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Tao MH, Gordon SC, Wu T, Trudeau S, Rupp LB, Gonzalez HC, Daida YG, Schmidt MA, Lu M. Antiviral Treatment and Response are Associated With Lower Risk of Dementia Among Hepatitis C Virus-Infected Patients. Am J Geriatr Psychiatry 2024; 32:611-621. [PMID: 38199936 DOI: 10.1016/j.jagp.2023.12.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Eradication of hepatitis C virus (HCV) infection has been linked with improvement in neurocognitive function, but few studies have evaluated the effect of antiviral treatment/ response on risk of dementia. Using data from the Chronic Hepatitis Cohort Study (CHeCS), we investigated how antiviral therapy impacts the risk of developing dementia among patients with HCV. METHODS A total of 17,485 HCV patients were followed until incidence of dementia, death, or last follow-up. We used an extended landmark modeling approach, which included time-varying covariates and propensity score justification for treatment selection bias, as well as generalized estimating equations (GEE) with a link function as multinominal distribution for a discrete time-to-event data. Death was considered a competing risk. RESULTS After 15 years of follow-up, 342 patients were diagnosed with incident dementia. Patients who achieved sustained virological response (SVR) had significantly decreased risk of dementia compared to untreated patients, with hazard ratios (HRs) of 0.32 (95% CI 0.22-0.46) among patients who received direct-acting antiviral (DAA) treatment and 0.41 (95% CI 0.26-0.60) for interferon-based (IFN) treatment. Risk reduction remained even when patients failed antiviral treatment (HR 0.38, 95% CI 0.38-0.51). Patients with cirrhosis, Black/African American patients, and those without private insurance were at significantly higher risk of dementia. CONCLUSION Antiviral treatment independently reduced the risk of dementia among HCV patients, regardless of cirrhosis. Our findings support the importance of initiation antiviral therapy in chronic HCV-infected patients.
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Affiliation(s)
- Meng-Hua Tao
- Department of Public Health Sciences (M-HT, TW, ST, HCG, ML), Henry Ford Health, Detroit MI.
| | - Stuart C Gordon
- Department of Gastroenterology and Hepatology (SCG, HCG), Henry Ford Health, Detroit MI; School of Medicine (SCG, HCG), Wayne State University, Detroit MI
| | - Trueman Wu
- Department of Public Health Sciences (M-HT, TW, ST, HCG, ML), Henry Ford Health, Detroit MI
| | - Sheri Trudeau
- Department of Public Health Sciences (M-HT, TW, ST, HCG, ML), Henry Ford Health, Detroit MI
| | - Loralee B Rupp
- Department of Health Policy and Health Services Research (LBR), Henry Ford Health, Detroit MI
| | - Humberto C Gonzalez
- Department of Public Health Sciences (M-HT, TW, ST, HCG, ML), Henry Ford Health, Detroit MI; Department of Gastroenterology and Hepatology (SCG, HCG), Henry Ford Health, Detroit MI; School of Medicine (SCG, HCG), Wayne State University, Detroit MI
| | - Yihe G Daida
- Center for Integrated Health Care Research (YGD), Kaiser Permanente Hawaii, Honolulu, HI
| | - Mark A Schmidt
- Center for Health Research (MAS), Kaiser Permanente Northwest, Portland, OR
| | - Mei Lu
- Department of Public Health Sciences (M-HT, TW, ST, HCG, ML), Henry Ford Health, Detroit MI
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Blechter B, Wong JYY, Chien LH, Shiraishi K, Shu XO, Cai Q, Zheng W, Ji BT, Hu W, Rahman ML, Jiang HF, Tsai FY, Huang WY, Gao YT, Han X, Steinwandel MD, Yang G, Daida YG, Liang SY, Gomez SL, DeRouen MC, Diver WR, Reddy AG, Patel AV, Le Marchand L, Haiman C, Kohno T, Cheng I, Chang IS, Hsiung CA, Rothman N, Lan Q. Age at lung cancer diagnosis in females versus males who never smoke by race and ethnicity. Br J Cancer 2024; 130:1286-1294. [PMID: 38388856 PMCID: PMC11014844 DOI: 10.1038/s41416-024-02592-z] [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: 08/26/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND We characterized age at diagnosis and estimated sex differences for lung cancer and its histological subtypes among individuals who never smoke. METHODS We analyzed the distribution of age at lung cancer diagnosis in 33,793 individuals across 8 cohort studies and two national registries from East Asia, the United States (US) and the United Kingdom (UK). Student's t-tests were used to assess the study population differences (Δ years) in age at diagnosis comparing females and males who never smoke across subgroups defined by race/ethnicity, geographic location, and histological subtypes. RESULTS We found that among Chinese individuals diagnosed with lung cancer who never smoke, females were diagnosed with lung cancer younger than males in the Taiwan Cancer Registry (n = 29,832) (Δ years = -2.2 (95% confidence interval (CI):-2.5, -1.9), in Shanghai (n = 1049) (Δ years = -1.6 (95% CI:-2.9, -0.3), and in Sutter Health and Kaiser Permanente Hawai'i in the US (n = 82) (Δ years = -11.3 (95% CI: -17.7, -4.9). While there was a suggestion of similar patterns in African American and non-Hispanic White individuals. the estimated differences were not consistent across studies and were not statistically significant. CONCLUSIONS We found evidence of sex differences for age at lung cancer diagnosis among individuals who never smoke.
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Affiliation(s)
- Batel Blechter
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | - Jason Y Y Wong
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Li-Hsin Chien
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- Department of Applied Mathematics, Chung-Yuan Christian University, Chung-Li, Taiwan
| | - Kouya Shiraishi
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan
- Department of Clinical Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Bu-Tian Ji
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Wei Hu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Mohammad L Rahman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Hsin-Fang Jiang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Fang-Yu Tsai
- National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan
| | - Wen-Yi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China
| | - Xijing Han
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mark D Steinwandel
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gong Yang
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Su-Ying Liang
- Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA, USA
| | - Scarlett L Gomez
- Greater Bay Area Cancer Registry, University of California, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Mindy C DeRouen
- Greater Bay Area Cancer Registry, University of California, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - W Ryan Diver
- Department of Population Science, American Cancer Society, Kennesaw, GA, USA
| | - Ananya G Reddy
- Department of Population Science, American Cancer Society, Kennesaw, GA, USA
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Kennesaw, GA, USA
| | | | - Christopher Haiman
- Greater Bay Area Cancer Registry, University of California, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Takashi Kohno
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan
| | - Iona Cheng
- Greater Bay Area Cancer Registry, University of California, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - I-Shou Chang
- National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan
| | - Chao Agnes Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Flores JP, Kahn G, Penfold RB, Stuart EA, Ahmedani BK, Beck A, Boggs JM, Coleman KJ, Daida YG, Lynch FL, Richards JE, Rossom RC, Simon GE, Wilcox HC. Adolescents Who Do Not Endorse Risk via the Patient Health Questionnaire Before Self-Harm or Suicide. JAMA Psychiatry 2024:2818039. [PMID: 38656403 PMCID: PMC11044012 DOI: 10.1001/jamapsychiatry.2024.0603] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/16/2024] [Indexed: 04/26/2024]
Abstract
Importance Given that the Patient Health Questionnaire (PHQ) item 9 is commonly used to screen for risk of self-harm and suicide, it is important that clinicians recognize circumstances when at-risk adolescents may go undetected. Objective To understand characteristics of adolescents with a history of depression who do not endorse the PHQ item 9 before a near-term intentional self-harm event or suicide. Design, Setting, and Participants This was a retrospective cohort study design using electronic health record and claims data from January 2009 through September 2017. Settings included primary care and mental health specialty clinics across 7 integrated US health care systems. Included in the study were adolescents aged 13 to 17 years with history of depression who completed the PHQ item 9 within 30 or 90 days before self-harm or suicide. Study data were analyzed September 2022 to April 2023. Exposures Demographic, diagnostic, treatment, and health care utilization characteristics. Main Outcome(s) and Measure(s) Responded "not at all" (score = 0) to PHQ item 9 regarding thoughts of death or self-harm within 30 or 90 days before self-harm or suicide. Results The study included 691 adolescents (mean [SD] age, 15.3 [1.3] years; 541 female [78.3%]) in the 30-day cohort and 1024 adolescents (mean [SD] age, 15.3 [1.3] years; 791 female [77.2%]) in the 90-day cohort. A total of 197 of 691 adolescents (29%) and 330 of 1024 adolescents (32%), respectively, scored 0 before self-harm or suicide on the PHQ item 9 in the 30- and 90-day cohorts. Adolescents seen in primary care (odds ratio [OR], 1.5; 95% CI, 1.0-2.1; P = .03) and older adolescents (OR, 1.2; 95% CI, 1.0-1.3; P = .02) had increased odds of scoring 0 within 90 days of a self-harm event or suicide, and adolescents with a history of inpatient hospitalization and a mental health diagnosis had twice the odds (OR, 2.0; 95% CI, 1.3-3.0; P = .001) of scoring 0 within 30 days. Conversely, adolescents with diagnoses of eating disorders were significantly less likely to score 0 on item 9 (OR, 0.4; 95% CI, 0.2-0.8; P = .007) within 90 days. Conclusions and Relevance Study results suggest that older age, history of an inpatient mental health encounter, or being screened in primary care were associated with at-risk adolescents being less likely to endorse having thoughts of death and self-harm on the PHQ item 9 before a self-harm event or suicide death. As use of the PHQ becomes more widespread in practice, additional research is needed for understanding reasons why many at-risk adolescents do not endorse thoughts of death and self-harm.
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Affiliation(s)
- Jean P. Flores
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Geoffrey Kahn
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | | | - Brian K. Ahmedani
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | | | - Karen J. Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | | | | | | | | | - Holly C. Wilcox
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Lu M, Rupp LB, Melkonian C, Trudeau S, Daida YG, Schmidt MA, Gordon SC. Correction to: Real-World Safety and Effectiveness of an 8-Week Regimen of Glecaprevir/Pibrentasvir in Patients with Hepatitis C and Cirrhosis. Adv Ther 2024:10.1007/s12325-024-02858-1. [PMID: 38598114 DOI: 10.1007/s12325-024-02858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Mei Lu
- Department of Public Health Sciences, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA.
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
| | - Loralee B Rupp
- Department of Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Christina Melkonian
- Department of Public Health Sciences, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Stuart C Gordon
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, MI, USA
- School of Medicine, Wayne State University, Detroit, MI, USA
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Yarborough BJH, Stumbo SP, Schneider JL, Ahmedani BK, Daida YG, Hooker SA, Negriff S, Rossom RC, Lapham G. Impact of Opioid Dose Reductions on Patient-Reported Mental Health and Suicide-Related Behavior and Relationship to Patient Choice in Tapering Decisions. J Pain 2024; 25:1094-1105. [PMID: 37952862 DOI: 10.1016/j.jpain.2023.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/28/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 11/14/2023]
Abstract
Mental health and suicide-related harms resulting from prescription opioid tapering are poorly documented and understood. Six health systems contributed opioid prescribing data from January 2016 to April 2020. Patients 18 to 70 years old with evidence of opioid tapering participated in semi-structured interviews. Individuals who experienced suicide attempts were oversampled. Family members of suicide decedents who had experienced opioid tapering were also interviewed. Interviews were analyzed using thematic analysis. The study participants included 176 patients and 16 family members. Patients were 68% female, 80% White, and 15% Hispanic, mean age 58. All family members were female spouses of White, non-Hispanic male decedents. Among the subgroup (n = 60) who experienced a documented suicide attempt, reported experiencing suicidal ideation during tapering, or were family members of suicide decedents, 40% reported that opioid tapering exacerbated previously recognized mental health issues, and 25% reported that tapering triggered new-onset mental health concerns. Among participants with suicide behavior, 47% directly attributed it to opioid tapering. Common precipitants included increased pain, reduced life engagement, sleep problems, withdrawal, relationship dissolution, and negative consequences of opioid substitution with other substances for pain relief. Most respondents reporting suicide behavior felt that the decision to taper was made by the health care system or a clinician (67%) whereas patients not reporting suicide behavior were more likely to report it was their own decision (42%). This study describes patient-reported mental health deterioration or suicide behavior while tapering prescription opioids. Clinicians should screen for, monitor, and treat suicide behavior while assisting patients in tapering opioids. PERSPECTIVE: This work describes changes in patient-reported mental health and suicide behavior while tapering prescription opioids. Recommendations for improving care include mental health and suicide risk screening during and following opioid tapering.
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Affiliation(s)
| | - Scott P Stumbo
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | | | | | | | | | - Sonya Negriff
- Kaiser Permanente Southern California, Pasadena, California
| | | | - Gwen Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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Bacong AM, Gibbs SL, Rosales AG, Frankland TB, Li J, Daida YG, Fortmann SP, Palaniappan L. Obesity Disparities Among Adult Single-Race and Multiracial Asian and Pacific Islander Populations. JAMA Netw Open 2024; 7:e240734. [PMID: 38502128 PMCID: PMC10951735 DOI: 10.1001/jamanetworkopen.2024.0734] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/09/2024] [Indexed: 03/20/2024] Open
Abstract
Importance Despite increasing numbers of multiracial individuals, they are often excluded in studies or aggregated within larger race and ethnicity groups due to small sample sizes. Objective To examine disparities in the prevalence of obesity among single-race and multiracial Asian and Pacific Islander individuals compared with non-Hispanic White (hereafter, White) individuals. Design, Setting, and Participants This cross-sectional study used electronic health record (EHR) data linked to social determinants of health and health behavior data for adult (age ≥18 years) members of 2 large health care systems in California and Hawai'i who had at least 1 ambulatory visit to a primary care practitioner between January 1, 2006, and December 31, 2018. Data were analyzed from October 31, 2022, to July 31, 2023. Exposure Self-identified race and ethnicity provided in the EHR as a single-race category (Asian Indian, Chinese, Filipino, Japanese, Native Hawaiian only, Other Pacific Islander, or White) or a multiracial category (Asian and Pacific Islander; Asian, Pacific Islander, and White; Asian and White; or Pacific Islander and White). Main Outcomes and Measures The main outcome was obesity (body mass index [BMI] ≥30.0), based on last measured height and weight from the EHR. Logistic regression was used to examine the association between race and ethnicity and odds of obesity. Results A total of 5229 individuals (3055 [58.4%] male; mean [SD] age, 70.73 [11.51] years) were examined, of whom 444 (8.5%) were Asian Indian; 1091 (20.9%), Chinese; 483 (9.2%), Filipino; 666 (12.7%), Japanese; 91 (1.7%), Native Hawaiian; 95 (1.8%), Other Pacific Islander; and 888 (17.0%), White. The percentages of individuals who identified as multiracial were as follows: 417 (8.0%) were Asian and Pacific Islander; 392 (7.5%), Asian, Pacific Islander, and White; 248 (4.7%), Asian and White; and 414 (7.9%), Pacific Islander and White. A total of 1333 participants (25.5%) were classified as having obesity based on standard BMI criteria. Obesity was highest among people who identified as Asian, Pacific Islander, and White (204 of 392 [52.0%]) followed by those who identified as Other Pacific Islander (47 of 95 [49.5%]), Native Hawaiian (44 of 91 [48.4%]), and Pacific Islander and White (186 of 414 [44.9%]). After accounting for demographic, socioeconomic, and health behavior factors, people who identified as Asian, Pacific Islander, and White (odds ratio [OR], 1.80; 95% CI, 1.37-2.38) or Pacific Islander and White (OR, 1.55; 95% CI, 1.18-2.04) had increased odds of obesity compared with White individuals. All single-race Asian groups had lower odds of obesity compared with White individuals: Asian Indian (OR, 0.29; 95% CI, 0.20-0.40), Chinese (OR, 0.22; 95% CI, 0.17-0.29), Filipino (OR, 0.46; 95% CI, 0.35-0.62), and Japanese (OR, 0.38, 95% CI, 0.29-0.50). Conclusions and Relevance In this study, multiracial Asian and Pacific Islander individuals had an increased prevalence of obesity compared with many of their single-race counterparts. As the number of multiracial individuals increases, it will be important for clinical and public health systems to track disparities in these populations.
