USA
| | - Sophie Mitra
- Department of Economics, Research Consortium on Disability, Fordham University, Bronx, New York, USA
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, Fort Worth, Texas, USA
| | - Chan Shen
- Department of Surgery, Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, “Vashisht” Professor for Health Disparities, HEARD Scholar, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, Texas, USA
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Wang H, Shen C, Barbaro M, Ho AF, Pathak M, Dunn C, Sambamoorthi U. A Multi-Level Analysis of Individual and Neighborhood Factors Associated with Patient Portal Use among Adult Emergency Department Patients with Multimorbidity. Int J Environ Res Public Health 2023; 20:1231. [PMID: 36673986 PMCID: PMC9859180 DOI: 10.3390/ijerph20021231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Background: Patient portals tethered to electronic health records (EHR) have become vital to patient engagement and better disease management, specifically among adults with multimorbidity. We determined individual and neighborhood factors associated with patient portal use (MyChart) among adult patients with multimorbidity seen in an Emergency Department (ED). Methods: This study adopted a cross-sectional study design and used a linked database of EHR from a single ED site to patients’ neighborhood characteristics (i.e., zip code level) from the American Community Survey. The study population included all adults (age > 18 years), with at least one visit to an ED and multimorbidity between 1 January 2019 to 31 December 2020 (N = 40,544). Patient and neighborhood characteristics were compared among patients with and without MyChart use. Random-intercept multi-level logistic regressions were used to analyze the associations of patient and neighborhood factors with MyChart use. Results: Only 19% (N = 7757) of adults with multimorbidity used the patient portal. In the fully adjusted multi-level model, at the patient level, having a primary care physician (AOR = 5.55, 95% CI 5.07−6.07, p < 0.001) and health insurance coverage (AOR = 2.41, 95% CI 2.23−2.61, p < 0.001) were associated with MyChart use. At the neighborhood level, 4.73% of the variation in MyChart use was due to differences in neighborhood factors. However, significant heterogeneity existed in patient portal use when neighborhood characteristics were included in the model. Conclusions: Among ED patients with multimorbidity, one in five adults used patient portals. Patient-level factors, such as having primary care physicians and insurance, may promote patient portal use.
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Affiliation(s)
- Hao Wang
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Chan Shen
- Department of Surgery, Penn State Cancer Institute, Hershey, PA 17033, USA
| | - Michael Barbaro
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Amy F. Ho
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Mona Pathak
- Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Cita Dunn
- TCU and UNTHSC School of Medicine, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA
| | - Usha Sambamoorthi
- Texas Center for Health Disparities, Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
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Ikram M, Shaikh NF, Siddiqui ZA, Dwibedi N, Misra R, Vishwanatha JK, Sambamoorthi U. Factors associated with COVID-19-related mental health among Asian Indians in the United States. J Affect Disord Rep 2023; 11:100472. [PMID: 36624854 PMCID: PMC9812469 DOI: 10.1016/j.jadr.2023.100472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/14/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Background In the United States, the COVID-19 pandemic has caused increased mental health symptoms and mental illness. Specific subgroups such as Asian Indians in the US have also been subject to additional stressors due to unprecedented loss of lives in their home country and increased Asian hate due to the misperception that Asians are to be blamed for the spread of the SARS-CoV-2. Objective We examined the various factors including discrimination associated with COVID-19-related mental health symptoms among Asian Indians. Methods We administered an online survey between May 2021 and July 2021 using convenient and snowball sampling methods to recruit Asian Indian adults (age > 18 years, N = 289). The survey included questions on mental health and the experience with unfair treatment in day-to-day life. Descriptive analysis and logistic regressions were performed. Results Overall, 46.0% reported feeling down, depressed, or lonely and feeling nervous, tense, or worried due to the COVID-19 pandemic; 90.0% had received at least one dose of vaccination and 74.7% reported some form of discrimination. In the fully-adjusted logistic regression, age (AOR = 0.95; 95%CI- 0.92, 0.97;p < 0.01) and general health (AOR=0.84; 95%CI- 0.73, 0.97; p < 0.015) were negatively associated with mental health symptoms. Participants who experienced discrimination were more likely (AOR=1.26; 95%CI- 1.08, 1.46; p < 0.01) to report mental health symptoms. Conclusion In this highly vaccinated group of Asian Indians discriminatory behaviors were associated with mental health symptoms suggesting the need for novel institutional level policy responses to reduce anti-Asian racism.
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Affiliation(s)
- Mohammad Ikram
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], P.O. Box 9510 Morgantown, WV 26506-9510, United States
| | - Nazneen Fatima Shaikh
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], P.O. Box 9510 Morgantown, WV 26506-9510, United States
| | - Zasim Azhar Siddiqui
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], P.O. Box 9510 Morgantown, WV 26506-9510, United States
| | - Nilanjana Dwibedi
- The Janssen Pharmaceutical Companies of Johnson & Johnson, United States
| | - Ranjita Misra
- Social and Behavioral Sciences, School of Public Health, West Virginia University, PO Box 9190,3812 B HSC South, Department of Social & Behavioral Sciences, Morgantown, WV 26506, United States
| | - Jamboor K Vishwanatha
- Texas Center for Health Disparities, National Research Mentoring Network, AIM-AHEAD Coordinating Center, Texas CEAL Consortium, Institute for Health Disparities, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, United States
| | - Usha Sambamoorthi
- Pharmacotherapy Department, College of Pharmacy, University of North Texas Health Sciences Center,"Vashisht" Professor of Asian Health Disparities HEARD Scholar, United States
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Wiener RC, Findley PA, Shen C, Wang H, Mitra S, Sambamoorthi U. Cost Conversation Research. J Am Dent Assoc 2023; 154:6-7. [PMID: 36428127 DOI: 10.1016/j.adaj.2022.10.009] [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: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022]
Affiliation(s)
- R Constance Wiener
- Associate Professor and Chair, Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, WV
| | - Patricia A Findley
- Professor, MSW Director, Special Assistant to the Dean for Interprofessional Health Initiatives, Rutgers School of Social Work, New Brunswick, NJ
| | - Chan Shen
- Associate Professor, Department of Health Services Research, Penn State College of Medicine, Hershey, PA
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, Fort Worth, TX
| | - Sophie Mitra
- Department of Economics, Fordham University, Bronx, NY
| | - Usha Sambamoorthi
- Professor, Department of Pharmacotherapy, College of Pharmacy, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, TX
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14
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Shaikh NF, Shen C, LeMasters T, Dwibedi N, Ladani A, Sambamoorthi U. Prescription Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Incidence of Depression Among Older Cancer Survivors With Osteoarthritis: A Machine Learning Analysis. Cancer Inform 2023; 22:11769351231165161. [PMID: 37101728 PMCID: PMC10123903 DOI: 10.1177/11769351231165161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 03/05/2023] [Indexed: 04/28/2023] Open
Abstract
ObjectiveS This study examined prescription NSAIDs as one of the leading predictors of incident depression and assessed the direction of the association among older cancer survivors with osteoarthritis. Methods This study used a retrospective cohort (N = 14, 992) of older adults with incident cancer (breast, prostate, colorectal cancers, or non-Hodgkin's lymphoma) and osteoarthritis. We used the longitudinal data from the linked Surveillance, Epidemiology, and End Results -Medicare data for the study period from 2006 through 2016, with a 12-month baseline and 12-month follow-up period. Cumulative NSAIDs days was assessed during the baseline period and incident depression was assessed during the follow-up period. An eXtreme Gradient Boosting (XGBoost) model was built with 10-fold repeated stratified cross-validation and hyperparameter tuning using the training dataset. The final model selected from the training data demonstrated high performance (Accuracy: 0.82, Recall: 0.75, Precision: 0.75) when applied to the test data. SHapley Additive exPlanations (SHAP) was used to interpret the output from the XGBoost model. Results Over 50% of the study cohort had at least one prescption of NSAIDs. Nearly 13% of the cohort were diagnosed with incident depression, with the rates ranging between 7.4% for prostate cancer and 17.0% for colorectal cancer. The highest incident depression rate of 25% was observed at 90 and 120 cumulative NSAIDs days thresholds. Cumulative NSAIDs days was the sixth leading predictor of incident depression among older adults with OA and cancer. Age, education, care fragmentation, polypharmacy, and zip code level poverty were the top 5 predictors of incident depression. Conclusion Overall, 1 in 8 older adults with cancer and OA were diagnosed with incident depression. Cumulative NSAIDs days was the sixth leading predictor with an overall positive association with incident depression. However, the association was complex and varied by the cumulative NSAIDs days.
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Affiliation(s)
- Nazneen Fatima Shaikh
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
| | - Chan Shen
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Chan Shen, Department of Surgery, College of Medicine, The Pennsylvania State University, 700 HMC Crescent Road, Hershey, PA 17033-2360, USA.
| | - Traci LeMasters
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
| | | | - Amit Ladani
- Department of Medicine, Section of Rheumatology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Pharmacotherapy Department College of Pharmacy, “Vashisht” Professor of Health Disparities, HEARD Scholar, Institute for Health Disparities, University of North Texas Health Sciences Center, Fort Worth, TX, USA
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Neba RA, Warner M, Manning SE, Wiener RC, Sambamoorthi U. The Association of Multimorbidity With Whole Health Activities Among Adults in the United States: Evidence From the NHIS and BRFSS. Glob Adv Integr Med Health 2023; 12:27536130231156857. [PMID: 37151572 PMCID: PMC10161296 DOI: 10.1177/27536130231156857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/20/2022] [Accepted: 01/24/2023] [Indexed: 05/09/2023]
Abstract
Background Whole health is a holistic approach encompassing integrative medicine, emotional, and spiritual health and is critical to improving health outcomes among individuals with multimorbidity. Objective To examine the prevalence of Whole Health activities and the association of multimorbidity and Whole Health activities using nationally representative datasets. Methods As no single dataset has information on Whole Health self-care activities, data from the 2017 National Health Interview Survey (n = 25 134) was used to measure participants' mind-body therapy usage, sleep, mental health, and physical activity. We used the 2017 Behavioral Risk Factor Surveillance System (n = 347 029) to assess regular vegetable and/or fruit consumption. Results A significantly lower percentage of adults with multimorbidity had adequate sleep (58.2%vs.67.1%), no psychological distress (71.8%vs.82.1%), adequate physical activity (48.2%vs.62.1%), and regular vegetable and/or fruit consumption (54.2%vs.56.6%) compared to those without multimorbidity. Although lower percentages of adults with multimorbidity utilized mind-body therapies (22.9%vs.25.2%), the association was reversed when adjusted for socioeconomic factors. In the fully adjusted models, adults with multimorbidity were more likely to use mind-body therapies (AOR = 1.19, 95%CI = 1.09, 1.31). Furthermore, when adjusting for other independent variables, the associations of multimorbidity with sleep, psychological distress, and diet were exacerbated, and the association of multimorbidity with physical activity was attenuated. Conclusion Adults with multimorbidity were less likely to engage in most of the Whole Health activities except mind-body therapies compared to the no multimorbidity group. Findings suggest that adjustment for other factors such as age and socioeconomic status changed the magnitude and direction of the association of multimorbidity with Whole Health activities.
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Affiliation(s)
- Rolake A. Neba
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Mayela Warner
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sydney E. Manning
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - R. Constance Wiener
- Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
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16
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Wiener RC, Waters C, Morgan E, Findley PA, Shen C, Wang H, Sambamoorthi U. Increase in body mass index during the COVID-19 pandemic among people who smoke: An analysis of multi-site electronic health records. PLOS Glob Public Health 2023; 3:e0001474. [PMID: 37040327 PMCID: PMC10089311 DOI: 10.1371/journal.pgph.0001474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/14/2023] [Indexed: 04/12/2023]
Abstract
The effects of the COVID-19 period among people who smoke (compared by sex) are largely unknown. The purpose of this study was to compare body mass index (BMI) increase among men and women who smoked during the pandemic. We used a retrospective longitudinal, observational study design of secondary data. We used electronic health records from TriNetX network (n = 486,072) from April 13, 2020-May 5, 2022 among adults aged 18-64 who smoked and had a normal BMI prior to the pandemic. The main measure was a change of BMI from < 25 to ≥25. Risk ratio was determined between men and women with propensity score matching. Overall, 15.8% increased BMI to ≥25; 44,540 (18.3%) were women and 32,341 (13.3%) were men (Risk Ratio = 1.38, 95% CI: 1.36, 1.40; p < .0001). Adults with diabetes, hypertension, asthma, COPD or emphysema or who were women, were more likely to develop BMI≥25 during the pandemic. Women who smoked were more likely to have an increase in BMI than men who smoked during the COVID-19 period.
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Affiliation(s)
- R Constance Wiener
- Department of Dental Public Health and Professional Practice, West Virginia University, Morgantown, West Virginia, United States of America
| | - Christopher Waters
- Department of Dental Research, West Virginia University, Morgantown, West Virginia, United States of America
| | - Emily Morgan
- Research Data Services, West Virginia University, Morgantown, West Virginia, United States of America
| | - Patricia A Findley
- Rutgers School of Social Work, New Brunswick, New Jersey, United States of America
| | - Chan Shen
- Department of Health Services Research, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas, United States of America
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, Texas, United States of America
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17
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Misra R, Madhavan SS, Dhumal T, Sambamoorthi U. Prevalence and factors associated with diagnosed diabetes mellitus among Asian Indian adults in the United States. PLOS Glob Public Health 2023; 3:e0001551. [PMID: 36963049 PMCID: PMC10021922 DOI: 10.1371/journal.pgph.0001551] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023]
Abstract
Higher prevalence of diabetes mellitus (DM) has been documented among South Asians living in the United States. However, combining the south Asian subgroups into one category masks the heterogeneity in the diagnosed DM, after controlling for known protective and risk factors. We assessed the association of Asian Indian ethnicity to diagnosed DM using a nationally representative sample of 1,986 Asian Indian adults in the US compared to 109,072 Non-Hispanic Whites (NHWs) using disaggregated data from the National Health Interview Survey (2012-2016) (NHIS). 2010 US census figures were used for age-sex standardization. Age-sex adjusted prevalence of DM was 8.3% in Asian Indians as compared to 5.8% in NHW. In adjusted multivariable logistic regression models, Asian Indians had higher odds ratios of reporting diagnosed DM compared to NHWs (AOR = 1.39, 95% CI: 1.12, 1.71). This association remained strong and significant even after controlling for other risk factors in the model (AOR = 1.47, 95% CI: 1.16, 1.85). Results suggest a favorable socio-economic profile of Asian Indians was not protective on diagnosed DM. In addition, they were more likely to have diagnosed DM due to higher prevalence of obesity despite healthier behaviors of smoking and exercise.
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Affiliation(s)
- Ranjita Misra
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia, United States of America
| | - Suresh S Madhavan
- College of Pharmacy, University of North Texas System, Denton, Texas, United States of America
| | - Trupti Dhumal
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, United States of America
| | - Usha Sambamoorthi
- College of Pharmacy, University of North Texas System, Denton, Texas, United States of America
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Manning SE, Wang H, Dwibedi N, Shen C, Wiener RC, Findley PA, Mitra S, Sambamoorthi U. Association of multimorbidity with the use of health information technology. Digit Health 2023; 9:20552076231163797. [PMID: 37124332 PMCID: PMC10134133 DOI: 10.1177/20552076231163797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 02/25/2023] [Indexed: 05/02/2023] Open
Abstract
Objective To examine the association of multimorbidity with health information technology use among adults in the USA. Methods We used cross-sectional study design and data from the Health Information National Trends Survey 5 Cycle 4. Health information technology use was measured with ten variables comprising access, recent use, and healthcare management. Unadjusted and adjusted logistic and multinomial logistic regressions were used to model the associations of multimorbidity with health information technology use. Results Among adults with multimorbidity, health information technology use for specific purposes ranged from 37.8% for helping make medical decisions to 51.7% for communicating with healthcare providers. In multivariable regressions, individuals with multimorbidity were more likely to report general use of health information technology (adjusted odds ratios = 1.48, 95% confidence intervals = 1.01-2.15) and more likely to use health information technology to check test results (adjusted odds ratios = 1.85, 95% confidence intervals = 1.33-2.58) compared to adults with only one chronic condition, however, there were no significant differences in other forms of health information technology use. We also observed interactive associations of multimorbidity and age on various components of health information technology use. Compared to younger adults with multimorbidity, older adults (≥ 65 years of age) with multimorbidity were less likely to use almost all aspects of health information technology. Conclusion Health information technology use disparities by age and multimorbidity were observed. Education and interventions are needed to promote health information technology use among older adults in general and specifically among older adults with multimorbidity.
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Affiliation(s)
- Sydney E Manning
- Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, Fort Worth, TX, USA
- Hao Wang, Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, Fort Worth, TX, USA.
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Chan Shen
- Department of Health Services Research, Penn State College of Medicine, Hershey, PA, USA
- Chan Shen, Department of Health Services Research, Penn State College of Medicine, Hershey, PA, USA.
| | - R Constance Wiener
- Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | | | - Sophie Mitra
- Department of Economics, Fordham University, Bronx, NY, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, TX, USA
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Ikram M, Shaikh NF, Vishwanatha JK, Sambamoorthi U. Leading Predictors of COVID-19-Related Poor Mental Health in Adult Asian Indians: An Application of Extreme Gradient Boosting and Shapley Additive Explanations. Int J Environ Res Public Health 2022; 20:775. [PMID: 36613095 PMCID: PMC9819341 DOI: 10.3390/ijerph20010775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
During the COVID-19 pandemic, an increase in poor mental health among Asian Indians was observed in the United States. However, the leading predictors of poor mental health during the COVID-19 pandemic in Asian Indians remained unknown. A cross-sectional online survey was administered to self-identified Asian Indians aged 18 and older (N = 289). Survey collected information on demographic and socio-economic characteristics and the COVID-19 burden. Two novel machine learning techniques-eXtreme Gradient Boosting and Shapley Additive exPlanations (SHAP) were used to identify the leading predictors and explain their associations with poor mental health. A majority of the study participants were female (65.1%), below 50 years of age (73.3%), and had income ≥ $75,000 (81.0%). The six leading predictors of poor mental health among Asian Indians were sleep disturbance, age, general health, income, wearing a mask, and self-reported discrimination. SHAP plots indicated that higher age, wearing a mask, and maintaining social distancing all the time were negatively associated with poor mental health while having sleep disturbance and imputed income levels were positively associated with poor mental health. The model performance metrics indicated high accuracy (0.77), precision (0.78), F1 score (0.77), recall (0.77), and AUROC (0.87). Nearly one in two adults reported poor mental health, and one in five reported sleep disturbance. Findings from our study suggest a paradoxical relationship between income and poor mental health; further studies are needed to confirm our study findings. Sleep disturbance and perceived discrimination can be targeted through tailored intervention to reduce the risk of poor mental health in Asian Indians.
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Affiliation(s)
- Mohammad Ikram
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Robert C. Byrd Health Sciences Center [North], P.O. Box 9510, Morgantown, WV 26506-9510, USA
| | - Nazneen Fatima Shaikh
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Robert C. Byrd Health Sciences Center [North], P.O. Box 9510, Morgantown, WV 26506-9510, USA
| | - Jamboor K. Vishwanatha
- Department of Microbiology, Immunology and Genetics, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
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Ikram M, Shaikh NF, Sambamoorthi U. A Linear Decomposition Approach to Explain Excess Direct Healthcare Expenditures Associated with Pain Among Adults with Osteoarthritis. Health Serv Insights 2022; 15:11786329221133957. [PMID: 36325378 PMCID: PMC9618757 DOI: 10.1177/11786329221133957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
Objective: Many patients with osteoarthritis experience pain which can lead to higher healthcare expenditures. It is important to understand the factors that drive the excess expenditures associated with pain in osteoarthritis. Design: Cross-sectional. Study sample: Our study sample consisted of adults (age ⩾ 18 years) from the Medical Expenditure Panel Survey (MEPS, 2018). Methods: Adults who were alive during the calendar year and had pain status were included in this study (N = 2804 weighted N = 32.03 million). Osteoarthritis was identified from the medical conditions file and household file. We used multivariable ordinary least squares regression to identify the statistically significant association of pain with direct healthcare expenditures. The Blinder-Oaxaca post-linear decomposition on log-transformed total direct healthcare expenditures was used to estimate the extent to which differences in characteristics contribute to the excess expenditures associated with pain. Results: Adults with osteoarthritis and pain had higher average expenditures ($21 814 vs $10 827, P < .001; 9.318 vs 8.538 in logtransformed expenditures) compared to those without pain. Pooled regression weights explained 62.9% of excess expenditures differences in characteristics between the 2 groups. The 2 main drivers of excess healthcare expenditures among adults with osteoarthritis and pain were (i) comorbidities (diabetes, asthma, chronic obstructive pulmonary disease, depression, heart diseases, cancer, and non-cancer pain conditions and (ii) prescription medications (NSAIDs, opioids, and polypharmacy). Conclusion: Need factors such as comorbid conditions, and prescription treatment explained the excess healthcare expenditures among adults with osteoarthritis and pain. The study findings suggest that reducing polypharmacy and appropriate management of comorbid conditions may be a pathway to reduce excess expenditures among adults with osteoarthritis and pain.