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Affiliation(s)
- Adrian M. Bacong
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Center for Asian Health Research and Education, Stanford, California
| | | | | | | | - Jiang Li
- Sutter Health Center for Health Systems Research/Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Yihe G. Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawai’i, Honolulu
| | | | - Latha Palaniappan
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Center for Asian Health Research and Education, Stanford, California
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Simon GE, Johnson E, Shortreed SM, Ziebell RA, Rossom RC, Ahmedani BK, Coleman KJ, Beck A, Lynch FL, Daida YG. Predicting suicide death after emergency department visits with mental health or self-harm diagnoses. Gen Hosp Psychiatry 2024; 87:13-19. [PMID: 38277798 PMCID: PMC10939795 DOI: 10.1016/j.genhosppsych.2024.01.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/21/2024] [Accepted: 01/21/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Use health records data to predict suicide death following emergency department visits. METHODS Electronic health records and insurance claims from seven health systems were used to: identify emergency department visits with mental health or self-harm diagnoses by members aged 11 or older; extract approximately 2500 potential predictors including demographic, historical, and baseline clinical characteristics; and ascertain subsequent deaths by self-harm. Logistic regression with lasso and random forest models predicted self-harm death over 90 days after each visit. RESULTS Records identified 2,069,170 eligible visits, 899 followed by suicide death within 90 days. The best-fitting logistic regression with lasso model yielded an area under the receiver operating curve of 0.823 (95% CI 0.810-0.836). Visits above the 95th percentile of predicted risk included 34.8% (95% CI 31.1-38.7) of subsequent suicide deaths and had a 0.303% (95% CI 0.261-0.346) suicide death rate over the following 90 days. Model performance was similar across subgroups defined by age, sex, race, and ethnicity. CONCLUSIONS Machine learning models using coded data from health records have moderate performance in predicting suicide death following emergency department visits for mental health or self-harm diagnosis and could be used to identify patients needing more systematic follow-up.
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Affiliation(s)
- Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America.
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Rebecca A Ziebell
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Rebecca C Rossom
- HealthPartners Institute, Minneapolis, MN, United States of America
| | - Brian K Ahmedani
- Henry Ford Health Center for Health Services Research, Detroit, MI, United States of America
| | - Karen J Coleman
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, CA, United States of America
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, United States of America
| | - Frances L Lynch
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States of America
| | - Yihe G Daida
- Kaiser Permanente Hawaii Center for Integrated Health Care Research, Honolulu, HI, United States of America
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8
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Yarborough BJ, Stumbo SP, Schneider JL, Ahmedani BK, Daida YG, Hooker SA, Lapham GT, Negriff S, Rossom RC. Patient perspectives on mental health and pain management support needed versus received during opioid deprescribing. J Pain 2024:S1526-5900(24)00367-5. [PMID: 38311195 DOI: 10.1016/j.jpain.2024.01.350] [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] [Received: 08/22/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
Prescription opioid tapering has increased significantly over the last decade. Evidence suggests that tapering too quickly or without appropriate support may unintentionally harm patients. The aim of this analysis was to understand patients' experiences with opioid tapering, including support received or not received for pain control or mental health. Patients with evidence of opioid tapering from six health care systems participated in semi-structured, in-depth interviews; family members of suicide decedents with evidence of opioid tapering were also interviewed. Interviews were analyzed using thematic analysis. Participants included 176 patients and 16 family members. Results showed that 24% of participants felt their clinicians checked in with them about their taper experiences while 41% reported their clinicians did not. A majority (68%) of individuals who experienced suicide behavior during tapering reported that clinicians did check in about mood and mental health changes specifically; however, 27% of that group reported no such check in. More individuals reported negative experiences (than positive) with pain management clinics-where patients are often referred for tapering and pain management support. Patients reporting successful tapering experiences named shared decision-making and ability to adjust taper speed or pause tapering as helpful components of care. Fifty-six percent of patients reported needing more support during tapering, including more empathy and compassion (48%) and an individualized approach to tapering (41%). Patient-centered approaches to tapering include reaching out to monitor how patients are doing, involving patients in decision-making, supporting mental health changes, and allowing for flexibility in the tapering pace. PERSPECTIVE: Patients tapering prescription opioids desire more provider-initiated communication including checking in about pain, setting expectations for withdrawal and mental health related changes, and providing support for mental health. Patients preferred opportunities to share decisions about taper speed and to have flexibility with pausing the taper as needed.
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Affiliation(s)
| | - Scott P Stumbo
- Kaiser Permanente Northwest Center for Health Research, Portland, OR USA
| | | | | | - Yihe G Daida
- Kaiser Permanente Hawaii Center for Integrated Health Care Research, Honolulu, HI USA
| | | | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle, WA USA
| | - Sonya Negriff
- Kaiser Permanente Southern California, Pasadena, CA USA
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9
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Lu M, Rupp LB, Melkonian C, Trudeau S, Daida YG, Schmidt MA, Gordon SC. Persistent pruritus associated with worse quality of life in patients with chronic hepatitis. Liver Int 2024; 44:577-588. [PMID: 38082499 DOI: 10.1111/liv.15803] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/06/2023] [Accepted: 11/12/2023] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Prevalence and severity of pruritus among US patients with chronic hepatitis B and C (HBV, HCV) are not well-documented. Chronic Hepatitis Cohort Study (CHeCS) patients were surveyed to examine pruritus prevalence and impact on quality of life (QoL). METHODS Patients who reported experiencing pruritus ≥3 on a Numeric Rating Scale (NRS) within the past 30 days were invited to participate in a 6-month study using the SF-36 questionnaire. General regression (univariate followed by multivariable modelling) was used to analyse pruritus intensity and eight QoL dimensions. RESULTS Among 1654 patients (HBV = 358, HCV = 1296, HBV/HCV = 6), pruritus prevalence was significantly higher among patients with HCV than those with HBV (44% vs. 35%; p < .05). One hundred and twenty-three patients (21 HBV and 102 HCV) participated in the QoL study (72% ≥60 years; 50% men; 25% Black; 37% with cirrhosis; 66% had BMI > 25). Mean NRS was 4.9-5.3. QoL responses for social functioning and emotional well-being were higher (70-72 points) than responses for energy/fatigue (50-51). Antiviral treatment rates were higher in HCV (92%, SVR 99%) than HBV (71% ever, 43% ongoing). Multivariable analyses showed no significant effect of hepatitis type or antiviral treatments on itch. Antihistamines were associated with severe itch. Higher NRS was associated with significantly reduced QoL. Each unit increase in NRS was associated with a 2-3 unit decline in emotional well-being, general health, physical function, energy/fatigue, social functioning and emotional health. CONCLUSION Pruritus negatively affects many viral hepatitis patients, regardless of antiviral treatment status. Improved treatment options are needed to address its impact on QoL.
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Affiliation(s)
- Mei Lu
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Loralee B Rupp
- Department of Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan, USA
| | - Christina Melkonian
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, Hawaii, USA
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Stuart C Gordon
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, Michigan, USA
- School of Medicine, Wayne State University, Detroit, Michigan, USA
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10
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Miller-Matero LR, Yeh HH, Maffett A, Mooney JT, Sala-Hamrick K, Frank CB, Simon GE, Rossom R, Owen-Smith AA, Lynch FL, Beck A, Waring S, Daida YG, Lu CY, Ahmedani BK. Racial-Ethnic Differences in Receipt of Past-Year Health Care Services Among Suicide Decedents: A Case-Control Study. Psychiatr Serv 2024; 75:124-130. [PMID: 37554000 PMCID: PMC10840630 DOI: 10.1176/appi.ps.20220578] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Suicide remains an urgent public health crisis. Although some sociodemographic characteristics are associated with greater suicide risk in the general population, it is unclear whether individuals utilizing health care in the United States have similar suicide incidence patterns. The authors examined whether race-ethnicity is associated with suicide death among patients seeking health care and investigated health care utilization patterns. METHODS Data were collected from electronic health records and government mortality records for patients seeking health care across nine health care systems in the United States. Patients who died by suicide (N=1,935) were matched with patients in a control group (N=19,350) within each health care system. RESULTS Patients who died by suicide were significantly more likely to be White, older, male, living in low-education areas, living in rural areas, or diagnosed as having mental health conditions or were significantly less likely to have commercial insurance (p<0.05). Among most racial-ethnic groups, those who died by suicide had a higher number of past-year mental health, primary care, and total health care visits; for American Indian/Alaska Native patients, the number of health care visits tended to be lower among suicide decedents. CONCLUSIONS These findings suggest that higher past-year health care utilization was associated with increased likelihood of suicide death across several racial-ethnic groups. This observation underscores the need for identifying and managing suicide risk in health care settings, including outside of mental health visits, among most racial-ethnic groups.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Hsueh-Han Yeh
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Anissa Maffett
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Jan T Mooney
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Kelsey Sala-Hamrick
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Cathrine B Frank
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Gregory E Simon
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Rebecca Rossom
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Ashli A Owen-Smith
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Frances L Lynch
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Arne Beck
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Stephen Waring
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Yihe G Daida
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Christine Y Lu
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Brian K Ahmedani
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
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11
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Lu M, Rupp LB, Melkonian C, Trudeau S, Daida YG, Schmidt MA, Gordon SC. Real-World Safety and Effectiveness of an 8-Week Regimen of Glecaprevir/Pibrentasvir in Patients with Hepatitis C and Cirrhosis. Adv Ther 2024; 41:744-758. [PMID: 38169058 PMCID: PMC11006752 DOI: 10.1007/s12325-023-02748-y] [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: 10/17/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION In 2019, an 8-week regimen of glecaprevir/ pibrentasvir (GLE/PIB) was FDA-approved for treatment of chronic hepatitis C (HCV) in patients with cirrhosis. We used data from the Chronic Hepatitis Cohort Study (CHeCS) to evaluate treatment response and adverse events among patients with HCV and cirrhosis under routine clinical care. METHODS Using an intention-to-treat (ITT)/modified ITT (mITT) approach, endpoints were (1) sustained virological response (SVR) at 12 weeks (SVR12) post-treatment; and (2) adverse events (AEs)/serious AEs during treatment. Patients with cirrhosis from two CHeCS sites were included if they were prescribed GLE/PIB from August 2017 to June 2020. Detailed treatment and clinical data were collected. Patient baseline characteristics were described with mean/standard deviation (std) for continuous variables, and proportions for categorical variables. Analyses were propensity score adjusted. The final model retained variables that were significant with p value < 0.05. RESULTS The ITT sample included 166 patients, with 43, 116, and 7 patients in the 8-week, 12-week, and > 12-week planned treatment groups. Among them, 159 had confirmed SVR (95.8%, LCL 93.2%). The mITT analysis included 160 patients after excluding 6 with unknown HCV RNA results; 159 achieved SVR (99.4%, LCL 98.3%). There were no significant differences in rates of SVR between the 8-week and 12-week regimens in either analysis, nor any association with patient characteristics. SAEs were experienced by 1 patient (2%) in the 8-week group, 7 (5%) in the 12-week group (including one death), and 2 (29%) in the > 12-week group; 4 patients (from the 12-week group) experienced serious AEs or hepatic events that were "likely attributable" to GLE/PIB treatment. CONCLUSION An 8-week regimen of GLE/PIB is well tolerated and highly effective among US patients with HCV and cirrhosis receiving routine clinical care.
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Affiliation(s)
- Mei Lu
- Department of Public Health Sciences, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA.
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
| | - Loralee B Rupp
- Department of Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Christina Melkonian
- Department of Public Health Sciences, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Stuart C Gordon
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, MI, USA
- School of Medicine, Wayne State University, Detroit, MI, USA
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12
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Miller-Matero LR, Yeh HH, Ahmedani BK, Rossom RC, Harry ML, Daida YG, Coleman KJ. Suicide attempts after bariatric surgery: comparison to a nonsurgical cohort of individuals with severe obesity. Surg Obes Relat Dis 2023; 19:1458-1466. [PMID: 37758538 PMCID: PMC10843496 DOI: 10.1016/j.soard.2023.08.013] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The rate of suicide is higher among individuals following bariatric surgery compared with the general population; however, it is not clear whether risk is associated with bariatric surgery beyond having severe obesity. OBJECTIVE To compare the risk of a suicide attempt among those who had bariatric surgery versus a nonsurgical cohort with severe obesity. SETTING Aggregate count data were collected from 5 healthcare systems. METHODS Individuals were identified in the surgical cohort if they underwent bariatric surgery between 2009 and 2017 (n = 35,522) and then were compared with a cohort of individuals with severe obesity who never had bariatric surgery (n = 691,752). Suicide attempts were identified after study enrollment date using International Classification of Diseases, Ninth and Tenth Editions (ICD-9 and ICD-10) diagnosis codes from 2009 to 2021. RESULTS The relative risk of a suicide attempt was 64% higher in the cohort with bariatric surgery than that of the nonsurgical cohort (2.2% versus 1.3%; relative risk = 1.64; 95% CI, 1.53-1.76). Within the cohort with bariatric surgery, suicide attempts were more common among the 18- to 39-year age group (P < .001), women (P = .002), Hawaiian-Pacific Islanders (P < .001), those with Medicaid insurance (P < .001), and those with a documented mental health condition at baseline (in the previous 2 years; P < .001). CONCLUSIONS The relative risk of suicide attempts was higher among those who underwent bariatric surgery compared with a nonsurgical cohort, though absolute risk remained low. Providers should be aware of this increased risk. Screening for suicide risk after bariatric surgery may be useful to identify high-risk individuals.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan.
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Brian K Ahmedani
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | | | | | - Karen J Coleman
- Kaiser Permanente Southern California, Irvine, California; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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13
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Llamocca EN, Yeh HH, Miller-Matero LR, Westphal J, Frank CB, Simon GE, Owen-Smith AA, Rossom RC, Lynch FL, Beck AL, Waring SC, Lu CY, Daida YG, Fontanella CA, Ahmedani BK. Association Between Adverse Social Determinants of Health and Suicide Death. Med Care 2023; 61:744-749. [PMID: 37708352 PMCID: PMC10592168 DOI: 10.1097/mlr.0000000000001918] [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] [Indexed: 09/16/2023]
Abstract
OBJECTIVE The aim of this study was to identify adverse social determinants of health (SDoH) International Statistical Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code prevalence among individuals who died by suicide and to examine associations between documented adverse SDoH and suicide. RESEARCH DESIGN A case-control study using linked medical record, insurance claim, and mortality data from 2000 to 2015 obtained from 9 Mental Health Research Network-affiliated health systems. We included 3330 individuals who died by suicide and 333,000 randomly selected controls matched on index year and health system location. All individuals in the study (cases and controls) had at least 10 months of enrollment before the study index date. The index date for the study for each case and their matched controls was the suicide date for that given case. RESULTS Adverse SDoH documentation was low; only 6.6% of cases had ≥1 documented adverse SDoH in the year before suicide. Any documented SDoH and several specific adverse SDoH categories were more frequent among cases than controls. Any documented adverse SDoH was associated with higher suicide odds [adjusted odds ratio (aOR)=2.76; 95% CI: 2.38-3.20], as was family alcoholism/drug addiction (aOR=18.23; 95% CI: 8.54-38.92), being an abuse victim/perpetrator (aOR=2.53; 95% CI: 1.99-3.21), other primary support group problems (aOR=1.91; 95% CI: 1.32-2.75), employment/occupational maladjustment problems (aOR=8.83; 95% CI: 5.62-13.87), housing/economic problems (aOR: 6.41; 95% CI: 4.47-9.19), legal problems (aOR=27.30; 95% CI: 12.35-60.33), and other psychosocial problems (aOR=2.58; 95% CI: 1.98-3.36). CONCLUSIONS Although documented SDoH prevalence was low, several adverse SDoH were associated with increased suicide odds, supporting calls to increase SDoH documentation in medical records. This will improve understanding of SDoH prevalence and assist in identification and intervention among individuals at high suicide risk.