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Affiliation(s)
- Mohammad Ikram
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
- Mohammad Ikram, Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], P.O. Box 9510, Morgantown, WV 26506-9510, USA. Emails: ;
| | - Nazneen Fatima Shaikh
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Pharmacotherapy Department,College of Pharmacy, “Vashisht” Professor of Health Disparities, University of North Texas Health Sciences Center, Fort Worth, TX, USA
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Misra R, Adelman MM, Kirk B, Sambamoorthi U. Relationship Among Diabetes Distress, Health Literacy, Diabetes Education, Patient-Provider Communication and Diabetes Self-Care. Am J Health Behav 2022; 46:528-540. [PMID: 36333828 DOI: 10.5993/ajhb.46.5.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Mechanisms underlying relationships among patients' health literacy, diabetes distress, diabetes education, and provider counseling for self-care of chronic conditions are unclear. This study tested these relationships using SEM with adult patients with comorbid diabetes and hypertension in rural WV. METHODS Ninety-one participants of a 12-week self-management program reported on diabetes self-care (diet, exercise, blood glucose (BG) monitoring) and related provider counseling. RESULTS Based on patient report, providers' recommendations included following a low-fat diet, eating fruits/ vegetables, limiting sweets, a daily low-level of exercise and/or exercise ≥20 minutes three times/week, and BG monitoring. Provider recommendations were shown to be associated with patients' self-care behaviors (r=0.22, p<0.05). Multiple factors directly influenced provider recommendations: diabetes distress, health literacy, and family history of diabetes. A positive association was also noted between prior diabetes education and provider recommendations and diabetes self-care (r=0.44, p<0.001). A negative association was noted between diabetes distress and self-care, but a positive effect on provider recommendations was found. The model demonstrated good fit [CFI=0.94, and Root Mean Square Error of Approximation (RMSEA) =0.05]. CONCLUSIONS To enhance diabetes self-care, providers should consistently provide education on self-care behaviors as well as partner with them to address diabetes distress.
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Affiliation(s)
- Ranjita Misra
- Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV
| | - Megan M Adelman
- Cleveland Clinic Akron General - Center for Family Medicine, Akron, OH
| | - Brenna Kirk
- Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV
| | - Usha Sambamoorthi
- College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX
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Wiener RC, Findley PA, Shen C, Dwibedi N, Sambamoorthi U. Acculturation and dental sealant use among US children. Community Dent Oral Epidemiol 2022; 50:367-374. [PMID: 34251694 PMCID: PMC8752649 DOI: 10.1111/cdoe.12678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/26/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Healthcare (including dental care) service use is influenced by predisposing, enabling and need factors. One area with limited research is the association of acculturation (defined as behavioural changes in the adaptation to another culture) as a predisposing factor for dental care preventive service use. Preventive service use is a primary objective of Healthy People, 2030. The purpose of this study was to determine the association of acculturation with the preventive dental service use of dental pit-and-fissure sealant placement, among children in the United States, ages 6-18 years. METHODS A cross-sectional, secondary data analysis study was completed using National Health and Nutrition Examination Survey (NHANES), 2013-2016 data. NHANES is a nationally representative survey of noninstitutionalized individuals across the United States. In the data set, children, ages 6-18 years, had been evaluated for pit-and-fissure dental sealant use. Information that served as proxies for acculturation was length of stay in the United States (a citizen at the time of the survey; not a citizen and in the country <5 years; or not a citizen and in the country ≥5 years) and whether English was spoken at home (yes; no). Data were analysed for descriptive statistics. Multivariable logistic regressions were used to examine strength of the associations. Odds ratios for pit-and-fissure sealants among groups were determined. RESULTS There were 2220 children participants whose data were used for this study. Less than half (45.5%) had received dental pit-and-fissure sealants. A majority (53.3%) were white and were ages 12-18 years (51.6%). The mean number of dental pit-and-fissure sealants among all children was 5.5. There was a lower percentage of children living in the United States <5 years who had received pit-and-fissure sealants than children who were citizens of the United States (22.2% vs 48.9%, respectively). The adjusted odds ratio was lower for dental pit-and-fissure sealants among children who were in the United States <5 years than children who were citizens of the United States (adjusted odds ratio, 0.38; 95% Confidence Interval: 0.24, 0.58). CONCLUSIONS In this study, children who had lived in the United States <5 years were less likely to have pit-and-fissure sealants than children who were citizens of the United States. There is a need to reach all children with preventive services to improve dental quality of life, reduce the need for dental restorations and decrease overall financial burden regardless of time in the United States.
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Affiliation(s)
- R Constance Wiener
- Department of Dental Practice and Rural Health, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | | | - Chan Shen
- Penn State College of Medicine, Hershey, PA, USA
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], Morgantown, WV, USA
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Kaholokula JK, AuYoung M, Chau M, Sambamoorthi U, Carson S, Thao C, Nguyen M, Alo A, Riklon S, Lepule T, Ma GX. Unified in Our Diversity to Address Health Disparities Among Asian Americans, Native Hawaiians, and Pacific Islanders. Health Equity 2022; 6:540-545. [PMID: 36186617 PMCID: PMC9518805 DOI: 10.1089/heq.2022.0034] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic disproportionately impacted Asian Americans, Native Hawaiians, and Pacific Islanders (AA/NHPIs) in the United States. AA/NHPIs have historically been subjected to discrimination, which was exacerbated by the pandemic. To bring attention to their unique concerns, an AA/NHPI Interest Group of the National Institutes of Health Community Engagement Alliance Against COVID-19 Disparities (CEAL) was formed. This article highlights major concerns raised by the Interest Group: The pervasive and arbitrary practice of data aggregation by public health agencies and health-related researchers, the lack of culturally responsive services in the context of cultural safety, and leadership underrepresentation.
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Affiliation(s)
- Joseph Keawe‘aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawai'i, USA
| | - Mona AuYoung
- Department of General Internal Medicine and Health Services Research, University of California, Los Angeles, California, USA
| | - Michelle Chau
- Department of Population Health, Grossman School of Medicine, New York University, New York City, New York, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy and Texas Center for Health Disparities, University of North Texas Health Sciences Center, Fort Worth, Texas, USA
| | - Savanna Carson
- Department of General Internal Medicine and Health Services Research, University of California, Los Angeles, California, USA
| | - Chia Thao
- Department of Public Health, University of California, Merced, California, USA
| | - May Nguyen
- Department of Health Systems and Population Health Sciences, College of Medicine, University of Houston College of Medicine, Houston, Texas, USA
| | - Audrey Alo
- Pacific Islander Health Partnership, Garden Grove, California, USA
| | - Sheldon Riklon
- Department of Family and Preventive Medicine and Center for Pacific Islander Health, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA
| | - Tana Lepule
- Pacific Islander Collective of San Diego, San Diego, California, USA
| | - Grace X. Ma
- Department of Urban Health and Population Science, Center for Asian Health and Fox Chase Cancer Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
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Siddiqui ZA, Sambamoorthi U. Psychological Distress Among Asian Indians and Non-Hispanic Whites in the United States. Health Equity 2022; 6:516-526. [PMID: 36186615 PMCID: PMC9518809 DOI: 10.1089/heq.2021.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: The prevalence of psychological distress (PD) among Asian Indians is unknown. This study estimated and compared moderate–serious PD in Asian Indians and non-Hispanic Whites (NHWs) in the United States. Methods: We used a cross-sectional design using the National Health Interview Survey (2012–2017). Adult (age >18 years) NHWs and Asian Indians (N=2,218) were included. PD was measured using the six-item Kessler (K6) scale. We used multivariable logistic regression to determine the association of Asian Indian ethnicity with PD. Results: In the analysis, 19.9% of NHWs and 11.0% of Asian Indians reported moderate–serious PD. Asian Indians were less likely to report PD in both unadjusted (unadjusted odds ratio=0.50; 95% confidence interval [CI]=0.42–0.58) and fully adjusted (adjusted odds ratio=0.7; 95% CI 0.59–0.82) models. Conclusions: Asian Indians had a lower prevalence of PD than NHWs, likely due to multiple protective factors such as high socioeconomic status and lower multimorbidity.
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Affiliation(s)
- Zasim Azhar Siddiqui
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center, Morgantown, West Virginia, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center, Morgantown, West Virginia, USA
- Department of Pharmacotherapy, College of Pharmacy, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, Texas, USA
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25
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Wang H, Manning SE, Ho AF, Sambamoorthi U. Factors Associated with Reducing Disparities in Electronic Personal Heath Records Use Among Non-Hispanic White and Hispanic Adults. J Racial Ethn Health Disparities 2022; 10:1201-1211. [PMID: 35476224 DOI: 10.1007/s40615-022-01307-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/09/2022] [Revised: 04/08/2022] [Accepted: 04/16/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Personal health records (PHR) use has improved individuals' health outcomes. The adoption of PHR remains low with documented racial disparities. We aim to determine factors associated with reducing racial and ethnic disparities among Hispanic adults in PHR use. METHODS Participants included non-Hispanic White (NHW) and Hispanic adults (age ≥ 18 years) enrolled in Health Information National Trends Survey in 2018 and 2019. We identified PHR use as online medical record access in the last 12 months. We considered three factors (1. accessing mHealth Apps on the phone, 2. having a usual source of care, and 3. electronically communicating (e-communication) with healthcare providers) as facilitating PHR use. Multivariable logistic regressions with replicate weights were analyzed to determine factors associated with racial/ethnic disparities in PHR use after controlling for general characteristics (i.e., sex, age, education, insurance status, and income). RESULTS A lower percentage of Hispanics than NHWs used PHR (42.0% vs. 53.5%, P < .001). When adjusted for individual general characteristics, the adjusted odds ratio (AOR) of e-communication with healthcare providers associated with PHR use was 1.49 (1.19-1.86, P < .001), AOR was 2.06 (1.62-2.6, P < .001) on accessing to mHealth App, and 2.60 (1.86-3.63, P < .001) on having a usual source of care. However, the racial difference was not statistically significant after adjusting three factors promoting PHR use (AOR = 0.90, 95% CI = 0.66, 1.22, P = .48). CONCLUSIONS Ethnic disparities were reduced when PHR use was facilitated by having a usual source of care, active e-communication, and having access to mHealth apps. Interventions focusing on these three factors may potentially reduce racial/ethnic disparities.
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Affiliation(s)
- Hao Wang
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA.
| | - Sydney E Manning
- Department of Pharmacotherapy, Texas Center for Health Disparity, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Amy F Ho
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, Texas Center for Health Disparity, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
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26
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Shen C, Rashiwala L, Wiener RC, Findley PA, Wang H, Sambamoorthi U. The association of COVID-19 vaccine availability with mental health among adults in the United States. Front Psychiatry 2022; 13:970007. [PMID: 36016977 PMCID: PMC9395690 DOI: 10.3389/fpsyt.2022.970007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess whether COVID-19 vaccine approval and availability was associated with reduction in the prevalence of depression and anxiety among adults in the United States. METHODS We adopted cross sectional and quasi-experimental design with mental health measurements before vaccine availability (June 2020, N = 68,009) and after vaccine availability (March 2021, N = 63,932) using data from Census Pulse Survey. Depression and anxiety were derived from PHQ-2 and GAD-2 questionnaires. We compared rates of depression and anxiety between June 2020 and March 2021. Unadjusted and adjusted analysis with replicate weights were conducted. RESULTS Depression prevalence was 25.0% in June 2020 and 24.6% in March 2021; anxiety prevalence was 31.7% in June 2020 and 30.0% in March 2021 in the sample. In adjusted analysis, there were no significant differences in likelihood of depression and anxiety between June 2020 and March 2021. CONCLUSION Depression and anxiety were not significantly different between June 2020 and March 2021, which suggests that the pandemic effect continues to persist even with widespread availability of vaccines.
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Affiliation(s)
- Chan Shen
- Departments of Surgery and Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Lucy Rashiwala
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - R Constance Wiener
- Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, WV, United States
| | | | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, Fort Worth, TX, United States
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, United States
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27
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Safarudin R, Ikram M, Marshal K, Shaikh N, Attal N, Dwibedi N, Sambamoorthi U. Attitudes and Beliefs of College Students towards Pain Management Modalities: Theory of Planned Behavior Approach. Chronic Pain Manag 2022; 6:147. [PMID: 36820006 PMCID: PMC9938960 DOI: 10.29011/2576-957x.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Chronic pain exhibits a burdening onset and duration in young adults. It is critical to understand appropriate pain management decision-making. Objective To investigate the associations of attitudes and beliefs of college students with their intention and behavior toward pain management modalities using the Theory of Planned Behavior (TPB). Methods In this cross-sectional online survey study, we recruited college students (age≥18 years) at West Virginia University, Morgantown, West Virginia, United States. We examined four pain management modalities: Over-the-Counter (OTC) pain medications, prescription pain medications (RX), mindfulness therapy, and yoga/exercise. Likert scales were used to assess TPB constructs (attitude, Subjective Norm [SN], Perceived Behavior Control [PBC], intention, and behavior). We analyzed the associations of the TPB constructs with both intention and behavior toward pain management modalities using multiple linear regression. Results Of the 364 returned surveys, 227 were completed and analyzed. Attitude was found to be significantly associated with the intention to use all pain management modalities, while PBC was significantly associated with the intentions to use RX, mindfulness, and yoga/exercise (RX: β = 0.38; 95%CI= 0.28, 0.84; p=<0.001, mindfulness: β=0.27; 95%CI=0.07, 0.76; p=0.019, and Yoga/exercise: β=0.35; 95%CI=0.25, 0.85; p=<0.001). Furthermore, the intention to use pain management modalities consistently predicted all behaviors (OTC: β=0.49; 95%CI=0.32, 0.76; p=<0.001, RX: β=0.47; 95%CI=0.17, 0.58; p=<0.001, Mindfulness: β=0.62; 95%CI=0.40, 0.72; p=<0.001, Yoga/Exercise: β=0.59; 95%CI=0.42, 0.84; p=<0.001). Conclusion College students' attitude and PBC were the top predictors of intention to choose pain management modalities, and intention predicted behavior. Research with robust study design is needed to confirm our study findings.
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Affiliation(s)
- Rudi Safarudin
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA,Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Tadulako University, Palu, Central Sulawesi, Indonesia,Corresponding author: Rudi Safarudin, Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Mohammad Ikram
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Kent Marshal
- West Virginia Clinical & Translational Science Institute, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Nazneen Shaikh
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Nawar Attal
- Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Nilanjana Dwibedi
- Neuroscience, The Janssen Pharmaceutical Companies of Johnson & Johnson, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, TX, USA
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Iloabuchi C, Dwibedi N, LeMasters T, Shen C, Ladani A, Sambamoorthi U. Low-value care and excess out-of-pocket expenditure among older adults with incident cancer - A machine learning approach. J Cancer Policy 2021; 30:100312. [PMID: 35559807 PMCID: PMC8916690 DOI: 10.1016/j.jcpo.2021.100312] [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] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/05/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the association of low-value care with excess out-of-pocket expenditure among older adults diagnosed with incident breast, prostate, colorectal cancers, and Non-Hodgkin's Lymphoma. METHODS We used a retrospective cohort study design with 12-month baseline and follow-up periods. We identified a cohort of older adults (age ≥ 66 years) diagnosed with breast, prostate, colorectal cancers, or Non-Hodgkin's lymphoma between January 2014 and December 2014. We assessed low-value care and patient out-of-pocket expenditure in the follow-up period. We identified relevant low-value services using ICD9/ICD10 and CPT/HCPCS codes from the linked health claims and patient out-of-pocket expenditure from Medicare claim files and expressed expenditure in 2016 USD. RESULTS About 29 % of older adults received at least one low-value care procedure during the follow-up period. Low-value care differed by gender, and rates were higher in women with colorectal cancer (32.7 %) vs. (28.8 %) and NHL (40 %) vs. (39 %) compared to men. Individuals who received one or more low-value care procedures had significantly higher mean out-of-pocket expenditure ($8,726 ± $7,214) vs. ($6,802 ± $6,102). XGBOOST, a machine learning algorithm revealed that low-value care was among the five leading predictors of OOP expenditure. CONCLUSION One in four older adults with incident cancer received low-value care in 12-months after a cancer diagnosis. Across all cancer populations, individuals who received low-value care had significantly higher out-of-pocket expenditure. Excess out-of-pocket expenditure was driven by low-value care, fragmentation of care, and an increasing number of pre-existing chronic conditions. POLICY STATEMENT This study focuses on health policy issues, specifically value-based care and its findings have important clinical and policy implications for Centers for Medicare and Medicaid Services (CMS) which has issued a roadmap for states to accelerate the adoption of value-based care, with the Department of Health and Human Services (HHS) setting a goal of converting 50 % of traditional Medicare payment systems to alternative payment models tied to value-based care by 2022.
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Affiliation(s)
- Chibuzo Iloabuchi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], P.O. Box 9510, Morgantown, WV, 26506-9510, USA.
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], P.O. Box 9510, Morgantown, WV, 26506-9510, USA.
| | - Traci LeMasters
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], P.O. Box 9510, Morgantown, WV, 26506-9510, USA.
| | - Chan Shen
- Division of Outcomes Research and Quality, Department of Surgery, College of Medicine, Pennsylvania State University, Hershey, PA, USA.
| | - Amit Ladani
- Department of Medicine, Division of Rheumatology, West Virginia University Medicine, Morgantown, WV, USA.
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, "Vashisht" Professor of Disparities, Health Education, Awareness & Research in Disparities (HEARD) Scholar, Texas Center for Health Disparities, University of North Texas Health Sciences Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
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Nili M, LeMasters TJ, Adelman M, Dwibedi N, Madhavan SS, Sambamoorthi U. Initial maintenance therapy adherence among older adults with asthma-COPD overlap. Am J Manag Care 2021; 27:463-470. [PMID: 34784138 DOI: 10.37765/ajmc.2021.88773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine the impact of initial maintenance therapy (IMT) type (inhaled corticosteroid [ICS] vs fixed-dose combination of ICS and long-acting β agonist [ICS/LABA]) on trajectories of adherence among older adults (≥ 65 years) with coexisting asthma and chronic obstructive pulmonary disease (COPD), known as asthma-COPD overlap (ACO). STUDY DESIGN We used a longitudinal, retrospective cohort design. METHODS This study used a cohort of older adults with ACO using longitudinal data from a 10% sample of Optum's Deidentified Clinformatics Data Mart. We adopted group-based trajectory modeling to identify medication adherence trajectories over 12 months. Multinomial logistic regressions were used to evaluate the unadjusted and adjusted associations of IMT medication and adherence trajectory categories. All analyses accounted for treatment option selection bias with inverse probability treatment weighting. RESULTS Of 1555 individuals, 73% of the sample used ICS/LABA for IMT. Four medication adherence trajectories were observed regardless of regimen: (1) persistent high adherence (12.0%), (2) progression to high adherence (20.8%), (3) progression to low adherence (10.5%), and (4) persistent low adherence (56.7%). Those who were initiated on ICS/LABA were less likely to have persistent low adherence (unadjusted odds ratio [OR], 0.44; 95% CI, 0.29-0.67) compared with those initiated on ICS monotherapy when "persistent high adherence" was used as the reference group. The relationship remained significant in adjusted regressions (adjusted OR, 0.38; 95% CI, 0.24-0.59). CONCLUSIONS Real-world evidence suggests that using ICS/LABA for IMT may decrease the likelihood of persistent low adherence over time among older adults with ACO compared with ICS monotherapy.
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Affiliation(s)
- Mona Nili
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center North, PO Box 9510, Morgantown, WV 26506-9510.
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30
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Khalid S, Sambamoorthi U, Umer A, Lilly CL, Gross DK, Innes KE. Increased Odds of Incident Alzheimer's Disease and Related Dementias in Presence of Common Non-Cancer Chronic Pain Conditions in Appalachian Older Adults. J Aging Health 2021; 34:158-172. [PMID: 34351824 DOI: 10.1177/08982643211036219] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a growing concern regarding the increasing prevalence of common non-cancer chronic pain conditions (NCPCs) and their possible association with Alzheimer's disease and related dementias (ADRD). However, large population-based studies are limited, especially in Appalachian and other predominantly rural, underserved populations who suffer elevated prevalence of both NCPCs and known ADRD risk factors. OBJECTIVES We investigated the relation of NCPC to risk of incident ADRD in older Appalachian Medicare beneficiaries and explored the potential mediating effects of mood and sleep disorders. METHODS Using a retrospective cohort design, we assessed the overall and cumulative association of common diagnosed NCPCs at baseline to incident ADRD in 161,573 elders ≥65 years, Medicare fee-for-service enrollees, 2013-2015. NCPCs and ADRD were ascertained using claims data. Additional competing risk for death analyses accounted for potential survival bias. MAIN FINDINGS Presence of any NCPC at baseline was associated with significantly increased odds for incident ADRD after adjustment for covariates [adjusted odds ratio (AOR) = 1.26 (1.20, 1.32), p < .0001]. The magnitude and strength of this association increased significantly with rising burden of NCPCs at baseline [AOR for ≥4 vs. no NCPC = 1.65 (1.34, 2.03), p-trend = .01]. The addition of depression and anxiety, but not sleep disorders, modestly attenuated these associations [AORs for any NCPC and ≥4 NCPCs, respectively = 1.16 (1.10, 1.22) and 1.39 (1.13, 1.71)], suggesting a partial mediating role of mood impairment. Sensitivity analyses, multinomial logistic regressions accounting for risk of death, yielded comparable findings. CONCLUSION In this large cohort of older Appalachian Medicare beneficiaries, baseline NCPCs showed a strong, positive, dose-response relationship to odds for incident ADRD; this association appeared partially mediated by depression and anxiety. Further longitudinal research in this and other high-risk, rural populations are needed to evaluate the causal relation between NCPC and ADRD.