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Affiliation(s)
- Elyse N Llamocca
- Henry Ford Health, Center for Health Policy and Health Services Research
| | - Hsueh-Han Yeh
- Henry Ford Health, Center for Health Policy and Health Services Research
| | - Lisa R Miller-Matero
- Henry Ford Health, Center for Health Policy and Health Services Research
- Henry Ford Health, Behavioral Health Services
| | - Joslyn Westphal
- Henry Ford Health, Center for Health Policy and Health Services Research
| | | | - Gregory E Simon
- Kaiser Permanente Washington, Health Research Institute, Seattle, WA
| | - Ashli A Owen-Smith
- Georgia State University, School of Public Health
- Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, GA
| | | | - Frances L Lynch
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR
| | - Arne L Beck
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO
| | | | - Christine Y Lu
- Harvard Medical School, Department of Population Medicine
- Harvard Pilgrim Health System, Harvard Pilgrim Health Care Institute, Boston, MA
| | - Yihe G Daida
- Kaiser Permanente Hawaii, Center for Integrated Health Research, Honolulu, HI
| | - Cynthia A Fontanella
- Nationwide Children's Hospital, Abigail Wexner Research Institute, Center for Suicide Prevention and Research
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH
| | - Brian K Ahmedani
- Henry Ford Health, Center for Health Policy and Health Services Research
- Henry Ford Health, Behavioral Health Services
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14
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Harry ML, Sanchez K, Ahmedani BK, Beck AL, Coleman KJ, Coley RY, Daida YG, Lynch FL, Rossom RC, Waring SC, Simon GE. Assessing the differential item functioning of PHQ-9 items for diverse racial and ethnic adults with mental health and/or substance use disorder diagnoses: A retrospective cohort study. J Affect Disord 2023; 338:402-413. [PMID: 37127116 PMCID: PMC10524453 DOI: 10.1016/j.jad.2023.04.091] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Improving health equity in depression care and suicide screening requires that measures like the Patient Health Questionnaire 9 (PHQ-9) function similarly for diverse racial and ethnic groups. We evaluated PHQ-9 differential item functioning (DIF) between racial/ethnic groups in a retrospective cohort study of secondary electronic health record (EHR) data from eight healthcare systems. METHODS The population (n = 755,156) included patients aged 18-64 with mental health and/or substance use disorder (SUD) diagnoses who had a PHQ-9 with no missing item data in the EHR for primary care or mental health visits between 1/1/2009-9/30/2017. We drew two random samples of 1000 from the following racial/ethnic groups originally recorded in EHRs (n = 14,000): Hispanic, and non-Hispanic White, Black, Asian, American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, multiracial. We assessed DIF using iterative hybrid ordinal logistic regression and item response theory with p < 0.01 and 1000 Monte Carlo simulations, where change in model R2 > 0.01 represented non-negligible (e.g., clinically meaningful) DIF. RESULTS All PHQ-9 items displayed statistically significant, but negligible (e.g., clinically unmeaningful) DIF between compared groups. The negligible DIF varied between random samples, although six items showed negligible DIF between the same comparison groups in both random samples. LIMITATIONS Our findings may not generalize to disaggregated racial/ethnic groups or persons without mental health and/or SUD diagnoses. CONCLUSIONS We found the PHQ-9 had clinically unmeaningful cross-cultural DIF for adult patients with mental health and/or SUD diagnoses. Future research could disaggregate race/ethnicity to discern if within-group identification impacts PHQ-9 DIF.
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Affiliation(s)
- Melissa L Harry
- Essentia Health, Essentia Institute of Rural Health, Duluth, MN, USA.
| | - Katherine Sanchez
- Baylor Scott and White, Center for Applied Health Research, Temple, TX, USA
| | - Brian K Ahmedani
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, MI, USA
| | - Arne L Beck
- The Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
| | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Yihe G Daida
- Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Frances L Lynch
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Stephen C Waring
- Essentia Health, Essentia Institute of Rural Health, Duluth, MN, USA
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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15
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Lu M, Salgia R, Li J, Trudeau S, Rupp LB, Wu T, Daida YG, Schmidt MA, Gordon SC. Dynamic risk assessment for hepatocellular carcinoma in patients with chronic hepatitis C. J Viral Hepat 2023; 30:746-755. [PMID: 37415492 DOI: 10.1111/jvh.13859] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/27/2023] [Indexed: 07/08/2023]
Abstract
Chronic hepatitis C (HCV) is a primary cause of hepatocellular carcinoma (HCC). Although antiviral treatment reduces risk of HCC, few studies quantify the impact of treatment on long-term risk in the era of direct-acting antivirals (DAA). Using data from the Chronic Hepatitis Cohort Study, we evaluated the impact of treatment type (DAA, interferon-based [IFN], or none) and outcome (sustained virological response [SVR] or treatment failure [TF]) on risk of HCC. We then developed and validated a predictive risk model. 17186 HCV patients were followed until HCC, death or last follow-up. We used extended landmark modelling, with time-varying covariates and propensity score justification and generalized estimating equations with a link function for discrete time-to-event data. Death was considered a competing risk. We observed 586 HCC cases across 104,000 interval-years of follow-up. SVR from DAA or IFN-based treatment reduced risk of HCC (aHR 0.13, 95% CI 0.08-0.20; and aHR 0.45, 95% CI 0.31-0.65); DAA SVR reduced risk more than IFN SVR (aHR 0.29, 95% CI 0.17-0.48). Independent of treatment, cirrhosis was the strongest risk factor for HCC (aHR 3.94, 95% CI 3.17-4.89 vs. no cirrhosis). Other risk factors included male sex, White race and genotype 3. Our six-variable predictive model had 'excellent' accuracy (AUROC 0.94) in independent validation. Our novel landmark interval-based model identified HCC risk factors across antiviral treatment status and interactions with cirrhosis. This model demonstrated excellent predictive accuracy in a large, racially diverse cohort of patients and could be adapted for 'real world' HCC monitoring.
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Affiliation(s)
- Mei Lu
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Reena Salgia
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, Michigan, USA
- School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Jia Li
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
- School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Loralee B Rupp
- Department of Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan, USA
| | - Trueman Wu
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, Hawaii, USA
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Stuart C Gordon
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, Michigan, USA
- School of Medicine, Wayne State University, Detroit, Michigan, USA
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16
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Sala-Hamrick KJ, Braciszewski JM, Yeh HH, Zelenak L, Westphal J, Beebani G, Frank C, Simon GE, Owen-Smith AA, Rossom RC, Lynch F, Lu CY, Waring SC, Harry ML, Beck A, Daida YG, Ahmedani BK. Diagnosed Posttraumatic Stress Disorder and Other Trauma-Associated Stress Disorders and Risk for Suicide Mortality. Psychiatr Serv 2023; 74:936-942. [PMID: 37143334 PMCID: PMC10497061 DOI: 10.1176/appi.ps.202100244] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Strong evidence exists for posttraumatic stress disorder (PTSD) as a risk factor for suicidal thoughts and behaviors across diverse populations. However, few empirical studies have examined PTSD and other trauma-associated stress disorders as risk factors for suicide mortality among health system populations. This study aimed to assess trauma-associated stress diagnoses as risk factors for suicide mortality in a U.S. health system population. METHODS This case-control, matched-design study examined individuals who died by suicide between 2000 and 2015 and had received care from nine U.S. health systems affiliated with the Mental Health Research Network (N=3,330). Individuals who died by suicide were matched with individuals from the general health system population (N=333,000): 120 individuals with PTSD who died by suicide were matched with 1,592 control group members, 84 with acute reaction to stress were matched with 2,218 control individuals, and 331 with other stress reactions were matched with 8,174 control individuals. RESULTS After analyses were adjusted for age and sex, individuals with any trauma-associated stress condition were more likely to have died by suicide. Risk was highest among individuals with PTSD (adjusted OR [AOR]=10.10, 95% CI=8.31-12.27), followed by those with other stress reactions (AOR=5.38, 95% CI=4.78-6.06) and those with acute reaction to stress (AOR=4.49, 95% CI=3.58-5.62). Patterns of risk remained the same when the analyses were adjusted for any comorbid psychiatric condition. CONCLUSIONS All trauma-associated stress disorders are risk factors for suicide mortality, highlighting the importance of health system suicide prevention protocols that consider the full spectrum of traumatic stress diagnoses.
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Affiliation(s)
- Kelsey J Sala-Hamrick
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Logan Zelenak
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Joslyn Westphal
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ganj Beebani
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Cathrine Frank
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Gregory E Simon
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ashli A Owen-Smith
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Rebecca C Rossom
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Frances Lynch
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Christine Y Lu
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Stephen C Waring
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Melissa L Harry
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Arne Beck
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Yihe G Daida
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
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17
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Loree AM, Hecht LM, Yeh HH, Gavrilova L, Furman K, Westphal J, Simon GE, Lynch FL, Beck A, Owen-Smith A, Rossom R, Daida YG, Lu CY, Boggs JM, Frank C, Waring S, Ahmedani BK. Factors associated with suicide mortality among reproductive age women: a case-control study. J Reprod Infant Psychol 2023:1-12. [PMID: 37310021 DOI: 10.1080/02646838.2023.2223636] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Examine demographic, psychosocial, pregnancy-related, and healthcare utilisation factors associated with suicide mortality among reproductive age women. METHODS Data from nine health care systems in the Mental Health Research Network were included. A case-control study design was used in which 290 reproductive age women who died by suicide (cases) from 2000 to 2015 were matched with 2,900 reproductive age women from the same healthcare system who did not die by suicide (controls). Conditional logistic regression was used to analyse associations between patient characteristics and suicide. RESULTS Women of reproductive age who died by suicide were more likely to have mental health (aOR = 7.08, 95% CI: 5.17, 9.71) or substance use disorders (aOR = 3.16, 95% CI: 2.19, 4.56) and to have visited the emergency department in the year prior to index date (aOR = 3.47, 95% CI: 2.50, 4.80). Non-Hispanic White women (aOR = 0.70, 95% CI: 0.51, 0.97) and perinatal (pregnant or postpartum) women were less likely to have died by suicide (aOR = 0.27, 95% CI: 0.13, 0.58). CONCLUSIONS Reproductive age women with mental health and/or substance use disorders, prior emergency department encounters, or who are of racial or ethnic minority status were at increased risk of suicide mortality and may benefit from routine screening and monitoring. Future research should further examine the relationship between pregnancy-related factors and suicide mortality.
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Affiliation(s)
- Amy M Loree
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Leah M Hecht
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Hsueh-Han Yeh
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Lyubov Gavrilova
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
| | | | - Joslyn Westphal
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Frances L Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, USA
| | - Ashli Owen-Smith
- Georgia State University School of Public Health, Atlanta, GA, USA
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Rebecca Rossom
- Research and Evaluation Division, HealthPartners Institute, Minneapolis, MN, USA
| | - Yihe G Daida
- Kaiser Permanente Hawaii Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Christine Y Lu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Jennifer M Boggs
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, USA
| | - Cathrine Frank
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
| | | | - Brian K Ahmedani
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
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18
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Waitzfelder B, Palaniappan L, Varga A, Frankland TB, Li J, Daida YG, Kaholokula JK, Bacong AM, Rawlings AM, Chung S, Howick C, Fortmann SP. Prevalence of cardiovascular disease among Asian, Pacific Islander and multi-race populations in Hawai'i and California. BMC Public Health 2023; 23:885. [PMID: 37189145 PMCID: PMC10184427 DOI: 10.1186/s12889-023-15795-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the leading cause of death in the US. CVD incidence is influenced by many demographic, clinical, cultural, and psychosocial factors, including race and ethnicity. Despite recent research, there remain limitations on understanding CVD health among Asians and Pacific Islanders (APIs), particularly some subgroups and multi-racial populations. Combining diverse API populations into one study group and difficulties in defining API subpopulations and multi-race individuals have hampered efforts to identify and address health disparities in these growing populations. METHODS The study cohort was comprised of all adult patients at Kaiser Permanente Hawai'i and Palo Alto Medical Foundation in California during 2014-2018 (n = 684,363). EHR-recorded ICD-9 and ICD-10 diagnosis codes were used to indicate coronary heart disease (CHD), stroke, peripheral vascular disease (PVD), and overall CVD. Self-reported race and ethnicity data were used to construct 12 mutually exclusive single and multi-race groups, and a Non-Hispanic White (NHW) comparison group. Logistic regression models were used to derive prevalence estimates, odds ratios, and confidence intervals for the 12 race/ethnicity groups. RESULTS The prevalence of CHD and PVD varied 4-fold and stroke and overall CVD prevalence varied 3-fold across API subpopulations. Among Asians, the Filipino subgroup had the highest prevalence of all three CVD conditions and overall CVD. Chinese people had the lowest prevalence of CHD, PVD and overall CVD. In comparison to Native Hawaiians, Other Pacific Islanders had significantly higher prevalence of CHD. For the multi-race groups that included Native Hawaiians and Other Pacific Islanders, the prevalence of overall CVD was significantly higher than that for either single-race Native Hawaiians or Other Pacific Islanders. The multi-race Asian + White group had significantly higher overall CVD prevalence than both the NHW group and the highest Asian subgroup (Filipinos). CONCLUSIONS Study findings revealed significant differences in overall CVD, CHD, stroke, and PVD among API subgroups. In addition to elevated risk among Filipino, Native Hawaiian, and Other Pacific Islander groups, the study identified particularly elevated risk among multi-race API groups. Differences in disease prevalence are likely mirrored in other cardiometabolic conditions, supporting the need to disaggregate API subgroups in health research.
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Affiliation(s)
- Beth Waitzfelder
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | | | - Alexandra Varga
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Timothy B Frankland
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Jiang Li
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, Palo Alto, CA, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | | | | | - Andreea M Rawlings
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | | | - Connor Howick
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Stephen P Fortmann
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, USA.
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19
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Rossom RC, Peterson EL, Chawa MS, Prabhakar D, Hu Y, Yeh HH, Owen-Smith AA, Simon GE, Williams LK, Hubley S, Lynch F, Beck A, Daida YG, Lu CY, Ahmedani BK. Understanding TBI as a Risk Factor Versus a Means of Suicide Death Using Electronic Health Record Data. Arch Suicide Res 2023; 27:599-612. [PMID: 35118931 PMCID: PMC9881390 DOI: 10.1080/13811118.2022.2029782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of this research was to examine predictors and characterize causes of suicide death in people with traumatic brain injury (TBI) and conduct sensitivity analyses with and without people whose first diagnosis of TBI occurred within 3 days of their suicide death. METHODS This case-control study examined suicide risk for people with TBI in eight Mental Health Research Network-affiliated healthcare systems. Sample 1 included 61 persons with TBI who died by suicide and their 75 matched controls with TBI who did not die by suicide between January 1, 2000, and December 31, 2013. Sample 2 excluded the 34 persons with TBI whose first TBI diagnosis occurred within 3 days of their suicide death and their 46 matched controls. Descriptive statistics characterized the sample stratified by cases and controls, while conditional logistic regression models estimated the adjusted odds of suicide. RESULTS Over half of suicide deaths occurred within 3 days of a person's first diagnosis of TBI in the larger sample. After excluding these persons, people with TBI were 2.84 (95% confidence interval [CI]: 2.15-2.73) times more likely to die by suicide than were people without TBI. Among those with TBI, men were 16.39 times (95% CI: 1.89-142.15) more likely to die by suicide than were women. CONCLUSIONS Accounting for TBI as a potential consequence of suicide attenuates the association between TBI and suicide, but a robust association persists-especially among men. Ultimately, all people with TBI should be carefully screened and monitored for suicide risk.HIGHLIGHTSPeople with traumatic brain injury (TBI) were at considerably elevated risk for suicide deathMen with TBI had significantly increased risk of suicide death compared to women with TBITBI timing suggests confusion of risk factors for and consequences of suicide.
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20
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Bulkley JE, Varga AM, Dickerson JF, Crawford P, Croen LA, Daida YG, Fombonne E, Hatch B, Lee A, Massolo M, Vaughn K, Lynch FL. A framework for measuring the cost to families of caring for children's health: the design, methodology, and study population of the r-Kids study. BMC Pediatr 2023; 23:128. [PMID: 36941585 PMCID: PMC10025806 DOI: 10.1186/s12887-023-03893-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 02/06/2023] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND All families experience financial and time costs related to caring for their children's health. Understanding the economic burden faced by families of children with chronic health conditions (CHC) is crucial for designing effective policies to support families. METHODS In this prospective study we used electronic health records to identify children between 3 and 17 years old with autism spectrum disorder (ASD), asthma, or neither (control) from three Kaiser Permanente regions and several community health centers in the OCHIN network. We oversampled children from racial and ethnic minority groups. Parent/guardian respondents completed surveys three times, approximately four months apart. The surveys included the Family Economic Impact Inventory (measuring financial, time, and employment costs of caring for a child's health), and standardized measures of children's quality of life, behavioral problems, and symptom severity for children with ASD or asthma. We also assessed parenting stress and parent physical and mental health. All materials were provided in English and Spanish. RESULTS Of the 1,461 families that enrolled (564 ASD, 468 asthma, 429 control), children were predominantly male (79%), with a mean age of 9.0 years, and racially and ethnically diverse (43% non-Hispanic white; 22% Hispanic; 35% Asian, Black, Native Hawaiian, or another race/ethnicity). The majority of survey respondents were female (86%), had a college degree (62%), and were married/partnered (79%). ASD group respondents were less likely to be employed (73%) than those in the asthma or control groups (both 80%; p = .023). Only 32% of the control group reported a household income ≤ $4,000/month compared with 41% of asthma and 38% of ASD families (p = .006). CONCLUSIONS Utilizing a novel measure assessing family economic burden, we successfully collected survey responses from a large and diverse sample of families. Drawing upon the conceptual framework, survey measures, and self-report data described herein we will conduct future analyses to examine the economic burdens related to CHC and the incremental differences in these burdens between health groups. This information will help policy makers to design more equitable health and social policies that could reduce the burden on families.