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Affiliation(s)
- Sumaira Khalid
- Department of Epidemiology, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, 5631West Virginia University, School of Pharmacy, Morgantown, WV, USA
| | - Amna Umer
- Department of Pediatrics, 5631West Virginia University, School of Medicine, Morgantown, WV, USA
| | - Christa L Lilly
- Department of Biostatistics, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
| | - Diane K Gross
- Department of Epidemiology, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
| | - Kim E Innes
- Department of Epidemiology, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
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Misra R, Shawley-Brzoska S, Khan R, Kirk BO, Wen S, Sambamoorthi U. Addressing Diabetes Distress in Self-Management Programs: Results of a Randomized Feasibility Study. J Appalach Health 2021; 3:68-85. [PMID: 35770030 PMCID: PMC9192112 DOI: 10.13023/jah.0303.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND West Virginia ranks 1st nationally in the prevalence of hypertension (HTN; 43.8%) and diabetes (16.2%). Patients with type 2 diabetes mellitus (T2DM) are distressed over physical and psychological burden of disease self-management. METHODS This study investigated the effectiveness of an intervention to reduce diabetes distress and outcomes [glycemic control, blood pressure (BP)] among T2DM adults with comorbid HTN. Participants were randomized to a 12-week diabetes and hypertension self-management program versus a 3-month wait-listed control group. Trained health coaches and experts implemented the lifestyle program in a faith-based setting using an adapted evidence-based curriculum. Twenty adults with T2DM and HTN (n=10 per group) completed baseline and 12-week assessments. Diabetes distress was measured by using a validated Diabetes Distress Survey (17-item Likert scale; four sub-scales of emotional burden, physician related burden, regimen related burden, and interpersonal distress). Baseline and post-intervention changes in diabetes distress were compared for both groups; reduction in distress in the intervention groups are depicted using waterfall plots. The mean age, HbA1c and BMI were 55 ± 9.6 years, 7.8 ± 2.24 and 36.4 ± 8.8, respectively. Diabetes distress (total; mean) was 1.84±0.71. RESULTS Participants reported higher diabetes distress related to emotional burden (2.1±0.94) and regimen-related distress (2.0 ± 0.74); physician-related distress was the lowest (1.18±0.64). In general, diabetes distress reduced among intervention participants and was especially significant among those with HbA1c ≤ 8% (r=0.28, p=0.4), and systolic/diastolic BP ≤140/80 mm Hg (r=0.045, P=0.18). IMPLICATIONS Findings suggest that lifestyle self-management programs have the potential to reduce diabetes distress.
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Affiliation(s)
| | | | - Raihan Khan
- College of Health and Behavioral Studies, James Madison University
| | | | - Sijin Wen
- School of Public Health, West Virginia University
| | - Usha Sambamoorthi
- Texas Center for Health Disparities, University of North Texas Health Sciences Center
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Mohamed R, Patel J, Shaikh NF, Sambamoorthi U. Absenteeism-Related Wage Loss Associated With Multimorbidity Among Employed Adults in the United States. J Occup Environ Med 2021; 63:508-513. [PMID: 34048383 DOI: 10.1097/jom.0000000000002180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the incremental absenteeism-related wage loss associated with multimorbidity and examine the influence of paid sick leave policy (PSLP) on multimorbidity-associated absenteeism wage loss. METHODS We used the Medical Expenditure Panel Survey (MEPS) 2015 data. Two-part generalized linear models (GLM) were employed, using binomial distribution and gamma distribution with a log link. RESULTS Nationally, multimorbidity was associated with a $9 billion incremental absenteeism-related wage loss annually among working adults. Absenteeism-related wage loss was higher among those with multimorbidity than those without multimorbidity. The incremental annual absenteeism-related wage loss associated with multimorbidity was lower in settings that offered paid sick leave than that did not offer paid sick leaves. CONCLUSION Multimorbidity is associated with higher absenteeism-related wage loss. Paid sick leave policies can reduce the impact of multimorbidity on absenteeism-related wage loss.
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Affiliation(s)
- Rowida Mohamed
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia (Ms Mohamed, Dr Patel, Ms Shaikh, Dr Sambamoorthi); Department of Pharmacotherapy, College of Pharmacy, Vashist Professor of Health Disparities, Health Education, Awareness & Research in Disparities Scholar, Texas Center for Health Disparities, University of North Texas Health Sciences Center, Fort Worth, Texas (Dr Sambamoorthi)
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Shah D, Allen L, Zheng W, Madhavan SS, Wei W, LeMasters TJ, Sambamoorthi U. Economic Burden of Treatment-Resistant Depression among Adults with Chronic Non-Cancer Pain Conditions and Major Depressive Disorder in the US. Pharmacoeconomics 2021; 39:639-651. [PMID: 33904144 PMCID: PMC8425301 DOI: 10.1007/s40273-021-01029-2] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Major depressive disorder (MDD) and chronic non-cancer pain conditions (CNPC) often co-occur and exacerbate one another. Treatment-resistant depression (TRD) in adults with CNPC can amplify the economic burden. This study examined the impact of TRD on direct total and MDD-related healthcare resource utilization (HRU) and costs among commercially insured patients with CNPC and MDD in the US. METHODS The retrospective longitudinal cohort study employed a claims-based algorithm to identify adults with TRD from a US claims database (January 2007 to June 2017). Costs (2018 US$) and HRU were compared between patients with and without TRD over a 12-month period after TRD/non-TRD index date. Counterfactual recycled predictions from generalized linear models were used to examine associations between TRD and annual HRU and costs. Post-regression linear decomposition identified differences in patient-level factors between TRD and non-TRD groups that contributed to the excess economic burden of TRD. RESULTS Of the 21,180 adults with CNPC and MDD, 10.1% were identified as having TRD. TRD patients had significantly higher HRU, translating into higher average total costs (US$21,015TRD vs US$14,712No TRD) and MDD-related costs (US$1201TRD vs US$471No TRD) compared with non-TRD patients (all p < 0.001). Prescription drug costs accounted for 37.6% and inpatient services for 30.7% of the excess total healthcare costs among TRD patients. TRD patients had a significantly higher number of inpatient (incidence rate ratio [IRR] 1.30, 95% CI 1.14-1.47) and emergency room visits (IRR 1.21, 95% CI 1.10-1.34) than non-TRD patients. Overall, 46% of the excess total costs were explained by differences in patient-level characteristics such as polypharmacy, number of CNPC, anxiety, sleep, and substance use disorders between the TRD and non-TRD groups. CONCLUSION TRD poses a substantial direct economic burden for adults with CNPC and MDD. Excess healthcare costs may potentially be reduced by providing timely interventions for several modifiable risk factors.
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Affiliation(s)
- Drishti Shah
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, PO Box 9510, Morgantown, WV, 26506-9510, USA.
| | - Lindsay Allen
- Health Policy, Management, and Leadership Department, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Wanhong Zheng
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
| | - Suresh S Madhavan
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, PO Box 9510, Morgantown, WV, 26506-9510, USA
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, TX, USA
| | - Wenhui Wei
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, PO Box 9510, Morgantown, WV, 26506-9510, USA
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Traci J LeMasters
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, PO Box 9510, Morgantown, WV, 26506-9510, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, PO Box 9510, Morgantown, WV, 26506-9510, USA
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, TX, USA
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Patel J, Ladani A, Sambamoorthi N, LeMasters T, Dwibedi N, Sambamoorthi U. Predictors of Co-occurring Cardiovascular and Gastrointestinal Disorders among Elderly with Osteoarthritis. Osteoarthritis and Cartilage Open 2021; 3:100148. [DOI: 10.1016/j.ocarto.2021.100148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/22/2021] [Indexed: 01/22/2023] Open
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Innes KE, Sambamoorthi U. The Association of Osteoarthritis and Related Pain Burden to Incident Alzheimer's Disease and Related Dementias: A Retrospective Cohort Study of U.S. Medicare Beneficiaries. J Alzheimers Dis 2021; 75:789-805. [PMID: 32333589 DOI: 10.3233/jad-191311] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Emerging evidence suggests osteoarthritis (OA) and related symptom burden may increase risk for Alzheimer's disease and related dementias (ADRD). However, longitudinal studies are sparse, and none have examined the potential mediating effects of mood or sleep disorders. OBJECTIVE To determine the association of OA and related pain to incident ADRD in U.S. elders. METHODS In this retrospective cohort study, we used baseline and two-year follow-up data from linked Medicare claims and Medicare Current Beneficiary Survey files (11 pooled cohorts, 2001-2013). The study sample comprised 16,934 community-dwelling adults≥65 years, ADRD-free at baseline and enrolled in fee-for-service Medicare. Logistic regression was used to assess the association of OA and related pain (back, neck, joint, neuropathic) to incident ADRD, explore the mediating inlfuence of mood and insomnia-related sleep disorders, and (sensitivity analyses) account for potential survival bias. RESULTS Overall, 25.5% of beneficiaries had OA at baseline (21.0% with OA and pain); 1149 elders (5.7%) were subsequently diagnosed with ADRD. Compared to beneficiaries without OA, those with OA were significantly more likely to receive a diagnosis of incident ADRD after adjustment for sociodemographics, lifestyle characteristics, comorbidities, and medications (adjusted odds ratio (AOR) = 1.23 (95% confidence interval (CI) 1.06, 1.42). Elders with OA and pain at baseline were significantly more likely to be diagnosed with incident ADRD than were those without OA or pain (AOR = 1.31, CI 1.08, 1.58). Sensitivity analyses yielded similar findings. Inclusion of depression/anxiety, but not sleep disorders, substantially attenuated these associations. CONCLUSION Findings of this study suggest that: OA is associated with elevated ADRD risk, this association is particularly pronounced in those with OA and pain, and mood disorders may partially mediate this relationship.
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Affiliation(s)
- Kim E Innes
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
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Shah D, Zheng W, Allen L, Wei W, LeMasters T, Madhavan S, Sambamoorthi U. Using a machine learning approach to investigate factors associated with treatment-resistant depression among adults with chronic non-cancer pain conditions and major depressive disorder. Curr Med Res Opin 2021; 37:847-859. [PMID: 33686881 PMCID: PMC8393457 DOI: 10.1080/03007995.2021.1900088] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Presence of chronic non-cancer pain conditions (CNPC) among adults with major depressive disorder (MDD) may reduce benefits of antidepressant therapy, thereby increasing the possibility of treatment resistance. This study sought to investigate factors associated with treatment-resistant depression (TRD) among adults with MDD and CNPC using machine learning approaches. METHODS This retrospective cohort study was conducted using a US claims database which included adults with newly diagnosed MDD and CNPC (January 2007-June 2017). TRD was identified using a clinical staging algorithm for claims data. Random forest (RF), a machine learning method, and logistic regression was used to identify factors associated with TRD. Initial model development included 42 known and/or probable factors that may be associated with TRD. The final refined model included 20 factors. RESULTS Included in the sample were 23,645 patients (73% female mean age: 55 years; 78% with ≥2 CNPC, and 91% with joint pain/arthritis). Overall, 11.4% adults (N = 2684) met selected criteria for TRD. The five leading factors associated with TRD were the following: mental health specialist visits, polypharmacy (≥5 medications), psychotherapy use, anxiety, and age. Cross-validated logistic regression model indicated that those with TRD were younger, more likely to have anxiety, mental health specialist visits, polypharmacy, and psychotherapy use with adjusted odds ratios (AORs) ranging from 1.93 to 1.27 (all ps < .001). CONCLUSION Machine learning identified several factors that warrant further investigation and may serve as potential targets for clinical intervention to improve treatment outcomes in patients with TRD and CNPC.
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Affiliation(s)
- Drishti Shah
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Wanhong Zheng
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
| | - Lindsay Allen
- Health Policy, Management, and Leadership Department, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Wenhui Wei
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Traci LeMasters
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Suresh Madhavan
- University of North Texas Health Sciences Center, College of Pharmacy, TX, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
- University of North Texas Health Sciences Center, College of Pharmacy, TX, USA
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Nili M, Dwibedi N, Adelman M, LeMasters T, Madhavan SS, Sambamoorthi U. Economic Burden of Asthma-Chronic Obstructive Pulmonary Disease Overlap among Older Adults in the United States. COPD 2021; 18:357-366. [PMID: 33902371 DOI: 10.1080/15412555.2021.1909549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The objective of this study is to estimate the excess economic burden of Asthma-COPD Overlap (ACO) among older adults in the United States. We used a cross-sectional study design with data from a nationally representative survey of Medicare beneficiaries (Medicare Current Beneficiary Survey) linked to Medicare fee-for-service claims. Older adults with ACO had higher average total healthcare expenditures ($45,532 vs. $12,743) and higher out-of-pocket spending burden (19% vs. 8.5%) compared to those with no-asthma no-COPD (NANC). Individuals with ACO also had almost two, and 1.5 times higher expenditures compared to individuals with asthma only and COPD only, respectively. Multivariable regression models indicated that the adjusted associations of ACO to economic burden remained positive and statistically significant. In comparison with NANC, nearly three-quarters of the excess total healthcare expenditures and 83% of the out-of-pocket spending burden of older adults with ACO were explained by differences in predisposing, enabling, need, personal healthcare practices, and external factors among the two groups. The higher number of unique medications and the increased incidence of fragmented care were the leading contributors to the excess economic burden among older adults with ACO comparing to NANC individuals. Interventions that reduce the number of medications and fragmented care have the potential to reduce the excess economic burden among older adults with ACO.
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Affiliation(s)
- Mona Nili
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Megan Adelman
- Department of Clinical Pharmacy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Traci LeMasters
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - S Suresh Madhavan
- System College of Pharmacy, University of North Texas, Fort Worth, Texas, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
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Garg R, Sambamoorthi U, Tan X, Basu SK, Haggerty T, Kelly KM. Impact of Diffuse Large B-Cell Lymphoma on Mammography and Bone Density Testing in Women. J Prim Prev 2021; 42:143-162. [PMID: 33710443 DOI: 10.1007/s10935-021-00621-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Accepted: 01/09/2021] [Indexed: 11/28/2022]
Abstract
Women with diffuse large B-cell lymphoma (DLBCL) are at an increased risk of mortality from breast cancer and osteoporosis. However, the impact of DLBCL on rates of mammography and bone density testing (BDT) is unknown. We compared female DLBCL and non-cancer patients utilizing the Surveillance, Epidemiology, and End Results-Medicare dataset to analyze the predictors of mammography and BDT. Guided by the Social Ecological Model (SEM), we used multivariable logistic regressions with inverse probability treatment weighting to examine the association of intrapersonal, interpersonal, healthcare system, and community factors with mammography and BDT. The rates of mammography (59.8%) and BDT (18.5%) in women with DLBCL were similar to those without cancer (60.2% and 19.6%, respectively). After adjusting for the SEM factors, DLBCL patients were less likely to get mammography and BDT than non-cancer patients. The treatments of radiotherapy and stem cell transplant were not associated with either mammography or BDT. DLBCL diagnosis was associated with lower rates of mammography and BDT rates among women with DLBCL, as compared to non-cancer patients. To reduce the morbidity and mortality from breast cancer and fractures in women with DLBCL, providers should increase their recommendations for mammography in those receiving radiotherapy and BDT in stem cell transplant patients.
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Affiliation(s)
- Rahul Garg
- Department of Pharmacy Practice, College of Pharmacy, Chicago State University, Chicago, IL, 60628, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, 26506, USA
| | - Xi Tan
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, 26506, USA
| | - Soumit K Basu
- Center for Bone Marrow Transplantation, Geisinger Medical Center, Danville, PA, 17822, USA
| | - Treah Haggerty
- Department of Family Medicine, School of Medicine, West Virginia University, Morgantown, WV, 26506, USA
| | - Kimberly M Kelly
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, 26506, USA. .,Robert C. Byrd Health Sciences Center, School of Pharmacy, West Virginia University Cancer Institute, PO Box 9510, Morgantown, WV, 26506, USA.
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Rai P, Shen C, Kolodney J, Kelly KM, Scott VG, Sambamoorthi U. Factors associated with immune checkpoint inhibitor use among older adults with late-stage melanoma: A population-based study. Medicine (Baltimore) 2021; 100:e24782. [PMID: 33607829 PMCID: PMC7899862 DOI: 10.1097/md.0000000000024782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/26/2021] [Indexed: 01/05/2023] Open
Abstract
Improvement in overall survival by immune checkpoint inhibitors (ICI) treatment in clinical trials encourages their use for late-stage melanoma. However, in the real-world, heterogeneity of population, such as older patients with multimorbidity, may lead to a slower diffusion of ICIs. The objective of this study was to examine the association of multimorbidity and other factors to ICI use among older patients with late-stage melanoma using real world data.A retrospective cohort study design with a 12-month baseline and follow-up period was adopted with data from the linked Surveillance, Epidemiology, and End Results cancer registry/Medicare database. Older patients (>65 years) with late-stage (stage III/IV) melanoma diagnosed between 2012 and 2015 were categorized as with or without multimorbidity (presence of 2 or more chronic conditions) and ICI use was identified in the post-index period. Chi-square tests and logistic regression were used to evaluate factors associated with ICI use.In the study cohort, 85% had multimorbidity, 18% received any treatment (chemotherapy, radiation, and/or ICI), and 6% received ICI. Only 5.5% of older patients with multimorbidity and 6% without multimorbidity received ICIs. Younger age, presence of social support, lower economic status, residence in northeastern regions, and recent year of diagnosis were significantly associated with ICI use; however, multimorbidity, sex, and race were not associated with ICI use.In the real-world clinical practice, only 1 in 18 older adults with late stage melanoma received ICI, suggesting slow pace of diffusion of innovation. However, multimorbidity was not a barrier to ICI use.
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Affiliation(s)
- Pragya Rai
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV
| | - Chan Shen
- Department of Surgery Chief, Division of Outcomes, Research and Quality Cancer Institute, Cancer Control Penn State Cancer Institute, Hershey, PA
| | - Joanna Kolodney
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Kimberly M. Kelly
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV
| | - Virginia G. Scott
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV
| | - Usha Sambamoorthi
- Professor and Associate Dean of Health Outcomes Research, Department of Pharmacotherapy University of North Texas Health Sciences Center College of Pharmacy
- Vashisht Professor, Health Disparities, Health Education, Awareness & Research in Disparities Scholar, Texas Center for Health Disparities, HSC, Fort Worth TX
- Professor Emeritus, West Virginia University School of Pharmacy, Pharmaceutical Systems and Policy, Morgantown WV
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Rai P, Shen C, Kolodney J, Kelly KM, Scott VG, Sambamoorthi U. Immune checkpoint inhibitor use, multimorbidity and healthcare expenditures among older adults with late-stage melanoma. Immunotherapy 2021; 13:103-112. [PMID: 33148082 PMCID: PMC8008205 DOI: 10.2217/imt-2020-0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/22/2020] [Accepted: 10/07/2020] [Indexed: 11/21/2022] Open
Abstract
Background: The objective of this study is to assess the impact of immune checkpoint inhibitors (ICIs) and multimorbidity on healthcare expenditures among older patients with late-stage melanoma. Materials & methods: A retrospective longitudinal cohort study using Surveillance, Epidemiology and End Results linked with Medicare claims was conducted. Generalized linear mixed models were used to analyze adjusted relationships of ICI, multimorbidity and ICI-multimorbidity interaction on average healthcare expenditures. Results: Patients who received ICI and those who had multimorbidity had significantly higher average total healthcare expenditures compared with ICI nonusers and no multimorbidity. In the fully adjusted model using ICI-multimorbidity interaction, no excess cost was added by multimorbidity. Conclusion: Use of ICIs, regardless of multimorbidity, is associated with increased healthcare expenditures.