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Affiliation(s)
- Joanna E Bulkley
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA.
| | - Alexandra M Varga
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - John F Dickerson
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Phil Crawford
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Lisa A Croen
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Yihe G Daida
- Kaiser Permanente Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Eric Fombonne
- Oregon Health & Science University, Portland, OR, USA
| | - Brigit Hatch
- Oregon Health & Science University, Portland, OR, USA
- OCHIN, Inc, Portland, OR, USA
| | | | - Maria Massolo
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Katherine Vaughn
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Frances L Lynch
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
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21
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Selim R, Gordon SC, Zhou Y, Zhang T, Lu M, Daida YG, Boscarino JA, Schmidt MA, Trudeau S, Rupp LB, Gonzalez HC. Impact of hepatitis C treatment status on risk of Parkinson's disease and secondary parkinsonism in the era of direct-acting antivirals. J Viral Hepat 2023; 30:544-550. [PMID: 36872452 DOI: 10.1111/jvh.13826] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/10/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
Research suggests a possible link between chronic infection with hepatitis C virus (HCV) and the development of Parkinson's Disease (PD) and secondary Parkinsonism (PKM). We investigated the impact of antiviral treatment status (untreated, interferon [IFN] treated, direct-acting antiviral [DAA] treated) and outcome (treatment failure [TF] or sustained virological response [SVR]) on risk of PD/PKM among patients with HCV. Using data from the Chronic Hepatitis Cohort Study (CHeCS), we applied a discrete time-to-event approach with PD/PKM as the outcome. We performed univariate followed by a multivariable modelling that used time-varying covariates, propensity scores to adjust for potential treatment selection bias and death as a competing risk. Among 17,199 confirmed HCV patients, we observed 54 incident cases of PD/PKM during a mean follow-up period of 17 years; 3753 patients died during follow-up. There was no significant association between treatment status/outcome and risk of PD/PKM. Type 2 diabetes tripled risk (hazard ratio [HR] 3.05; 95% CI 1.75-5.32; p < .0001) and presence of cirrhosis doubled risk of PD/PKM (HR 2.13, 95% CI 1.31-3.47). BMI >30 was associated with roughly 50% lower risk of PD/PKM than BMI <25 (HR 0.43; 0.22-0.84; p = .0138). After adjustment for treatment selection bias, we did not observe a significant association between HCV patients' antiviral treatment status/outcome on risk of PD/PKM. Several clinical risk factors-diabetes, cirrhosis and BMI-were associated with PD/PKM.
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Affiliation(s)
- Ranya Selim
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, Michigan, United States
| | - Stuart C Gordon
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, Michigan, United States.,School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Yueren Zhou
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, United States
| | - Talan Zhang
- Center on Aging & Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Mei Lu
- Center on Aging & Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, Hawaii, United States
| | | | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, United States
| | - Sheri Trudeau
- Center on Aging & Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Loralee B Rupp
- Department of Health Policy and Health Systems Research, Henry Ford Health, Detroit, Michigan, United States
| | - Humberto C Gonzalez
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, Michigan, United States.,School of Medicine, Wayne State University, Detroit, Michigan, United States
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22
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Lynch FL, Bulkley JE, Varga A, Crawford P, Croen LA, Daida YG, Fombonne E, Hatch B, Massolo M, Dickerson JF. The impact of autism spectrum disorder on parent employment: Results from the r-Kids study. Autism Res 2023; 16:642-652. [PMID: 36546608 DOI: 10.1002/aur.2882] [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: 03/17/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
Parents of children with autism spectrum disorder (ASD) and other chronic health conditions often face exceptional caregiving demands that can lead to challenges related to maintaining and succeeding in employment. Detailed information on the specific ways in which these health conditions impact parent employment could aid in designing equitable, effective policies to support families. The r-Kids study used electronic health records to identify three groups of children: those with ASD, asthma, or neither condition (control), from several health care systems. We oversampled racial and ethnic minorities and matched the asthma and control groups to the age and sex distribution of the ASD group. Parents completed three online surveys over the course of a year to measure annual employment outcomes. Surveys included the Family Economic Impact Inventory (measuring employment impacts) and measures of quality of life and symptom severity. All materials were provided in English and Spanish. The study enrolled 1461 families (564 ASD, 468 asthma, 429 control). Youth were 3-16.5 years old and predominantly male (79%). The sample was diverse (43% non-Hispanic White; 35% non-Hispanic Asian, Black, Native Hawaiian, or Other; and 21% Hispanic ethnicity). Parents of children with ASD were significantly less likely to be employed than parents of youth with asthma and control combined (OR: 14.2, p < 0.001), and were more likely to have other difficulties with employment and productivity while at work. Public and employer policies to help mitigate these impacts could aid families in managing care for youth with ASD.
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Affiliation(s)
- Frances L Lynch
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA.,OCHIN, Inc., Portland, Oregon, USA
| | - Joanna E Bulkley
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Alexandra Varga
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Phillip Crawford
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Lisa A Croen
- Kaiser Permanente Autism Research Program, Kaiser Permanente Northern California, Oakland, California, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente, Honolulu, Hawaii, USA
| | - Eric Fombonne
- School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Brigit Hatch
- OCHIN, Inc., Portland, Oregon, USA.,School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Maria Massolo
- Kaiser Permanente Autism Research Program, Kaiser Permanente Northern California, Oakland, California, USA
| | - John F Dickerson
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
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23
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Wong RJ, Rupp L, Lu M, Yang Z, Daida YG, Schmidt M, Boscarino JA, Gordon SC, Chitnis AS. Prevalence of hepatitis B virus (HBV) and latent tuberculosis co-infection and risk of drug-induced liver injury across two large HBV cohorts in the United States. J Viral Hepat 2023; 30:512-519. [PMID: 36843435 DOI: 10.1111/jvh.13823] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 02/28/2023]
Abstract
The epidemiology of latent tuberculosis and hepatitis B virus (HBV-LTBI) co-infection among U.S. populations is not well studied. We aim to evaluate LTBI testing patterns and LTBI prevalence among two large U.S. cohorts of adults with chronic HBV (CHB). Adults with CHB in the Chronic Hepatitis Cohort Study (CHeCS) and Veterans Affairs national cohort were included in the analyses. Prevalence of HBV-LTBI co-infection was defined as the number of HBV patients with LTBI divided by the number of HBV patients in a cohort. Multivariable logistic regression evaluated odds of HBV-LTBI co-infection among CHB patients who underwent TB testing. Among 6019 CHB patients in the CHeCS cohort (44% female, 47% Asian), 9.1% were tested for TB, among whom 7.7% had HBV-LTBI co-infection. Among HBV-LTBI co-infected patient, only 16.7% (n = 7) received LTBI treatment, among whom 28.6% (n = 2) developed DILI. Among 12,928 CHB patients in the VA cohort (94% male, 42% African American, 39% non-Hispanic white), 14.7% were tested for TB, among whom 14.5% had HBV-LTBI. Among HBV-LTBI co-infected patient, 18.6% (n = 51) received LTBI treatment, among whom 3.9% (n = 3) developed DILI. Presence of cirrhosis, race/ethnicity, and country of birth were observed to be associated with odds of HBV-LTBI co-infection among CHB patients who received TB testing. In summary, among two large distinct U.S. cohorts of adults with CHB, testing for LTBI was infrequent despite relatively high prevalence of HBV-LTBI co-infection. Moreover, low rates of LTBI treatment were observed among those with HBV-LTBI co-infection.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.,Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Loralee Rupp
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, Michigan, USA
| | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Zeyuan Yang
- Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Portland, Oregon, USA
| | - Mark Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | | | - Stuart C Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health System and Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Amit S Chitnis
- Tuberculosis Section, Alameda County Public Health Department, Oakland, California, USA
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24
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Braciszewski JM, Lanier A, Yeh HH, Sala-Hamrick K, Simon GE, Rossom RC, Lynch FL, Waring SC, Lu CY, Owen-Smith AA, Beck A, Daida YG, Maye M, Frank C, Hendriks M, Fabian N, Ahmedani BK. Health Diagnoses and Service Utilization in the Year Before Youth and Young Adult Suicide. Psychiatr Serv 2022:appips20220145. [PMID: 36349497 PMCID: PMC10166760 DOI: 10.1176/appi.ps.20220145] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Suicide rates among young people are rising. Health care visits provide opportunities for identification and intervention, yet studies have been limited by small or circumscribed samples. This study sought to expand the knowledge base by examining health care encounters and diagnoses among young people who later died by suicide. METHODS This case-control study examined diagnoses of mental and general medical disorders and health care utilization in the 30 and 365 days before suicide death in nine large U.S. health care systems. Data (years 2000-2015) from 445 suicide decedents ages 10-24 years were matched with data from 4,450 control group patients. RESULTS Suicide decedents were more likely to have at least one mental disorder diagnosis (51% vs. 16%; adjusted OR [AOR]=5.74, 95% CI=4.60-7.18) and had higher rates of nearly all mental health conditions. Substance use disorders were common (12%) and more likely (AOR=8.50, 95% CI=5.53-13.06) among suicide decedents. More than one in three (42%) suicide decedents had a health care visit in the month before death, and nearly all (88%) had a visit in the previous year. CONCLUSIONS Despite the greater likelihood of suicide associated with mental disorder diagnoses, such disorders were present among only 51% of suicide decedents. High rates of health care utilization among suicide decedents indicate a need for improving identification of mental health conditions and suicide risk across the health care system. Increased substance use screening may help identify youths at high risk because substance use disorders were significantly more prevalent and likely among suicide decedents.
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Affiliation(s)
- Jordan M Braciszewski
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ana Lanier
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Kelsey Sala-Hamrick
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Gregory E Simon
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Rebecca C Rossom
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Frances L Lynch
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Stephen C Waring
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Christine Y Lu
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ashli A Owen-Smith
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Arne Beck
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Yihe G Daida
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Melissa Maye
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Cathrine Frank
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Melissa Hendriks
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Nina Fabian
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
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25
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Kahn GD, Tam SH, Felton JW, Westphal J, Simon GE, Owen‐Smith AA, Rossom RC, Beck AL, Lynch FL, Daida YG, Lu CY, Waring S, Frank CB, Akinyemi EO, Ahmedani BK. Cancer and psychiatric diagnoses in the year preceding suicide. Cancer Med 2022; 12:3601-3609. [PMID: 36114785 PMCID: PMC9939190 DOI: 10.1002/cam4.5201] [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: 05/31/2022] [Revised: 08/09/2022] [Accepted: 08/23/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with cancer are known to be at increased risk for suicide but little is known about the interaction between cancer and psychiatric diagnoses, another well-documented risk factor. METHODS Electronic medical records from nine healthcare systems participating in the Mental Health Research Network were aggregated to form a retrospective case-control study, with ICD-9 codes used to identify diagnoses in the 1 year prior to death by suicide for cases (N = 3330) or matching index date for controls (N = 297,034). Conditional logistic regression was used to assess differences in cancer and psychiatric diagnoses between cases and controls, controlling for sex and age. RESULTS Among patients without concurrent psychiatric diagnoses, cancer at disease sites with lower average 5-year survival rates were associated with significantly greater relative risk, while cancer disease sites with survival rates of >70% conferred no increased risk. Patients with most psychiatric diagnoses were at higher risk, however, there was no additional risk conferred to these patients by a concurrent cancer diagnosis. CONCLUSION We found no evidence of a synergistic effect between cancer and psychiatric diagnoses. However, cancer patients with a concurrent psychiatric illness remain at the highest relative risk for suicide, regardless of cancer disease site, due to strong independent associations between psychiatric diagnoses and suicide. For patients without a concurrent psychiatric illness, cancer disease sites associated with worse prognoses appeared to confer greater suicide risk.
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Affiliation(s)
- Geoffrey D. Kahn
- Center for Health Policy & Health Services ResearchHenry Ford HealthDetroitMichiganUSA
| | - Samantha H. Tam
- Department of Otolaryngology – Head and Neck SurgeryHenry Ford HealthDetroitMichiganUSA
| | - Julia W. Felton
- Center for Health Policy & Health Services ResearchHenry Ford HealthDetroitMichiganUSA
| | - Joslyn Westphal
- Center for Health Policy & Health Services ResearchHenry Ford HealthDetroitMichiganUSA
| | - Gregory E. Simon
- Kaiser Permanente Washington Health Research InstituteSeattleWAUSA
| | - Ashli A. Owen‐Smith
- Department of Health Policy and Behavioral SciencesGeorgia State University School of Public HealthAtlantaGeorgiaUSA
| | | | - Arne L. Beck
- Institute for Health Research, Kaiser Permanente ColoradoAuroraColoradoUSA
| | - Frances L. Lynch
- Center for Health ResearchKaiser Permanente HawaiiPortlandOregonUSA
| | - Yihe G. Daida
- Center for Integrated Health Care ResearchKaiser Permanente HawaiiHonoluluHawaiiUSA
| | - Christine Y. Lu
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMassachusettsUSA
| | | | | | | | - Brian K. Ahmedani
- Center for Health Policy & Health Services ResearchHenry Ford HealthDetroitMichiganUSA
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26
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Li J, Lu M, Zhou Y, Bowlus CL, Lindor K, Rodriguez-Watson C, Romanelli RJ, Haller IV, Anderson H, VanWormer JJ, Boscarino JA, Schmidt MA, Daida YG, Sahota A, Vincent J, Wu KHH, Trudeau S, Rupp LB, Melkonian C, Gordon SC. Dynamic Risk Prediction of Response to Ursodeoxycholic Acid Among Patients with Primary Biliary Cholangitis in the USA. Dig Dis Sci 2022; 67:4170-4180. [PMID: 34499271 DOI: 10.1007/s10620-021-07219-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ursodeoxycholic acid (UDCA) remains the first-line therapy for primary biliary cholangitis (PBC); however, inadequate treatment response (ITR) is common. The UK-PBC Consortium developed the modified UDCA Response Score (m-URS) to predict ITR (using alkaline phosphatase [ALP] > 1.67 times the upper limit of normal [*ULN]) at 12 months post-UDCA initiation). Using data from the US-based Fibrotic Liver Disease Consortium, we assessed the m-URS in our multi-racial cohort. We then used a dynamic modeling approach to improve prediction accuracy. METHODS Using data collected at the time of UDCA initiation, we assessed the m-URS using the original formula; then, by calibrating coefficients to our data, we also assessed whether it remained accurate when using Paris II criteria for ITR. Next, we developed and validated a dynamic risk prediction model that included post-UDCA initiation laboratory data. RESULTS Among 1578 patients (13% men; 8% African American, 9% Asian American/American Indian/Pacific Islander; 25% Hispanic), the rate of ITR was 27% using ALP > 1.67*ULN and 45% using Paris II criteria. M-URS accuracy was "very good" (AUROC = 0.87, sensitivity = 0.62, and specificity = 0.82) for ALP > 1.67*ULN and "moderate" (AUROC = 0.74, sensitivity = 0.57, and specificity = 0.70) for Paris II. Our dynamic model significantly improved accuracy for both definitions of ITR (ALP > 1.67*ULN: AUROC = 0.91; Paris II: AUROC = 0.81); specificity approached 100%. Roughly 9% of patients in our cohort were at the highest risk of ITR. CONCLUSIONS Early identification of patients who will not respond to UDCA treatment using a dynamic prediction model based on longitudinal, repeated risk factor measurements may facilitate earlier introduction of adjuvant treatment.
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Affiliation(s)
- Jia Li
- Department of Public Health Sciences, Henry Ford Health System, 3E One Ford Place, Detroit, MI, 48202, USA.
| | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, 3E One Ford Place, Detroit, MI, 48202, USA
| | - Yueren Zhou
- Department of Public Health Sciences, Henry Ford Health System, 3E One Ford Place, Detroit, MI, 48202, USA
| | | | - Keith Lindor
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Carla Rodriguez-Watson
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
- Innovation in Medical Evidence Development and Surveillance, The Reagan-Udall Foundation for the FDA, Washington, DC, USA
| | | | - Irina V Haller
- Essentia Institute of Rural Health, Essentia Health, Duluth, MN, USA
| | - Heather Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | | | - Joseph A Boscarino
- Department of Epidemiology and Health Services Research, Geisinger Clinic, Danville, PA, USA
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Amandeep Sahota
- Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | | | - Kuan-Han Hank Wu
- Department of Public Health Sciences, Henry Ford Health System, 3E One Ford Place, Detroit, MI, 48202, USA
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health System, 3E One Ford Place, Detroit, MI, 48202, USA
| | - Loralee B Rupp
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Christina Melkonian
- Department of Public Health Sciences, Henry Ford Health System, 3E One Ford Place, Detroit, MI, 48202, USA
| | - Stuart C Gordon
- Department of Gastroenterology and Hepatology, Henry Ford Health System, and Wayne State University School of Medicine, Detroit, MI, USA
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27
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Blakney RA, Ricotta EE, Frankland TB, Honda S, Zelazny A, Mayer-Barber KD, Dean SG, Follmann D, Olivier KN, Daida YG, Prevots DR. Incidence of Nontuberculous Mycobacterial Pulmonary Infection, by Ethnic Group, Hawaii, USA, 2005-2019. Emerg Infect Dis 2022; 28:1543-1550. [PMID: 35876462 PMCID: PMC9328927 DOI: 10.3201/eid2808.212375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To further clarify differences in the risk for nontuberculous mycobacterial pulmonary infection (NTM-PI) among ethnic populations in Hawaii, USA, we conducted a retrospective cohort study among beneficiaries of Kaiser Permanente Hawaii (KPH). We abstracted demographic, socioeconomic, clinical, and microbiological data from KPH electronic health records for 2005-2019. An NTM-PI case-patient was defined as a person from whom >1 NTM pulmonary isolate was obtained. We performed Cox proportional hazards regression to estimate incidence of NTM-PI while controlling for confounders. Across ethnic groups, risk for NTM-PI was higher among persons who were underweight (body mass index [BMI] <18.5 kg/m2). Among beneficiaries who self-identified as any Asian ethnicity, risk for incident NTM-PI was increased by 30%. Low BMI may increase susceptibility to NTM-PI, and risk may be higher for persons who self-identify as Asian, independent of BMI.
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28
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Ahmedani BK, Cannella CE, Yeh HH, Westphal J, Simon GE, Beck A, Rossom RC, Lynch FL, Lu CY, Owen-Smith AA, Sala-Hamrick KJ, Frank C, Akinyemi E, Beebani G, Busuito C, Boggs JM, Daida YG, Waring S, Gui H, Levin AM. Detecting and distinguishing indicators of risk for suicide using clinical records. Transl Psychiatry 2022; 12:280. [PMID: 35831289 PMCID: PMC9279332 DOI: 10.1038/s41398-022-02051-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022] Open
Abstract
Health systems are essential for suicide risk detection. Most efforts target people with mental health (MH) diagnoses, but this only represents half of the people who die by suicide. This study seeks to discover and validate health indicators of suicide death among those with, and without, MH diagnoses. This case-control study used statistical modeling with health record data on diagnoses, procedures, and encounters. The study included 3,195 individuals who died by suicide from 2000 to 2015 and 249,092 randomly selected matched controls, who were age 18+ and affiliated with nine Mental Health Research Network affiliated health systems. Of the 202 indicators studied, 170 (84%) were associated with suicide in the discovery cohort, with 148 (86%) of those in the validation cohort. Malignant cancer diagnoses were risk factors for suicide in those without MH diagnoses, and multiple individual psychiatric-related indicators were unique to the MH subgroup. Protective effects across MH-stratified models included diagnoses of benign neoplasms, respiratory infections, and utilization of reproductive services. MH-stratified latent class models validated five subgroups with distinct patterns of indicators in both those with and without MH. The highest risk groups were characterized via high utilization with multiple healthcare concerns in both groups. The lowest risk groups were characterized as predominantly young, female, and high utilizers of preventive services. Healthcare data include many indicators of suicide risk for those with and without MH diagnoses, which may be used to support the identification and understanding of risk as well as targeting of prevention in health systems.
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Affiliation(s)
- Brian K. Ahmedani
- Henry Ford Health, Center for Health Policy & Health Services Research, 1 Ford Place, Suite 3A, Detroit, MI 48202 USA ,grid.427930.b0000 0004 4903 9942Henry Ford Health, Behavioral Health Services, Detroit, MI USA
| | - Cara E. Cannella
- Henry Ford Health, Public Health Sciences, Detroit, MI USA ,Henry Ford Health, Center for Bioinformatics, Detroit, MI USA
| | - Hsueh-Han Yeh
- Henry Ford Health, Center for Health Policy & Health Services Research, 1 Ford Place, Suite 3A, Detroit, MI 48202 USA
| | - Joslyn Westphal
- Henry Ford Health, Center for Health Policy & Health Services Research, 1 Ford Place, Suite 3A, Detroit, MI 48202 USA
| | - Gregory E. Simon
- grid.488833.c0000 0004 0615 7519Kaiser Permanente Washington, Health Research Institute, Seattle, WA USA
| | - Arne Beck
- grid.280062.e0000 0000 9957 7758Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO USA
| | - Rebecca C. Rossom
- grid.280625.b0000 0004 0461 4886HealthPartners Institute, Minneapolis, MN USA
| | - Frances L. Lynch
- grid.414876.80000 0004 0455 9821Kaiser Permanente Northwest, Center for Health Research, Portland, OR USA
| | - Christine Y. Lu
- grid.38142.3c000000041936754XHarvard Pilgrim Health Care Institute & Harvard Medical School, Department of Population Health, Boston, MA USA
| | - Ashli A. Owen-Smith
- grid.256304.60000 0004 1936 7400Georgia State University & Kaiser Permanente Georgia, Atlanta, GA USA
| | - Kelsey J. Sala-Hamrick
- Henry Ford Health, Center for Health Policy & Health Services Research, 1 Ford Place, Suite 3A, Detroit, MI 48202 USA
| | - Cathrine Frank
- grid.427930.b0000 0004 4903 9942Henry Ford Health, Behavioral Health Services, Detroit, MI USA
| | - Esther Akinyemi
- grid.427930.b0000 0004 4903 9942Henry Ford Health, Behavioral Health Services, Detroit, MI USA
| | - Ganj Beebani
- grid.427930.b0000 0004 4903 9942Henry Ford Health, Behavioral Health Services, Detroit, MI USA
| | - Christopher Busuito
- grid.427930.b0000 0004 4903 9942Henry Ford Health, Behavioral Health Services, Detroit, MI USA
| | - Jennifer M. Boggs
- grid.280062.e0000 0000 9957 7758Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO USA
| | - Yihe G. Daida
- grid.280062.e0000 0000 9957 7758Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu, HI USA
| | - Stephen Waring
- grid.428919.f0000 0004 0449 6525Essentia Institute of Rural Health, Duluth, MN USA
| | - Hongsheng Gui
- grid.427930.b0000 0004 4903 9942Henry Ford Health, Behavioral Health Services, Detroit, MI USA
| | - Albert M. Levin
- Henry Ford Health, Public Health Sciences, Detroit, MI USA ,Henry Ford Health, Center for Bioinformatics, Detroit, MI USA
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29
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Goger P, Zerr AA, Weersing VR, Dickerson JF, Crawford PM, Sterling SA, Waitzfelder B, Daida YG, Ahmedani BK, Penfold RB, Lynch FL. Health Service Utilization Among Children and Adolescents with Posttraumatic Stress Disorder: A Case-Control Study. J Dev Behav Pediatr 2022; 43:283-290. [PMID: 34817448 PMCID: PMC9124718 DOI: 10.1097/dbp.0000000000001041] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/01/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Trauma exposure is widely prevalent, with more than 60% of adolescents having experienced at least 1 traumatic event and a third of those at high risk to develop posttraumatic stress disorder (PTSD). Data are scarce and out of date on the services children and adolescents with PTSD receive, impeding efforts to improve care and outcomes. This study examines health service use for a large and diverse sample of children and adolescents with and without a diagnosis of PTSD. METHOD Using a matched case-control study, we gathered information from 4 large health care systems participating in the Mental Health Research Network. Data from each site's electronic medical records on diagnoses, health care encounters, and demographics were analyzed. Nine hundred fifty-five 4- to 18-year-olds with a diagnosis of PTSD were identified and matched on a 1:5 ratio to 4770 controls. We compared cases with controls on frequency of service use in outpatient primary care, medical specialty care, acute care, and mental health care. We also assessed psychotropic medication use. RESULTS Children and adolescents diagnosed with PTSD used nearly all physical and mental health service categories at a higher rate than controls. However, one-third of children and adolescents did not receive even 1 outpatient mental health visit (36.86%) during the year-long sampling window. CONCLUSION Our findings suggest that children and adolescents diagnosed with PTSD may have unmet mental health needs. They are high utilizers of health services overall, but lower utilizers of the sectors that may be most helpful in resolving their symptoms.
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Affiliation(s)
- Pauline Goger
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Argero A. Zerr
- California State University Channel Islands, Camarillo, CA
| | - V. Robin Weersing
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | | | | | | | - Beth Waitzfelder
- Kaiser Permanente Center for Integrated Health Care Research, Honolulu, HI
| | - Yihe G. Daida
- Kaiser Permanente Center for Integrated Health Care Research, Honolulu, HI
| | - Brian K. Ahmedani
- Center for Health Services Research, Henry Ford Health System, Detroit, MI
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30
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Fombonne E, Croen LA, Bulkley JE, Varga AM, Daida YG, Hatch BA, Dickerson JF, Lynch FL. Emotional and Behavioral Problems in Youth with Autism: High Prevalence and Impact on Functioning. J Dev Behav Pediatr 2022; 43:140-148. [PMID: 34693924 PMCID: PMC9021329 DOI: 10.1097/dbp.0000000000001028] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Emotional and behavioral problems (EBPs) may co-occur with autism spectrum disorder (ASD) and impair children's functioning beyond autism symptomatology. We compared the prevalence of EBPs in youths with or without ASD and evaluated their unique contribution to impairment in ASD. METHODS We surveyed 1267 children (79.4% boys, mean age: 9.2 years, range: 3-17) recruited at 3 sites in Kaiser Permanente and OCHIN primary care clinical networks, with confirmed International Classification of Diseases-10th ed. diagnosis of ASD (N = 564), asthma (N = 468), or neither (N = 429). Children from the 2 comparison groups were age-matched and sex-matched to the ASD group. EBPs and impairment were measured by the Strengths and Difficulties Questionnaire and autism symptomatology by the Social Responsiveness Scale in the ASD group only. RESULTS EBPs and impairment mean scores were significantly (p < 0.001) higher in participants with ASD compared with children from the 2 comparison groups, across sexes and age groups, with no significant difference between the asthma and control groups. Among children with ASD, both EBPs and autistic symptoms were significantly correlated with impairment (r = 0.64 and r = 0.65, respectively) and explained a significant proportion of impairment variance (R2 = 0.525; p < 0.001) in multiple linear regression. In the relative importance analysis, EBPs and autistic symptoms explained comparable proportions of impairment variance (46% and 52%, respectively) with no significant difference between their relative weights (mean difference: 0.03; 95% confidence interval: -0.049 to 0.114). CONCLUSION Among youth with ASD, high levels of EBPs impair daily functioning as much as autistic symptoms. Systematic detection and management of EBPs may improve functioning and outcomes in youth with ASD.
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Affiliation(s)
| | | | - Joanna E. Bulkley
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Yihe G. Daida
- Center for Integrated Health Care Research, Kaiser Permanente, Honolulu, HI
| | - Brigit A. Hatch
- Oregon Health & Science University, Portland, OR
- OCHIN, Inc., Portland, OR
| | - John F. Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Frances L. Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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Zhou Y, Li J, Gordon SC, Trudeau S, Rupp LB, Boscarino JA, Daida YG, Schmidt MA, Lu M. Laboratory monitoring and antiviral treatment for chronic hepatitis B among routine care patients in the United States. J Viral Hepat 2022; 29:189-195. [PMID: 34905259 DOI: 10.1111/jvh.13639] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 12/09/2022]
Abstract
We investigated factors associated with rates of recommended monitoring of chronic hepatitis B (HBV) patients for viral DNA and alanine aminotransferase (ALT), and initiation of antiviral treatment among eligible patients, in a US cohort of patients under routine care. Patients were categorised by treatment indication: definite, equivocal or ineligible. Baseline covariates included demographics, clinical characteristics and specialist care status. 'Recommended monitoring' was defined ≥1 ALT or HBV DNA test per year. Logit models, univariate then multivariable, were used to evaluate factors associated with monitoring and treatment. Among 3,830 patients, treatment was received by 67.5% (788/1168 patients) in the 'definite' category, and 34.1% (208/610 patients) in the 'equivocal' category, of whom 109 moved up to 'definite' status at some point during follow-up. Sex, age and specialist care were independently associated with receipt of treatment in 'definite' patients. Routine monitoring rates were high prior to treatment in 'definite/ treated' patients (ALT: 77%; DNA: 85%) but declined afterwards (ALT 63%; DNA 36%). Rates of monitoring were lower in 'definite/ untreated' patients (ALT: 48%; DNA: 32%). Among 'equivocal/ treated' patients, lower age and comorbidity scores were associated with receipt of treatment; ALT monitoring rates were similar before and after treatment initiation (41% and 46%, respectively), while rates of DNA monitoring declined (55% and 29%). Monitoring among 'treatment ineligible' patients was similar to those in the 'equivocal' and untreated 'definite' groups. A large proportion of US HBV patients under routine care did not receive recommended annual laboratory monitoring, especially after initiation of antiviral treatment, and nearly one-third of patients with 'definite' indications for antiviral therapy remained untreated.
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Affiliation(s)
- Yueren Zhou
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Jia Li
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Stuart C Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan, USA.,School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Loralee B Rupp
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, USA
| | - Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente-Hawai'i, Honolulu, Hawaii, USA
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente-Northwest, Portland, Oregon, USA
| | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
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Yarborough BJH, Stumbo SP, Rosales AG, Ahmedani BK, Boggs JM, Daida YG, Negriff S, Rossom RC, Simon G, Perrin NA. Opioid-related variables did not improve suicide risk prediction models in samples with mental health diagnoses. Journal of Affective Disorders Reports 2022; 8. [PMID: 36276588 PMCID: PMC9583814 DOI: 10.1016/j.jadr.2022.100346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Suicide risk prediction models derived from machine learning of electronic health records and insurance claims are an innovation in suicide prevention. Some models do not include opioid-related variables despite the relationship between opioids and suicide. This study evaluated whether inclusion of opioid-related variables improved suicide risk prediction models developed by the Mental Health Research Network. Methods Approximately 630 opioid-related variables and interactions terms were introduced into existing suicide prediction models run in datasets of patient visits in mental health care (n = 27,755,401 visits) or primary care when a mental health diagnosis was given (n = 19,340,461 visits). Training and validation datasets were created. LASSO regression with 10-fold validation identified variables to be added to the models. Results The new models predicting suicide attempts and suicide deaths in the mental health specialty visit sample performed as well as the existing models (new C-statistic for attempts model = 0.855, CI: 0.853-0.857 versus original C-statistic = 0.851, CI 0.848-0.853; death model = 0.868, CI: 0.856-0.879 versus 0.861, CI 0.848-0.875). The new model for suicide death in the primary care sample improved (0.855, CI: 0.837-0.874 versus 0.833, CI 0.813-0.853) while performance of the new model for suicide attempt in that sample degraded (0.843, CI: 0.839-0.847 versus 0.853, CI 0.849-0.857). Limitations Analyses did not include patients without recent care, data did not include illicit opioid use or unrecognized opioid use disorder. Conclusions Among patients with mental health diagnoses, inclusion of opioid-related variables did not improve prediction of suicide risk beyond mental health predictors.