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Affiliation(s)
- Pragya Rai
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
| | - Chan Shen
- Department of Surgery Chief, Division of Outcomes, Research & Quality Cancer Institute, Cancer Control Penn State Cancer Institute, Hershey 17033, PA
| | - Joanna Kolodney
- Department of Medicine, West Virginia University School of Medicine, Morgantown 26506, WV
| | - Kimberly M Kelly
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
| | - Virginia G Scott
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
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Nili M, Adelman M, Madhavan SS, LeMasters T, Dwibedi N, Sambamoorthi U. Asthma-chronic obstructive pulmonary disease overlap and cost-related medication non-adherence among older adults in the United States. J Asthma 2021; 59:484-493. [PMID: 33356680 DOI: 10.1080/02770903.2020.1868497] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cost-related medication non-adherence (CRN) can negatively impact health outcomes in older adults with asthma and chronic obstructive pulmonary disease (COPD) overlap (ACO) by reducing access and adherence to essential medications. The objective of this study is to examine the association of ACO to any CRN and specific forms of CRN among a nationally representative sample of older (age ≥ 65 years) adults. METHODS We adopted a cross-sectional study design using data from pooled cross-sectional Medicare Current Beneficiary Surveys (MCBS) (2006-2013) and linked fee-for-service Medicare claims. Unadjusted and adjusted logistic regressions that accounted for the complex survey design examined the association of ACO to any CRN and specific forms of CRN. RESULTS Among older adults with ACO, 16% reported any CRN. The most common form of CRN was "failing to get prescription". As compared to older adults with no asthma and no COPD, those with ACO were more likely to report any CRN (adjusted odds ratios [AOR] = 1.50, 95%CI = [1.14, 1.96]) and all forms of CRN. However, when the number of unique medications was added to the model, there were no statistically significant differences in CRN between the two groups. CONCLUSIONS Older adults with ACO represent a vulnerable population with increased risk for CRN. Multiple factors can contribute to CRN including: a higher number of prescribed medications, multiple co-morbidities, and cost of therapies. Medication comprehensive review interventions have the potential of reducing the risk of CRN among the older Medicare beneficiaries with ACO.
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Affiliation(s)
- M Nili
- School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - M Adelman
- School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - S S Madhavan
- System College of Pharmacy, University of North Texas, Fort Worth, TX, USA
| | - T LeMasters
- School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - N Dwibedi
- School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - U Sambamoorthi
- School of Pharmacy, West Virginia University, Morgantown, WV, USA
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Alhussain K, Kido K, Dwibedi N, LeMasters T, Rose DE, Misra R, Sambamoorthi U. Identifying knowledge gaps in heart failure research among women using unsupervised machine-learning methods. Future Cardiol 2021; 17:1215-1224. [PMID: 33426899 DOI: 10.2217/fca-2020-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/21/2022] Open
Abstract
Aim: To identify knowledge gaps in heart failure (HF) research among women, especially postmenopausal women. Materials & methods: We retrieved HF articles from PubMed. Natural language processing and text mining techniques were used to screen relevant articles and identify study objective(s) from abstracts. After text preprocessing, we performed topic modeling with non-negative matrix factorization to cluster articles based on the primary topic. Clusters were independently validated and labeled by three investigators familiar with HF research. Results: Our model yielded 15 topic clusters from articles on HF among women. Atrial fibrillation was found to be the most understudied topic. From articles specific to postmenopausal women, five clusters were identified. The smallest cluster was about stress-induced cardiomyopathy. Conclusion: Topic modeling can help identify understudied areas in medical research.
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Affiliation(s)
- Khalid Alhussain
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
| | - Kazuhiko Kido
- Department of Clinical Pharmacy, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA
| | - Traci LeMasters
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA
| | - Danielle E Rose
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA 91343, USA
| | - Ranjita Misra
- Department of Social & Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV 26505, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, HSC College of Pharmacy, The University of North Texas Health Science Center, Fort Worth, TX 76107, USA
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Findley PA, Wiener RC, Shen C, Dwibedi N, Sambamoorthi U. Clinical Preventive Services and Self-Management Practices Among Adult Cancer Survivors in the United States Over Time. Cancer Control 2021; 28:10732748211059106. [PMID: 34823385 PMCID: PMC8641110 DOI: 10.1177/10732748211059106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objective of this research was to determine if the engagement/participation in health promotion activities of cancer survivors in the United States (US) changed between 2006 and 2015. We pooled two independent cross-sectional data of cancer survivors using Medical Expenditure Panel Surveys from 2006 (N = 791; weighted N = 9,532,674) and 2015 (N = 1067; weighted N = 15,744,959). Health promoting activities consisted of past year influenza immunization, routine physical examination, and dental visit. Self-care included maintaining normal weight, not smoking, and engagement in recommended vigorous physical activity. We conducted unadjusted and adjusted logistic regression analyses to examine the change in engagement in health promoting activities over time. We found rates of annual influenza immunization (66.8% vs 70.3%), dental visit (71.8% vs 70.3%), and normal weight (33.9% vs 33.5%) did not change from 2006 to 2015. The percent with physical examination (90.8% vs 93.8%; P = .03) and non-smokers increased (87.9% vs 91.2; P = .04). Between 2006 and 2015, despite guidelines and recommendations for personalized cancer survivorship health plans, health promoting activities among cancer survivors did not change significantly.
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Affiliation(s)
- Patricia A Findley
- School of Social Work, 242612Rutgers The State University of New Jersey, New Brunswick, NJ, USA
| | - R Constance Wiener
- Department of Dental Practice and Rural Health, School of Dentistry, 5631West Virginia University, Morgantown, WV, USA
| | - Chan Shen
- Department of Surgery and Public Health Sciences, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Nilajana Dwibedi
- Department of Pharmaceutical Systems and Policy, 5631West Virginia University, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, 5631West Virginia University, Morgantown, WV, USA
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Patel J, Ladani A, Sambamoorthi N, LeMasters T, Dwibedi N, Sambamoorthi U. A Machine Learning Approach to Identify Predictors of Potentially Inappropriate Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Use in Older Adults with Osteoarthritis. Int J Environ Res Public Health 2020; 18:ijerph18010155. [PMID: 33379288 PMCID: PMC7794853 DOI: 10.3390/ijerph18010155] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
Evidence from some studies suggest that osteoarthritis (OA) patients are often prescribed non-steroidal anti-inflammatory drugs (NSAIDs) that are not in accordance with their cardiovascular (CV) or gastrointestinal (GI) risk profiles. However, no such study has been carried out in the United States. Therefore, we sought to examine the prevalence and predictors of potentially inappropriate NSAIDs use in older adults (age > 65) with OA using machine learning with real-world data from Optum De-identified Clinformatics® Data Mart. We identified a retrospective cohort of eligible individuals using data from 2015 (baseline) and 2016 (follow-up). Potentially inappropriate NSAIDs use was identified using the type (COX-2 selective vs. non-selective) and length of NSAIDs use and an individual's CV and GI risk. Predictors of potentially inappropriate NSAIDs use were identified using eXtreme Gradient Boosting. Our study cohort comprised of 44,990 individuals (mean age 75.9 years). We found that 12.8% individuals had potentially inappropriate NSAIDs use, but the rate was disproportionately higher (44.5%) in individuals at low CV/high GI risk. Longer duration of NSAIDs use during baseline (AOR 1.02; 95% CI:1.02-1.02 for both non-selective and selective NSAIDs) was associated with a higher risk of potentially inappropriate NSAIDs use. Additionally, individuals with low CV/high GI (AOR 1.34; 95% CI:1.20-1.50) and high CV/low GI risk (AOR 1.61; 95% CI:1.34-1.93) were also more likely to have potentially inappropriate NSAIDs use. Heightened surveillance of older adults with OA requiring NSAIDs is warranted.
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Affiliation(s)
- Jayeshkumar Patel
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV 26506, USA; (T.L.); (N.D.); (U.S.)
- Correspondence:
| | - Amit Ladani
- Rheumatology, West Virginia University Medicine, Morgantown, WV 26506, USA;
| | - Nethra Sambamoorthi
- Masters in Data Science Program, School of Professional Studies, Northwestern University, Chicago, IL 60201, USA;
| | - Traci LeMasters
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV 26506, USA; (T.L.); (N.D.); (U.S.)
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV 26506, USA; (T.L.); (N.D.); (U.S.)
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV 26506, USA; (T.L.); (N.D.); (U.S.)
- Department of Pharmacotherapy, HSC College of Pharmacy, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX 76107, USA
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Innes KE, Sambamoorthi U. The Potential Contribution of Chronic Pain and Common Chronic Pain Conditions to Subsequent Cognitive Decline, New Onset Cognitive Impairment, and Incident Dementia: A Systematic Review and Conceptual Model for Future Research. J Alzheimers Dis 2020; 78:1177-1195. [PMID: 33252087 DOI: 10.3233/jad-200960] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Growing evidence suggests that chronic pain and certain chronic pain conditions may increase risk for cognitive decline and dementia. OBJECTIVE In this systematic review, we critically evaluate available evidence regarding the association of chronic pain and specific common chronic pain conditions to subsequent decline in cognitive function, new onset cognitive impairment (CI), and incident Alzheimer's disease and related dementias (ADRD); outline major gaps in the literature; and provide a preliminary conceptual model illustrating potential pathways linking pain to cognitive change. METHODS To identify qualifying studies, we searched seven scientific databases and scanned bibliographies of identified articles and relevant review papers. Sixteen studies met our inclusion criteria (2 matched case-control, 10 retrospective cohort, 2 prospective cohort), including 11 regarding the association of osteoarthritis (N = 4), fibromyalgia (N = 1), or headache/migraine (N = 6) to incident ADRD (N = 10) and/or its subtypes (N = 6), and 5 investigating the relation of chronic pain symptoms to subsequent cognitive decline (N = 2), CI (N = 1), and/or ADRD (N = 3). RESULTS Studies yielded consistent evidence for a positive association of osteoarthritis and migraines/headaches to incident ADRD; however, findings regarding dementia subtypes were mixed. Emerging evidence also suggests chronic pain symptoms may accelerate cognitive decline and increase risk for memory impairment and ADRD, although findings and measures varied considerably across studies. CONCLUSION While existing studies support a link between chronic pain and ADRD risk, conclusions are limited by substantial study heterogeneity, limited investigation of certain pain conditions, and methodological and other concerns characterizing most investigations to date. Additional rigorous, long-term prospective studies are needed to elucidate the effects of chronic pain and specific chronic pain conditions on cognitive decline and conversion to ADRD, and to clarify the influence of potential confounding and mediating factors.