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Affiliation(s)
| | - Scott P Stumbo
- Kaiser Permanente Northwest Center for Health Research, Portland, OR
| | | | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI
| | - Jennifer M Boggs
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI
| | - Sonya Negriff
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, CA
| | | | - Greg Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
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Lu M, Li J, Zhou Y, Rupp LB, Moorman AC, Spradling PR, Teshale EH, Boscarino JA, Daida YG, Schmidt MA, Trudeau S, Gordon SC. Trends in Cirrhosis and Mortality by Age, Sex, Race, and Antiviral Treatment Status Among US Chronic Hepatitis B Patients (2006-2016). J Clin Gastroenterol 2022; 56:273-279. [PMID: 33780209 PMCID: PMC10257940 DOI: 10.1097/mcg.0000000000001522] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/31/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Changing US demographics and evolving chronic hepatitis B (CHB) treatments may affect longitudinal trends in CHB-related complications. We studied trends in the prevalence of cirrhosis (past or present) and incidence of all-cause mortality, stratified by patient age, sex, race, and antiviral treatment status, in a sample from US health care systems. METHODS Joinpoint and Poisson regression (univariate and multivariable) were used to estimate the annual percent change in each outcome from 2006 to 2016. RESULTS Among 5528 CHB patients, cirrhosis prevalence (including decompensated cirrhosis) rose from 6.7% in 2006 to 13.7% in 2016; overall mortality was unchanged. Overall rates of cirrhosis and mortality were higher among treated patients, but adjusted annual percent changes (aAPC) were significantly lower among treated than untreated patients (cirrhosis: aAPC +2.4% vs. +6.2%, mortality: aAPC -3.9% vs. +4.0%). Likewise, among treated patients, the aAPC for mortality declined -3.9% per year whereas among untreated patients, mortality increased +4.0% per year. CONCLUSIONS From 2006 to 2016, the prevalence of cirrhosis among CHB patients doubled. Notably, all-cause mortality increased among untreated patients but decreased among treated patients. These results suggest that antiviral treatment attenuates the progression of cirrhosis and the risk of death among patients with CHB.
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Affiliation(s)
- Mei Lu
- Department of Public Health Sciences
| | - Jia Li
- Department of Public Health Sciences
| | | | - Loralee B. Rupp
- Center for Health Policy and Health Services Research, Henry Ford Health System
| | - Anne C. Moorman
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Philip R. Spradling
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Eyasu H. Teshale
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joseph A. Boscarino
- Department of Epidemiology and Health Research, Geisinger Clinic, Danville, PA
| | - Yihe G. Daida
- Center for Health Research, Kaiser Permanente—Hawaii, Honolulu, HI
| | - Mark A. Schmidt
- Center for Health Research, Kaiser Permanente—Northwest, Portland, OR
| | | | - Stuart C. Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health System and Wayne State University School of Medicine, Detroit, MI
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Gordon SC, Teshale EH, Spradling PR, Moorman AC, Boscarino JA, Schmidt MA, Daida YG, Rupp LB, Trudeau S, Zhang J, Lu M. Lower rates of emergency visits and hospitalizations among chronic hepatitis C patients with sustained virological response to interferon-free direct-acting antiviral therapy (2014-2018). Clin Infect Dis 2022; 75:1453-1456. [PMID: 35147184 DOI: 10.1093/cid/ciac124] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Indexed: 12/09/2022] Open
Abstract
We compared rates of emergency department (ED) visits and hospitalizations between HCV patients who achieved sustained virological response (SVR) after direct-acting antiviral (DAA) therapy (cases) to matched controls. Among 3049 pairs, cases demonstrated lower rates of liver-related ED visits (P=.01) than controls; all-cause and liver-related hospitalization rates and hospitalized days were also lower in cases (P<.0001).
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Affiliation(s)
- Stuart C Gordon
- Department of Hepatology and Gastroenterology, Henry Ford Health System; and Wayne State University School of Medicine, Detroit MI
| | - Eyasu H Teshale
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Philip R Spradling
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Anne C Moorman
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI
| | - Loralee B Rupp
- Center for Health Policy and Health Systems Research, Henry Ford Health System, Detroit MI
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health System, Detroit MI
| | - Jiaqi Zhang
- Department of Public Health Sciences, Henry Ford Health System, Detroit MI
| | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, Detroit MI
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35
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Spradling PR, Xing J, Zhong Y, Rupp LB, Moorman AC, Lu M, Teshale EH, Schmidt MA, Daida YG, Boscarino JA, Gordon SC. Incidence of malignancies among patients with chronic hepatitis B in US health care organizations, 2006-2018. J Infect Dis 2022; 226:896-900. [PMID: 35039863 DOI: 10.1093/infdis/jiac011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/22/2021] [Accepted: 01/13/2022] [Indexed: 12/09/2022] Open
Abstract
Hepatitis B virus (HBV) infection causes hepatocellular carcinoma but its association with other cancers is not well established. We compared age-adjusted incidence of primary cancers among 5,773 HBV-infected persons with US cancer registries during 2006-2018. Compared with the US population, substantially higher incidence among HBV-infected persons was observed for hepatocellular carcinoma (Standardized rate ratio [SRR] 30.79), gastric (SRR 7.95), neuroendocrine (SRR 5.88), cholangiocarcinoma (SRR 4.62), and ovarian (SRR 3.72) cancers, and non-Hodgkin lymphoma (SRR 2.52). Clinicians should be aware of a heightened potential for certain non-hepatic malignancies among hepatitis B patients, as earlier diagnosis favors improved survival.
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Affiliation(s)
- Philip R Spradling
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jian Xing
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Y Zhong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Anne C Moorman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mei Lu
- Henry Ford Health System, Detroit, MI, USA
| | - Eyasu H Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark A Schmidt
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Yihe G Daida
- The Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, Danville, PA, USA
| | - Stuart C Gordon
- Henry Ford Health System, Detroit, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
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DeRouen MC, Canchola AJ, Thompson CA, Jin A, Nie S, Wong C, Lichtensztajn D, Allen L, Patel MI, Daida YG, Luft HS, Shariff-Marco S, Reynolds P, Wakelee HA, Liang SY, Waitzfelder BE, Cheng I, Gomez SL. Incidence of Lung Cancer Among Never-Smoking Asian American, Native Hawaiian, and Pacific Islander Females. J Natl Cancer Inst 2022; 114:78-86. [PMID: 34345919 PMCID: PMC8755498 DOI: 10.1093/jnci/djab143] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/17/2021] [Accepted: 07/16/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Although lung cancer incidence rates according to smoking status, sex, and detailed race/ethnicity have not been available, it is estimated that more than half of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) females with lung cancer have never smoked. METHODS We calculated age-adjusted incidence rates for lung cancer according to smoking status and detailed race/ethnicity among females, focusing on AANHPI ethnic groups, and assessed relative incidence across racial/ethnic groups. We used a large-scale dataset that integrates data from electronic health records from 2 large health-care systems-Sutter Health in Northern California and Kaiser Permanente Hawai'i-linked to state cancer registries for incident lung cancer diagnoses between 2000 and 2013. The study population included 1 222 694 females (n = 244 147 AANHPI), 3297 of which were diagnosed with lung cancer (n = 535 AANHPI). RESULTS Incidence of lung cancer among never-smoking AANHPI as an aggregate group was 17.1 per 100 000 (95% confidence interval [CI] = 14.9 to 19.4) but varied widely across ethnic groups. Never-smoking Chinese American females had the highest rate (22.8 per 100 000, 95% CI = 17.3 to 29.1). Except for Japanese American females, incidence among every never-smoking AANHPI female ethnic group was higher than that of never-smoking non-Hispanic White females, from 66% greater among Native Hawaiian females (incidence rate ratio = 1.66, 95% CI = 1.03 to 2.56) to more than 100% greater among Chinese American females (incidence rate ratio = 2.26, 95% CI = 1.67 to 3.02). CONCLUSIONS Our study revealed high rates of lung cancer among most never-smoking AANHPI female ethnic groups. Our approach illustrates the use of innovative data integration to dispel the myth that AANHPI females are at overall reduced risk of lung cancer and demonstrates the need to disaggregate this highly diverse population.
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Affiliation(s)
- Mindy C DeRouen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Greater Bay Area Cancer Registry, University of California San Francisco, CA, USA
| | - Caroline A Thompson
- San Diego State University School of Public Health, San Diego, CA, USA
- University of California San Diego School of Medicine, San Diego, CA, USA
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Anqi Jin
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Sixiang Nie
- Kaiser Permanente Hawai’i Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Carmen Wong
- Kaiser Permanente Hawai’i Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Daphne Lichtensztajn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Greater Bay Area Cancer Registry, University of California San Francisco, CA, USA
| | - Laura Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - Yihe G Daida
- Kaiser Permanente Hawai’i Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Harold S Luft
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
- Greater Bay Area Cancer Registry, University of California San Francisco, CA, USA
| | - Peggy Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Su-Ying Liang
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Beth E Waitzfelder
- Kaiser Permanente Hawai’i Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
- Greater Bay Area Cancer Registry, University of California San Francisco, CA, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
- Greater Bay Area Cancer Registry, University of California San Francisco, CA, USA
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DeRouen MIC, Canchola AJ, Thompson CA, Jin A, Nie S, Wong C, Lichtensztajn D, Allen L, Patel MI, Daida YG, Luft HS, Shariff-Marco S, Reynolds P, Wakelee HA, Liang SY, Waitzfelder BE, Cheng I, Gomez SL. Abstract IA-21: Applying a data integrative and convergence epidemiology approach to study multilevel risk factors for cancer in distinct AANHPI populations. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-ia-21] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: For Asian American, Native Hawaiian and Pacific Islander (AANHPI) females, lung cancer is one of the most common cancers and the leading cause of cancer death. More than half of lung cancers among AANHPI females occur among never-smokers, but incidence rates of lung cancer according to smoking status have not been available. Purpose: With a large, integrated dataset of electronic health record data from two healthcare systems—Sutter Health in Northern California and Kaiser Permanente Hawai'i—linked to state cancer registry data on incident lung cancer diagnoses 2000-2013, we describe incidence of lung cancer according to smoking status among females across detailed race and ethnicity. Methods: We calculated age-adjusted incidence rates for lung cancer according to smoking status and detailed race and ethnicity among females, focusing on AANHPI ethnic groups, and assessed relative incidence across racial and ethnic groups. The study population included N=1,222,694 females (n=244,147 AANHPI), n=3,297 (n=535) of whom were diagnosed with lung cancer. We examined relative incidence across group defined by detailed race and ethnicity. We also provided incidence of lung cancer among AANHPI males who never smoked in a supplement. Results: Among AANHPI female groups, proportions of lung cancers among never-smokers ranged from 25% among Native Hawaiian to 80% among Chinese females. Incidence of lung cancer among never-smoking AANHPI females as an aggregate was 17.1 per 100,000 (95% CI: 14.9, 19.4), but rates varied widely across ethnic groups. Never-smoking Chinese females had the highest rate (22.8; 95% CI: 17.3, 29.1). Except for Japanese females, incidence among every never-smoking AANHPI female ethnic group was higher than that of all never-smoking females combined. Never-smoking AANHPI males also have higher incidence of lung cancer compared to other groups defined by race and ethnicity. Conclusions: The integrative data analysis approach offers great advantages over traditional cancer cohorts, but it does require substantial time and effort to assure data confidentiality, integrity, and transparency to provide robust results. However, with convergence epidemiology—in this case leveraging needed expertise in data science and analysis to answer an epidemiology question—it is also a valuable approach to study disparate cancer outcomes among small populations. Illustrating this, our study is the first to document high rates of lung cancer among never-smoking AANHPI ethnic groups, dispels the myth that AANHPI females are at overall reduced risk of lung cancer, and demonstrates the need to disaggregate this highly diverse population. Results should inform lung cancer prevention strategies among AANHPI populations.
Citation Format: MIndy C. DeRouen, Alison J. Canchola, Caroline A. Thompson, Anqi Jin, Sixiang Nie, Carmen Wong, Daphne Lichtensztajn, Laura Allen, Manali I. Patel, Yihe G. Daida, Harold S. Luft, Salma Shariff-Marco, Peggy Reynolds, Heather A. Wakelee, Su-Ying Liang, Beth E. Waitzfelder, Iona Cheng, Scarlett L. Gomez. Applying a data integrative and convergence epidemiology approach to study multilevel risk factors for cancer in distinct AANHPI populations [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-21.
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Affiliation(s)
| | | | | | - Anqi Jin
- 3Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA,
| | - Sixiang Nie
- 4Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, HI,
| | - Carmen Wong
- 4Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, HI,
| | | | - Laura Allen
- 1University of California, San Francisco, San Francisco, CA,
| | | | - Yihe G. Daida
- 4Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, HI,
| | - Harold S. Luft
- 3Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA,
| | | | - Peggy Reynolds
- 1University of California, San Francisco, San Francisco, CA,
| | | | - Su-Ying Liang
- 3Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA,
| | - Beth E. Waitzfelder
- 6Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, CA
| | - Iona Cheng
- 1University of California, San Francisco, San Francisco, CA,
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Spradling PR, Zhong Y, Moorman AC, Rupp LB, Lu M, Teshale EH, Schmidt MA, Daida YG, Boscarino JA, Gordon SC. The Persistence of Underreporting of Hepatitis C as an Underlying or Contributing Cause of Death, 2011-2017. Clin Infect Dis 2021; 73:891-894. [PMID: 33561187 DOI: 10.1093/cid/ciab108] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Indexed: 11/14/2022] Open
Abstract
Using electronic health records, we found that hepatitis C virus (HCV) reporting on death certificates of 2901 HCV-infected decedents from 4 US healthcare organizations during 2011-2017 was documented in only 50% of decedents with hepatocellular carcinoma and less than half with decompensated cirrhosis. National figures likely underestimate the US HCV mortality burden.
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Affiliation(s)
- Philip R Spradling
- Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Yuna Zhong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Anne C Moorman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | | | - Mei Lu
- Henry Ford Health System, Detroit, Michigan, USA
| | - Eyasu H Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Mark A Schmidt
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Yihe G Daida
- The Center for Integrated Health Research, Kaiser Permanente Hawaii, Honolulu, Hawaii, USA
| | - Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Stuart C Gordon
- Henry Ford Health System, Detroit, Michigan, USA.,Wayne State University School of Medicine, Detroit, Michigan, USA
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Walker RL, Shortreed SM, Ziebell RA, Johnson E, Boggs JM, Lynch FL, Daida YG, Ahmedani BK, Rossom R, Coleman KJ, Simon GE. Evaluation of Electronic Health Record-Based Suicide Risk Prediction Models on Contemporary Data. Appl Clin Inform 2021; 12:778-787. [PMID: 34407559 PMCID: PMC8373461 DOI: 10.1055/s-0041-1733908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Suicide risk prediction models have been developed by using information from patients' electronic health records (EHR), but the time elapsed between model development and health system implementation is often substantial. Temporal changes in health systems and EHR coding practices necessitate the evaluation of such models in more contemporary data. OBJECTIVES A set of published suicide risk prediction models developed by using EHR data from 2009 to 2015 across seven health systems reported c-statistics of 0.85 for suicide attempt and 0.83 to 0.86 for suicide death. Our objective was to evaluate these models' performance with contemporary data (2014-2017) from these systems. METHODS We evaluated performance using mental health visits (6,832,439 to mental health specialty providers and 3,987,078 to general medical providers) from 2014 to 2017 made by 1,799,765 patients aged 13+ across the health systems. No visits in our evaluation were used in the previous model development. Outcomes were suicide attempt (health system records) and suicide death (state death certificates) within 90 days following a visit. We assessed calibration and computed c-statistics with 95% confidence intervals (CI) and cut-point specific estimates of sensitivity, specificity, and positive/negative predictive value. RESULTS Models were well calibrated; 46% of suicide attempts and 35% of suicide deaths in the mental health specialty sample were preceded by a visit (within 90 days) with a risk score in the top 5%. In the general medical sample, 53% of attempts and 35% of deaths were preceded by such a visit. Among these two samples, respectively, c-statistics were 0.862 (95% CI: 0.860-0.864) and 0.864 (95% CI: 0.860-0.869) for suicide attempt, and 0.806 (95% CI: 0.790-0.822) and 0.804 (95% CI: 0.782-0.829) for suicide death. CONCLUSION Performance of the risk prediction models in this contemporary sample was similar to historical estimates for suicide attempt but modestly lower for suicide death. These published models can inform clinical practice and patient care today.
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Affiliation(s)
- Rod L. Walker
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States
| | - Susan M. Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States
| | - Rebecca A. Ziebell
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States
| | - Jennifer M. Boggs
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, Colorado, United States
| | - Frances L. Lynch
- Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, United States
| | - Yihe G. Daida
- Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu, Hawaii, United States
| | - Brian K. Ahmedani
- Henry Ford Health System, Center for Health Policy & Health Services Research, Detroit, Michigan, United States
| | - Rebecca Rossom
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota, United States
| | - Karen J. Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, United States
| | - Gregory E. Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States
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DeRouen MC, Thompson CA, Canchola AJ, Jin A, Nie S, Wong C, Jain J, Lichtensztajn DY, Li Y, Allen L, Patel MI, Daida YG, Luft HS, Shariff-Marco S, Reynolds P, Wakelee HA, Liang SY, Waitzfelder BE, Cheng I, Gomez SL. Integrating Electronic Health Record, Cancer Registry, and Geospatial Data to Study Lung Cancer in Asian American, Native Hawaiian, and Pacific Islander Ethnic Groups. Cancer Epidemiol Biomarkers Prev 2021; 30:1506-1516. [PMID: 34001502 PMCID: PMC8530225 DOI: 10.1158/1055-9965.epi-21-0019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/11/2021] [Revised: 03/18/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A relatively high proportion of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) females with lung cancer have never smoked. We used an integrative data approach to assemble a large-scale cohort to study lung cancer risk among AANHPIs by smoking status with attention to representation of specific AANHPI ethnic groups. METHODS We leveraged electronic health records (EHRs) from two healthcare systems-Sutter Health in northern California and Kaiser Permanente Hawai'i-that have high representation of AANHPI populations. We linked EHR data on lung cancer risk factors (i.e., smoking, lung diseases, infections, reproductive factors, and body size) to data on incident lung cancer diagnoses from statewide population-based cancer registries of California and Hawai'i for the period between 2000 and 2013. Geocoded address data were linked to data on neighborhood contextual factors and regional air pollutants. RESULTS The dataset comprises over 2.2 million adult females and males of any race/ethnicity. Over 250,000 are AANHPI females (19.6% of the female study population). Smoking status is available for over 95% of individuals. The dataset includes 7,274 lung cancer cases, including 613 cases among AANHPI females. Prevalence of never-smoking status varied greatly among AANHPI females with incident lung cancer, from 85.7% among Asian Indian to 14.4% among Native Hawaiian females. CONCLUSION We have developed a large, multilevel dataset particularly well-suited to conduct prospective studies of lung cancer risk among AANHPI females who never smoked. IMPACT The integrative data approach is an effective way to conduct cancer research assessing multilevel factors on cancer outcomes among small populations.
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Affiliation(s)
- Mindy C DeRouen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Caroline A Thompson
- San Diego State University School of Public Health, San Diego, California
- University of California San Diego School of Medicine, San Diego, California
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Anqi Jin
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Sixiang Nie
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Carmen Wong
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Jennifer Jain
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Daphne Y Lichtensztajn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Yuqing Li
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Laura Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Manali I Patel
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- VA Palo Alto Health Care System, Palo Alto, California
| | - Yihe G Daida
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Harold S Luft
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Peggy Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Su-Ying Liang
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Beth E Waitzfelder
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
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Spradling PR, Zhong Y, Moorman AC, Rupp LB, Lu M, Gordon SC, Teshale EH, Schmidt MA, Daida YG, Boscarino JA. Psychosocial Obstacles to Hepatitis C Treatment Initiation Among Patients in Care: A Hitch in the Cascade of Cure. Hepatol Commun 2021; 5:400-411. [PMID: 33681675 PMCID: PMC7917278 DOI: 10.1002/hep4.1632] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
There are limited data examining the relationship between psychosocial factors and receipt of direct-acting antiviral (DAA) treatment among patients with hepatitis C in large health care organizations in the United States. We therefore sought to determine whether such factors were associated with DAA initiation. We analyzed data from an extensive psychological, behavioral, and social survey (that incorporated several health-related quality of life assessments) coupled with clinical data from electronic health records of patients with hepatitis C enrolled at four health care organizations during 2017-2018. Of 2,681 patients invited, 1,051 (39.2%) responded to the survey; of 894 respondents eligible for analysis, 690 (77.2%) initiated DAAs. Mean follow-up among respondents was 9.2 years. Compared with DAA recipients, nonrecipients had significantly poorer standardized scores for depression, anxiety, and life-related stressors as well as poorer scores related to physical and mental function. Lower odds of DAA initiation in multivariable analysis (adjusted by age, race, sex, study site, payment provider, cirrhosis status, comorbidity status, and duration of follow-up) included Black race (adjusted odds ratio [aOR], 0.59 vs. White race), perceived difficulty getting medical care in the preceding year (aOR, 0.48 vs. no difficulty), recent injection drug use (aOR, 0.11 vs. none), alcohol use disorder (aOR, 0.58 vs. no alcohol use disorder), severe depression (aOR, 0.42 vs. no depression), recent homelessness (aOR, 0.36 vs. no homelessness), and recent incarceration (aOR, 0.34 vs. no incarceration). Conclusion: In addition to racial differences, compared with respondents who initiated DAAs, those who did not were more likely to have several psychological, behavioral, and social impairments. Psychosocial barriers to DAA initiation among patients in care should also be addressed to reduce hepatitis C-related morbidity and mortality.
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Affiliation(s)
- Philip R Spradling
- Division of Viral HepatitisCenters for Disease Control and PreventionAtlantaGAUSA
| | - Yuna Zhong
- Division of Viral HepatitisCenters for Disease Control and PreventionAtlantaGAUSA
| | - Anne C Moorman
- Division of Viral HepatitisCenters for Disease Control and PreventionAtlantaGAUSA
| | | | - Mei Lu
- Henry Ford Health SystemDetroitMIUSA
| | - Stuart C Gordon
- Henry Ford Health SystemDetroitMIUSA.,Wayne State University School of MedicineDetroitMIUSA
| | - Eyasu H Teshale
- Division of Viral HepatitisCenters for Disease Control and PreventionAtlantaGAUSA
| | - Mark A Schmidt
- Center for Health ResearchKaiser Permanente NorthwestPortlandORUSA
| | - Yihe G Daida
- Center for Integrated Health Care ResearchKaiser Permanente HawaiiHonoluluHIUSA
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Spradling PR, Xing J, Rupp LB, Moorman AC, Gordon SC, Lu M, Teshale EH, Boscarino JA, Schmidt MA, Daida YG, Holmberg SD. Low Uptake of Direct-acting Antiviral Therapy Among Hepatitis C Patients With Advanced Liver Disease and Access to Care, 2014-2017. J Clin Gastroenterol 2021; 55:77-83. [PMID: 32250999 PMCID: PMC10711731 DOI: 10.1097/mcg.0000000000001344] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/09/2023]
Abstract
GOALS To determine the proportion and characteristics of adults with hepatitis C at health care organizations in 4 US states who initiated direct-acting antivirals (DAAs). BACKGROUND There are almost no data to assess the penetrance of treatment of the hepatitis C population in general US health care settings. STUDY We conducted a prospective observational study using electronic clinical, pharmacy, and mortality data to determine the fraction of patients who initiated DAAs between January 2014 and December 2017, by start date and regimen. We used stepwise multivariate logistic regression analysis to identify sociodemographic and clinical characteristics associated with receipt of DAAs. RESULTS Of 8823 patients, 2887 (32.7%) received DAAs. Quarterly (Q) uptake ranged from 1.1% in Q3 2014 to a high of 5.6% in Q2 2015. Characteristics associated with receipt of DAAs included age 51 to 70 years, higher income, pre-2014 treatment failure, and higher noninvasive fibrosis score (FIB4); however, over one half of patients with FIB4 scores >3.25, consistent with severe liver disease, were not treated. A lower likelihood of initiation was associated with Medicaid coverage. Of 5936 patients who did not initiate treatment, 911 (15.3%) had died and 2774 (46.7%) had not had a clinical encounter in ≥12 months by the end of the study. Fewer than 1% of DAA prescriptions originated from nonspecialty providers. CONCLUSIONS During 4 calendar years of follow-up, one third of patients initiated DAAs. Large fractions of untreated patients had advanced liver disease, died, or were lost to follow-up. Even among patients in integrated health care systems, receipt of DAAs was limited.
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Affiliation(s)
- Philip R. Spradling
- Division of Viral Hepatitis, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Jian Xing
- Division of Viral Hepatitis, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | - Anne C. Moorman
- Division of Viral Hepatitis, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Stuart C. Gordon
- Henry Ford Health System, Detroit, Michigan
- Wayne State University School of Medicine, Detroit, MI
| | - Mei Lu
- Henry Ford Health System, Detroit, Michigan
| | - Eyasu H. Teshale
- Division of Viral Hepatitis, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | - Mark A. Schmidt
- The Center for Health Research, Kaiser Permanente-Northwest, Portland, Oregon
| | - Yihe G. Daida
- The Center for Health Research, Kaiser Permanente-Hawaii, Honolulu, Hawaii
| | - Scott D. Holmberg
- Division of Viral Hepatitis, National Centers for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Lu M, Bowlus CL, Lindor K, Rodriguez-Watson CV, Romanelli RJ, Haller IV, Anderson H, VanWormer JJ, Boscarino JA, Schmidt MA, Daida YG, Sahota A, Vincent J, Li J, Trudeau S, Rupp LB, Gordon SC. Validity of an Automated Algorithm to Identify Cirrhosis Using Electronic Health Records in Patients with Primary Biliary Cholangitis. Clin Epidemiol 2020; 12:1261-1267. [PMID: 33204167 PMCID: PMC7666983 DOI: 10.2147/clep.s262558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 07/08/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background Biopsy remains the gold standard for determining fibrosis stage in patients with primary biliary cholangitis (PBC), but it is unavailable for most patients. We used data from the 11 US health systems in the FibrOtic Liver Disease Consortium to explore a combination of biochemical markers and electronic health record (EHR)-based diagnosis/procedure codes (DPCs) to identify the presence of cirrhosis in PBC patients. Methods Histological fibrosis staging data were obtained from liver biopsies. Variables considered for the model included demographics (age, gender, race, ethnicity), total bilirubin, alkaline phosphatase, albumin, aspartate aminotransferase (AST) to platelet ratio index (APRI), Fibrosis 4 (FIB4) index, AST to alanine aminotransferase (ALT) ratio, and >100 DPCs associated with cirrhosis/decompensated cirrhosis, categorized into ten clusters. Using least absolute shrinkage and selection operator regression (LASSO), we derived and validated cutoffs for identifying cirrhosis. Results Among 4328 PBC patients, 1350 (32%) had biopsy data; 121 (9%) were staged F4 (cirrhosis). DPC clusters (including codes related to cirrhosis and hepatocellular carcinoma diagnoses/procedures), Hispanic ethnicity, ALP, AST/ALT ratio, and total bilirubin were retained in the final model (AUROC=0.86 and 0.83 on learning and testing data, respectively); this model with two cutoffs divided patients into three categories (no cirrhosis, indeterminate, and cirrhosis) with specificities of 81.8% (for no cirrhosis) and 80.3% (for cirrhosis). A model excluding DPCs retained ALP, AST/ALT ratio, total bilirubin, Hispanic ethnicity, and gender (AUROC=0.81 and 0.78 on learning and testing data, respectively). Conclusion An algorithm using laboratory results and DPCs can categorize a majority of PBC patients as cirrhotic or noncirrhotic with high accuracy (with a small remaining group of patients' cirrhosis status indeterminate). In the absence of biopsy data, this EHR-based model can be used to identify cirrhosis in cohorts of PBC patients for research and/or clinical follow-up.
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Affiliation(s)
- Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | | | - Keith Lindor
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Carla V Rodriguez-Watson
- Center for Health Research Kaiser Permanente Mid-Atlantic Research Institute, Rockville, MD; Reagan-Udall Foundation for the FDA, Washington, DC, USA
| | | | - Irina V Haller
- Essentia Institute of Rural Health, Essentia Health, Duluth, MN, USA
| | - Heather Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, Danville, PA, USA
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Amandeep Sahota
- Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | | | - Jia Li
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Loralee B Rupp
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Stuart C Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health System; and Wayne State University School of Medicine, Detroit, MI, USA
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Abara WE, Spradling P, Zhong Y, Moorman A, Teshale EH, Rupp L, Gordon SC, Schmidt M, Boscarino JA, Daida YG, Holmberg SD. Hepatocellular Carcinoma Surveillance in a Cohort of Chronic Hepatitis C Virus-Infected Patients with Cirrhosis. J Gastrointest Cancer 2020; 51:461-468. [PMID: 31124041 PMCID: PMC6874701 DOI: 10.1007/s12029-019-00255-4] [Citation(s) in RCA: 2] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND Six-monthly hepatocellular carcinoma (HCC) screening in cirrhotic patients has been recommended since 2011. HCC prognosis is associated with diagnosis at an early stage. We examined the prevalence and correlates of 6-monthly HCC surveillance in a cohort of HCV-infected cirrhotic patients. METHODS Data were obtained from the medical records of patients receiving care from four hospitals between January 2011 and December 2016. Frequencies and logistic regression were conducted. RESULTS Of 2,933 HCV-infected cirrhotic patients, most were ≥ 60 years old (68.5%), male (62.2%), White (65.8%), and had compensated cirrhosis (74.2%). The median follow-up period was 3.5 years. Among these patients, 10.9% were consistently screened 6 monthly and 21.4% were never screened. Patients with a longer history of cirrhosis (AOR = 0.86, 95% CI = 0.80-0.93) were less likely to be screened 6 monthly while decompensated cirrhotic patients (AOR = 1.39, 95% CI = 1.06-1.81) and cirrhotic patients between 18 and 44 years (AOR = 2.01, 95% CI = 1.07-3.74) were more likely to be screened 6 monthly compared to compensated cirrhotic patients and patients 60 years and older respectively. There were no significant differences by race, gender, or insurance type. CONCLUSION The prevalence of consistent HCC surveillance remains low despite formalized recommendations. One in five patients was never surveilled. Patients with a longer history of cirrhosis were less likely to be surveilled consistently despite their greater HCC risk. Improving providers' knowledge about current HCC surveillance guidelines, educating patients about the benefits of consistent HCC surveillance, and systemic interventions like clinical reminders and standing HCC surveillance protocols can improve guideline-concordant surveillance in clinical practice.
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Affiliation(s)
- Winston E Abara
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30333, USA.
| | - P Spradling
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30333, USA
| | - Y Zhong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30333, USA
| | - A Moorman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30333, USA
| | - E H Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30333, USA
| | - L Rupp
- Henry Ford Hospital, Detroit, MI, USA
| | | | - M Schmidt
- Kaiser Permanente Northwest, Portland, OR, USA
| | | | - Y G Daida
- Kaiser Permanente, Hawaii, Honolulu, HI, USA
| | - S D Holmberg
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30333, USA
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DeRouen MC, Shariff-Marco S, Lichtensztajn D, Jin A, Daida YG, Canchola AJ, Li Y, Jain J, Allen L, Nie S, Wong C, Haile R, Patel M, Reynolds P, Wakelee H, Luft H, Thompson C, Liang SY, Waitzfelder BE, Cheng I, Gomez SL. Abstract IA37: Lung cancer incidence and risk factors in never-smoking Asian American, Native Hawaiian, and Pacific Islander women: The development of a multilevel integrated dataset of EHR, cancer registry, and environmental data. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-ia37] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: For Asian American, Native Hawaiian, and Pacific Islander (AANHPI) females, lung cancer is one of the most common cancers and the leading cause of cancer death. More than half of AANHPI female lung cancers occur in never-smokers, and contributing risk factors among never-smokers remain largely unknown. Until now, there was no single sufficiently-large data source to document lung cancer incidence rates by smoking status and sex among specific AANHPI ethnic groups, which is central to understanding and reducing the burden of this disease in this population. We assembled a large-scale cohort to quantify the burden of lung cancer by smoking status among single- and multiethnic AANHPI groups, with an emphasis on identifying the underlying factors driving lung cancer risk among never-smoking AANHPI females.
Methods: Assembly of the cohort involved (1) harmonizing and pooling electronic health record (EHR) data on known and putative lung cancer risk factors from two large health systems (i.e., Northern California Sutter Health system and Kaiser Permanente Hawaii [KPH]); (2) linking EHR data from Sutter and KPH with tumor and diagnosis data from the California Cancer Registry and Hawaii Tumor Registry, respectively; (3) geocoding and linking the Sutter portion of the cohort to regional air pollutant data and data on specific neighborhood contextual factors from the California Neighborhoods Data System; and (4) developing neighborhood contextual variables to enhance the geocoded data for KPH cohort members. Incidence rates stratified by sex, detailed race/ethnicity, and smoking status were calculated.