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Affiliation(s)
- Kim E Innes
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
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Rai P, Shen C, Kolodney J, Kelly KM, Scott VG, Sambamoorthi U. Prevalence and risk factors for multimorbidity in older US patients with late-stage melanoma. J Geriatr Oncol 2020; 12:388-393. [PMID: 32988783 DOI: 10.1016/j.jgo.2020.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/06/2020] [Accepted: 09/16/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Presence of multimorbidity can affect prognosis, treatment, and outcomes of individuals with cancer. However, the prevalence and factors associated with multimorbidity among older late-stage melanoma is not well studied. We estimated the prevalence of any type of pre-existing multimorbidity (autoimmune disorder (AD), physical health conditions (PHC), and mental health conditions (MHC)) among older adults with late-stage melanoma in the United States. We further examined the association of patient-level factors to multimorbidity in late-stage melanoma. METHODS We derived data on older fee-for-service Medicare beneficiaries (age ≥ 66 years) diagnosed with late-stage melanoma between 2011 and 2015 (N = 4,519) from the linked Surveillance, Epidemiology, and End Results cancer registry and Medicare claims. We defined multimorbidity as the prevalence of two or more chronic conditions prior to the diagnosis of melanoma. We used unadjusted and adjusted logistic regressions to examine the association of patient-level factors to multimorbidity. RESULTS An overwhelming majority (85%) of older patients with late-stage melanoma had multimorbidity. Pre-existing PHC multimorbidity (84%) was the most prevalent, followed by AD (12%), and MHC (6%). Age and region were associated with any and PHC multimorbidity. Sex, marital status, and region were factors associated with pre-existing AD while sex, marital status, and dual eligibility were associated with MHC multimorbidity. CONCLUSIONS Pre-existing multimorbidity was highly prevalent among older individuals with late-stage melanoma; prevalence rates and factors associated with multimorbidity varied by type of chronic conditions. This highlights the need for developing systematic approaches to optimizing care of older patients with late-stage melanoma and multimorbidity.
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Affiliation(s)
- Pragya Rai
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, United States.
| | - Chan Shen
- Department of Surgery Chief, Division of Outcomes, Research and Quality Cancer Institute, Cancer Control Penn State Cancer Institute, Hershey, PA, United States
| | - Joanna Kolodney
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, United States
| | - Kimberly M Kelly
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, United States
| | - Virginia G Scott
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, United States
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, United States
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Zhao X, Bhattacharjee S, Innes KK, LeMasters TJ, Dwibedi N, Sambamoorthi U. The impact of telemental health use on healthcare costs among commercially insured adults with mental health conditions. Curr Med Res Opin 2020; 36:1541-1548. [PMID: 32609549 PMCID: PMC7535072 DOI: 10.1080/03007995.2020.1790345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine the impact of telemental health (TMH) use on total healthcare costs and mental health (MH)-related costs paid by a third party among adults with mental health conditions (MHC). METHOD This study employed a pre-post design with a non-equivalent control group. The cohort comprised adults with MHCs identified using diagnosis codes from de-identified claims data of the Optum Clinformatics DataMart (2010 January 01 to 2017 June 30). We identified mental health (MH) service users and TMH users (N = 348) based on procedure codes. Non-users (N = 238,595) were defined as those who only used in-person MH services. A Difference-in-Differences (DID) analysis was performed within a multivariable two-part model (TPM) framework to examine the impact of TMH use on adjusted standardized costs (2018 US $) of all healthcare services and MH services. Patient-level and state-level factors were adjusted in TPM. RESULTS TMH use was associated with significantly higher MH-related costs [Marginal effect = $461.3, 95% confidence interval: $142.4-$780.2] and an excess of $370 increase in MH-related costs at follow-up as compared to baseline. However, TMH use was not associated with an increase in total third-party healthcare costs nor with changes in total costs from baseline to follow-up. CONCLUSIONS Despite having a higher likelihood of MH services use and MH-related costs, TMH users did not have higher total costs as compared to adults using only in-person MH services. Our findings suggest that TMH can increase access to MH care without increasing total healthcare costs among adults with MHC. Future studies exploring whether TMH use can lead to cost-savings over a longer period are warranted.
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Affiliation(s)
- Xiaohui Zhao
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Sandipan Bhattacharjee
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Kim K. Innes
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Traci J. LeMasters
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
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Ashcraft AM, Farjo S, Ponte CD, Dotson S, Sambamoorthi U, Murray PJ. Harder to get than you think: Levonorgestrel emergency contraception access in West Virginia community pharmacies. J Am Pharm Assoc (2003) 2020; 60:969-977. [PMID: 32830066 DOI: 10.1016/j.japh.2020.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Emergency contraception (EC) is the only noninvasive form of contraception available after risk exposure and is an important tool for preventing unintended pregnancy resulting from unprotected sex, sexual assault, or contraceptive failure. The U.S. Food and Drug Administration (FDA) removed age restrictions on levonorgestrel EC and made it available over-the-counter to everyone in 2013. Despite improved availability and accessibility since the change in FDA regulations, community pharmacies have not uniformly embraced the policy. West Virginia is a rural state with high rates of poverty and teen pregnancy. DESIGN The investigators called community pharmacies in West Virginia to assess the availability and accessibility of levonorgestrel EC in addition to the pharmacy staff's knowledge of effectiveness for this cross-sectional study. SETTING AND PARTICIPANTS The study sample consisted of 509 community pharmacies throughout the state. OUTCOME MEASURES A structured script was employed to conduct phone calls to community pharmacies with items assessing availability, accessibility, and knowledge of effectiveness. RESULTS At the time of the phone calls, levonorgestrel EC was reported to be available in 48.9% of the community pharmacies in West Virginia. Chain pharmacies were more likely to report EC as being in stock (0.76) than independent pharmacies (0.15.). Other measures of accessibility also favored chain pharmacies versus independent pharmacies. The overall accessibility of EC at West Virginia community pharmacies was derived from a binary composite variable of "completely accessible" or "not completely accessible" by combining 5 predetermined items. Overall, EC was completely accessible to callers in 0.27 of all pharmacies with significant differences by pharmacy type (0.47 of chain pharmacies as compared with 0.03 of independent pharmacies). CONCLUSION Accessible EC could reduce unintended pregnancy and help break the state's generational cycle of poverty and poor educational, social, and health outcomes. Pharmacists will be instrumental in expanding access to EC.
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Attarabeen O, Alkhateeb F, Sambamoorthi U, Larkin K, Newton M, Kelly K. Impact of Cognitive and Social Factors on Smoking Cessation Attempts among US Adult Muslim Smokers. Innov Pharm 2020; 11. [PMID: 34007626 PMCID: PMC8075139 DOI: 10.24926/iip.v11i3.3382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Muslims in the United States (US) exhibit high rates of cigarette smoking. Guided by the Social Cognitive Theory, the study aimed to investigate the associations between the number of serious cigarette smoking cessation attempts and cognitive as well as environmental factors in adult US Muslim smokers. Methods This cross-sectional study was based on a convenience sample of adult (≥ 18 years) US Muslim smokers. After receiving IRB approval, data were collected using an on-line survey. Unadjusted Poisson regression followed by adjusted multivariable Poisson regression analyses were conducted to answer the research question. Results One hundred thirty-two smokers completed the questionnaire. Smokers reported more serious cigarette smoking cessation attempts if they 1) had more knowledge about the consequences of cigarette smoking cessation, 2) had more positive attitudes regarding quitting, and 3) reported greater religiosity. Additionally, smokers reported fewer serious cigarette smoking cessation attempts if they 1) were employed, 2) affiliated with Sunnah sect, 3) reported better self-assessed health, 4) reported higher perceived value for quitting, and 5) indicated that using tobacco was not allowed inside the home. Only three smokers reported using both prescription medications and counseling to aid with smoking cessation attempts. Conclusions Inadequate utilization of pharmaceutical smoking cessation products and provider professional assistance may exacerbate the problems associated with elevated rates of smoking among US Muslim smokers. Knowledge of the consequences, more positive attitudes, and greater religiosity can be influential constructs in future interventions aimed at encouraging smoking cessation attempts in this population.
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Affiliation(s)
- Omar Attarabeen
- Department of Pharmacy Practice, Research, & Administration, School of Pharmacy, Marshall University
| | - Fadi Alkhateeb
- Department of Pharmacy Practice, South College School of Pharmacy, Knoxville, TN
| | - Usha Sambamoorthi
- Robert C. Byrd Health Sciences Center (North), Department of Pharmaceutical Systems & Policy, West Virginia University
| | - Kevin Larkin
- Department of Psychology, Eberly College of Arts & Sciences, Life Sciences Building, West Virginia University
| | - Michael Newton
- Robert C. Byrd Health Sciences Center (North), Department of Clinical Pharmacy, West Virginia University
| | - Kimberly Kelly
- Robert C. Byrd Health Sciences Center (North), Department of Pharmaceutical Systems & Policy, West Virginia University
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Khalid S, Sambamoorthi U, Innes KE. Non-Cancer Chronic Pain Conditions and Risk for Incident Alzheimer's Disease and Related Dementias in Community-Dwelling Older Adults: A Population-Based Retrospective Cohort Study of United States Medicare Beneficiaries, 2001-2013. Int J Environ Res Public Health 2020; 17:E5454. [PMID: 32751107 PMCID: PMC7432104 DOI: 10.3390/ijerph17155454] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/13/2020] [Accepted: 07/23/2020] [Indexed: 01/02/2023]
Abstract
Accumulating evidence suggests that certain chronic pain conditions may increase risk for incident Alzheimer's disease and related dementias (ADRD). Rigorous longitudinal research remains relatively sparse, and the relation of overall chronic pain condition burden to ADRD risk remains little studied, as has the potential mediating role of sleep and mood disorders. In this retrospective cohort study, we investigated the association of common non-cancer chronic pain conditions (NCPC) at baseline to subsequent risk for incident ADRD, and assessed the potential mediating effects of mood and sleep disorders, using baseline and 2-year follow-up data using 11 pooled cohorts (2001-2013) drawn from the U.S. Medicare Current Beneficiaries Survey (MCBS). The study sample comprised 16,934 community-dwelling adults aged ≥65 and ADRD-free at baseline. NCPC included: headache, osteoarthritis, joint pain, back or neck pain, and neuropathic pain, ascertained using claims data; incident ADRD (N = 1149) was identified using claims and survey data. NCPC at baseline remained associated with incident ADRD after adjustment for sociodemographics, lifestyle characteristics, medical history, medications, and other factors (adjusted odds ratio (AOR) for any vs. no NCPC = 1.21, 95% confidence interval (CI) = 1.04-1.40; p = 0.003); the strength and magnitude of this association rose significantly with increasing number of diagnosed NCPCs (AOR for 4+ vs. 0 conditions = 1.91, CI = 1.31-2.80, p-trend < 0.00001). Inclusion of sleep disorders and/or depression/anxiety modestly reduced these risk estimates. Sensitivity analyses yielded similar findings. NCPC was significantly and positively associated with incident ADRD; this association may be partially mediated by mood and sleep disorders. Additional prospective studies with longer-term follow-up are warranted to confirm and extend our findings.
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Affiliation(s)
- Sumaira Khalid
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV 26506, USA;
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV 26506, USA;
| | - Kim E. Innes
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV 26506, USA;
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