Results: The cohort comprises 1.8 million individuals, including 750,000 females of whom 190,000 are AANHPI females, with up to 15 years' follow-up for incident lung cancer. It includes over 24,000 incident lung cancer cases, of which 10,595 are females and over 1,500 are single- and multiethnic AANHPI females. The cohort has high representation of Asian Indian, Chinese, Japanese, Filipino, Korean, and Pacific Islander never-smoking females in addition to multiple multiethnic AANHPI ethnic groups. Ongoing analyses, including overall and histologic cell-type specific incidence rates of lung cancer by sex, race/ethnicity, and smoking status will be presented.
Conclusions: We have assembled a large, integrated dataset well suited to study multilevel risk of lung cancer that will serve as a critical evidence base to inform screening, research, and public health priorities, especially among AANHPI females. Future work will include longitudinal analyses of lung cancer risk among never-smoking AANHPI females, including absolute risk modeling, examining six exposure domains representing putative lung cancer risk factors: second-hand smoke, previous lung diseases, infections, reproductive history and hormone exposure, body size, and neighborhood environmental factors, including measures of particulate matter, traffic density, neighborhood socioeconomic status, and ethnic enclave.
Citation Format: Mindy C. DeRouen, Salma Shariff-Marco, Daphne Lichtensztajn, Anqi Jin, Yihe G. Daida, Alison J. Canchola, Yuqing Li, Jennifer Jain, Laura Allen, Sixiang Nie, Carmen Wong, Robert Haile, Manali Patel, Peggy Reynolds, Heather Wakelee, Hal Luft, Caroline Thompson, Su-Ying Liang, Beth E. Waitzfelder, Iona Cheng, Scarlett L. Gomez. Lung cancer incidence and risk factors in never-smoking Asian American, Native Hawaiian, and Pacific Islander women: The development of a multilevel integrated dataset of EHR, cancer registry, and environmental data [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA37.
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Affiliation(s)
| | | | | | - Anqi Jin
- 2Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA,
| | - Yihe G. Daida
- 3Kaiser Permanente Center for Health Research Hawaii, Honolulu, HI,
| | | | - Yuqing Li
- 1University of California, San Francisco, San Francisco, CA,
| | - Jennifer Jain
- 1University of California, San Francisco, San Francisco, CA,
| | - Laura Allen
- 1University of California, San Francisco, San Francisco, CA,
| | - Sixiang Nie
- 3Kaiser Permanente Center for Health Research Hawaii, Honolulu, HI,
| | - Carmen Wong
- 3Kaiser Permanente Center for Health Research Hawaii, Honolulu, HI,
| | | | - Manali Patel
- 5Stanford University School of Medicine, Stanford, CA,
| | - Peggy Reynolds
- 1University of California, San Francisco, San Francisco, CA,
| | | | | | | | - Su-Ying Liang
- 2Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, CA,
| | | | - Iona Cheng
- 1University of California, San Francisco, San Francisco, CA,
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Lu M, Wu KH, Li J, Moorman AC, Spradling PR, Teshale EH, Boscarino JA, Daida YG, Schmidt MA, Rupp LB, Zhang T, Trudeau S, Gordon SC. Adjuvant ribavirin and longer direct-acting antiviral treatment duration improve sustained virological response among hepatitis C patients at risk of treatment failure. J Viral Hepat 2019; 26:1210-1217. [PMID: 31197910 PMCID: PMC6764853 DOI: 10.1111/jvh.13162] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/06/2019] [Accepted: 05/15/2019] [Indexed: 12/13/2022]
Abstract
The role of ribavirin (RBV) in the era of direct-acting antivirals (DAA) is not clear, and DAA studies have been largely genotype- and regimen-specific. Using data from the Chronic Hepatitis Cohort Study, we evaluated the role of RBV and increased DAA treatment duration among patients with chronic hepatitis C (HCV) in routine clinical care. We performed multivariable analysis of data from 4133 patients receiving any of the following: sofosbuvir (SOF); daclatasvir + SOF; grazoprevir + elbasvir; paritaprevir/ritonavir + ombitasvir; simeprevir + SOF; and SOF + ledipasvir; SOF + velpatasvir ± voxilaprevir; and glecaprevir + pibrentasvir-all with/ without RBV. Inverse probability treatment weighting was used to adjust for treatment selection bias. Sustained virological response (SVR) was defined by undetectable HCV RNA 12 weeks after end of therapy. The overall SVR rate was 95%. Mean treatment duration was 12 ± 4.5 weeks. The final model included treatment duration and diabetes, as well as the interaction of RBV with previous treatment status (treatment naïve, interferon treatment failure [TF] or previous DAA TF), cirrhosis status, and HCV genotype (GT). Each one-month increment of treatment duration increased odds of SVR by 99% (aOR = 1.99). Diabetes, previous DAA TF, and decompensated cirrhosis significantly reduced odds of SVR. RBV significantly increased the likelihood of SVR among patients with decompensated cirrhosis (aOR = 5.05), previous DAA treatment failure (aOR = 5.43), and GT3 (aOR = 13.28). Among RBV-free regimens, patients with GT3 were less likely to achieve SVR than those with GT1 or 2 (aOR 0.07). Diabetes, decompensated cirrhosis, and prior DAA TF independently reduced the likelihood of SVR. Longer treatment duration increased likelihood of SVR. Conclusion: RBV increased likelihood of SVR among patients with GT3, previous DAA TF, or decompensated cirrhosis.
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Affiliation(s)
- Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Kuan-Han Wu
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Jia Li
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Anne C. Moorman
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Philip R. Spradling
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eyasu H. Teshale
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph A. Boscarino
- Department of Epidemiology and Health Services Research, Geisinger Clinic, Danville, Pennsylvania
| | - Yihe G. Daida
- Center for Health Research, Kaiser Permanente-Hawai’i, Waipahu, Hawaii
| | - Mark A. Schmidt
- Center for Health Research, Kaiser Permanente-Northwest, Portland, Oregon
| | - Loralee B. Rupp
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Talan Zhang
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Stuart C. Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan,Wayne State University School of Medicine, Detroit, Michigan
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Moorman AC, Xing J, Rupp LB, Gordon SC, Lu M, Spradling PR, Boscarino JA, Schmidt MA, Daida YG, Teshale EH. Late diagnosis of hepatitis C virus infection, 2014-2016: continuing missed intervention opportunities. Am J Manag Care 2019; 25:369-374. [PMID: 31419094] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Chronic hepatitis C virus (HCV) infection is typically asymptomatic until severe liver disease occurs and even then can remain undiagnosed for some time; thus, screening and treatment of asymptomatic persons are needed to prevent poor outcomes. In a previous analysis of data from between 2006 and 2011, we found that 17% of newly diagnosed HCV infections in 4 large health systems were among persons with cirrhosis and/or end-stage liver disease, termed "late diagnosis." We sought to determine the proportion with late diagnosis during 2014-2016, after release of CDC baby boomer (1945-1965 birth cohort) testing guidelines in 2012. STUDY DESIGN The cohort was based on analysis of electronic health records and administrative data of about 2.7 million patients visiting the same healthcare systems during 2014-2016. METHODS Among persons with newly diagnosed chronic HCV infection during 2014-2016, we analyzed data collected up to January 1, 2017. RESULTS Among 2695 patients with newly diagnosed HCV infection, 576 (21.4%) had late diagnosis. Most were born between 1945 and 1965 (n = 1613 [59.9%]), and among these, 27.6% had late diagnosis. Patients with versus without late diagnosis had equally lengthy prediagnosis observation in the health systems (mean and median, 9.1 and 9.1 vs 8.3 and 7.8 years, respectively) but were more likely to have a postdiagnosis hospitalization (32.5% vs 12.5%; P <.001) with greater number of hospital days (358.8 vs 78.5 per 100 person-years; P <.001). CONCLUSIONS More than one-fifth of patients with newly diagnosed HCV infection during 2014-2016-and more than a quarter of those born between 1945 and 1965-had late diagnosis despite many years of in-system care, an increase of 5 percentage points since 2006-2011, after the interim initiation of age-based screening recommendations. Our data highlight missed opportunities for diagnosis and therapeutic intervention before the onset of severe liver disease, which is associated with high cost and diminished outcomes.
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Affiliation(s)
- Anne C Moorman
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, Mailstop G-37, Atlanta, GA 30329.
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48
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Lu M, Zhou Y, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Boscarino JA, Daida YG, Schmidt MA, Li J, Rupp LB, Trudeau S, Gordon SC. Trends in Diagnosed Chronic Hepatitis B in a US Health System Population, 2006-2015. Open Forum Infect Dis 2019; 6:ofz286. [PMID: 31341929 PMCID: PMC6641786 DOI: 10.1093/ofid/ofz286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/02/2019] [Accepted: 06/13/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Trends in the epidemiology of chronic hepatitis B (CHB) among routine clinical care patients in the United States are not well documented. We used data from the Chronic Hepatitis Cohort Study to investigate changes in prevalence and newly recorded cases of CHB from 2006 to 2015. METHODS Annual percentage changes (APCs) were estimated using join point Poisson regression. Analyses were adjusted by study site; when an interaction with the trend was observed, APCs were estimated by subgroups. Differences in rates based on race, age, and sex were calculated with rate ratios. RESULTS We identified 5492 patients with CHB within select health systems with total populations that ranged from 1.9 to 2.4 million persons. From 2006 to 2014, the prevalence of diagnosed CHB increased from 181.3 to 253.0 per 100 000 persons in the health system population; from 2014 to 2015, it declined to 237.0 per 100 000 persons. APC was +3.7%/y through 131 December 2014 (P < .001) and -15.0%/y (P < .001) thereafter. The rate of newly reported cases of CHB did not change significantly across the study period (APC, -1.1%/y; P = .07). The rates of newly reported cases were 20.5 times higher among patients in the Asian American/American Indian/Pacific Islander (ASINPI) category, compared with white patients, and 2.8 times higher among African American patients. The ratio of male to female patients was roughly 3:2. CONCLUSIONS The prevalence of diagnosed CHB in this US patient population increased from 2006 to 2014, after which it decreased significantly. Rates declined most rapidly among patients ≤40 or 61-70 years old, as well as among ASINPI patients. The rate of newly reported cases remained steady over the study period.
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Affiliation(s)
- Mei Lu
- Department of Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Yueren Zhou
- Department of Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Scott D Holmberg
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta Georgia
| | - Anne C Moorman
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta Georgia
| | - Philip R Spradling
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta Georgia
| | - Eyasu H Teshale
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta Georgia
| | - Joseph A Boscarino
- Department of Epidemiology and Health Services Research, Geisinger Clinic, Danville, Pennsylvania
| | - Yihe G Daida
- Center for Health Research, Kaiser Permanente Hawaii, Honolulu, Hawai’i
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jia Li
- Department of Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Loralee B Rupp
- Center for Health Policy and Health Services Research, Wayne State University School of Medicine, Detroit, Michigan
| | - Sheri Trudeau
- Department of Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Stuart C Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health System, and Wayne State University School of Medicine, Detroit, Michigan
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49
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Li J, Gordon SC, Rupp LB, Zhang T, Trudeau S, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Boscarino JA, Schmidt MA, Daida YG, Lu M. Sustained virological response does not improve long-term glycaemic control in patients with type 2 diabetes and chronic hepatitis C. Liver Int 2019; 39:1027-1032. [PMID: 30570808 PMCID: PMC6628708 DOI: 10.1111/liv.14031] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/25/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sustained virological response to treatment for chronic hepatitis C virus may improve short-term glucose control among patients with type 2 diabetes, but the long-term impact remains largely unknown. We used data from the Chronic Hepatitis Cohort Study to investigate the impact of sustained virological response on long-term trends in haemoglobin A1c in patients with type 2 diabetes. METHODS "Index date" was defined as the date of treatment initiation (treated patients) or hepatitis C virus diagnosis (untreated patients). To address treatment selection bias, we used a propensity score approach. We used a piecewise, linear spline, mixed-effects model to evaluate changes in haemoglobin A1c over a 5-year period. RESULTS Our sample included 384 hepatitis C virus patients with type 2 diabetes (192 untreated, 192 treated, with sustained virological response or treatment failure). After adjusting for body mass index, haemoglobin A1c was stable among untreated and treatment failure patients. In sustained virological response patients, Hb1Ac trajectories evolved in three phases: (a) index through 6 months post-index, average haemoglobin A1c decreased significantly from 7.7% to 5.4% per 90 days (P < 0.001); (b) 6-30 months post-index, haemoglobin A1c rebounded at a rate of 1.5% every 90 days (P = 0.003); and (c) from 30 months onward, haemoglobin A1c stabilized at an average level of 7.9 (P-value = 0.34). Results from an analysis restricted to patients receiving direct-acting antivirals were consistent with the main findings. CONCLUSION Successful hepatitis C virus treatment among patients with type 2 diabetes significantly reduces HbA1c shortly after treatment, but these decreases are not sustained long-term. Less than three years after sustained virological response, haemoglobin A1c rebounds to levels similar to untreated/treatment failure patients, and higher than recommended for type 2 diabetic maintenance.
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Affiliation(s)
- Jia Li
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Stuart C. Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health System and Wayne State University School of Medicine, Detroit, Michigan
| | - Loralee B. Rupp
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Talan Zhang
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Scott D. Holmberg
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anne C. Moorman
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Philip R. Spradling
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eyasu H. Teshale
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph A. Boscarino
- Department of Epidemiology & Health Services Research, Geisinger Clinic, Danville, Pennsylvania
| | - Mark A. Schmidt
- Center for Health Research, Kaiser Permanente–Northwest, Portland, Oregon
| | - Yihe G. Daida
- Center for Health Research, Kaiser Permanente–Hawai’i, Honolulu, Hawaii
| | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
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Li J, Gordon SC, Rupp LB, Zhang T, Trudeau S, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Boscarino JA, Schmidt MA, Daida YG, Lu M. Sustained virological response to hepatitis C treatment decreases the incidence of complications associated with type 2 diabetes. Aliment Pharmacol Ther 2019; 49:599-608. [PMID: 30650468 PMCID: PMC6599612 DOI: 10.1111/apt.15102] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/12/2018] [Accepted: 11/28/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND The role of hepatitis C (HCV) eradication on the long-term complications of type 2 diabetes mellitus remains incompletely studied. AIM To investigate whether antiviral treatment impacted risk of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy among diabetic patients from the four US health systems comprising the Chronic Hepatitis Cohort Study (CHeCS). METHODS We included CHeCS HCV patients with diagnosis codes for type 2 diabetes who were on antidiabetic medications. Patients were followed until an outcome of interest, death, or last health system encounter. The effect of treatment on outcomes was estimated using the competing risk analysis (Fine-Gray subdistribution hazard ratio [sHR]), with death as a competing event. RESULTS Among 1395 HCV-infected patients with type 2 diabetes, 723 (52%) were treated with either interferon-based or direct-acting antivirals (DAAs); 539 (75% of treated) achieved sustained virological response (SVR). After propensity score adjustment to address treatment selection bias, patients with SVR demonstrated significantly decreased risk of acute coronary syndrome (sHR = 0.36; P < 0.001), end-stage renal disease (sHR = 0.46; P < 0.001), stroke (sHR = 0.34; P < 0.001), and retinopathy (sHR = 0.24; P < 0.001) compared to untreated patients. Results were consistent in subgroup analyses of DAA-treated patients and interferon-treated patients, an analysis of cirrhotic patients, as well as in sensitivity analyses considering cause-specific hazards, exclusion of patients with on-treatment retinopathy, and treatment status as a time-varying covariate. CONCLUSION Successful HCV treatment among patients with type 2 diabetes significantly reduces incidence of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy, regardless of cirrhosis. Our findings support the importance of HCV antiviral therapy among patients with type 2 diabetes to reduce the risk of these extrahepatic outcomes.
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Affiliation(s)
- Jia Li
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Stuart C. Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health System, and Wayne State University School of Medicine, Detroit, Michigan
| | - Loralee B. Rupp
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Talan Zhang
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Scott D. Holmberg
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anne C. Moorman
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Philip R. Spradling
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eyasu H. Teshale
- Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph A. Boscarino
- Department of Epidemiology & Health Services Research, Geisinger Clinic, Danville, Pennsylvania
| | - Mark A. Schmidt
- Center for Health Research, Kaiser Permanente-Northwest, Portland, Oregon
| | - Yihe G. Daida
- Center for Health Research, Kaiser Permanente-Hawai’i, Honolulu, Hawaii
| | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
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