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LaRiccia PJ, Cafaro T, John D, van Helmond N, Mitrev LV, Bandomer B, Brobyn TL, Hunter K, Roy S, Ng KQ, Goldstein H, Tsai A, Thwing D, Maag MA, Chung MK. Healthcare Costs and Healthcare Utilization Outcomes of Vitamin D3 Supplementation at 5000 IU Daily during a 10.9 Month Observation Period within a Pragmatic Randomized Clinical Trial. Nutrients 2023; 15:4435. [PMID: 37892510 PMCID: PMC10609978 DOI: 10.3390/nu15204435] [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: 09/25/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Vitamin D insufficiency has been linked to multiple conditions including bone disease, respiratory disease, cardiovascular disease, diabetes, and cancer. Observational studies indicate lower healthcare costs and healthcare utilization with sufficient vitamin D levels. The secondary aims of our previously published pragmatic clinical trial of vitamin D3 supplementation were comparisons of healthcare costs and healthcare utilization. Comparisons were made between the vitamin D3 at 5000 IU supplementation group and a non-supplemented control group. Costs of care between the groups differed but were not statistically significant. Vitamin D3 supplementation reduced healthcare utilization in four major categories: hospitalizations for any reason (rate difference: -0.19 per 1000 person-days, 95%-CI: -0.21 to -0.17 per 1000 person-days, p < 0.0001); ICU admissions for any reason (rate difference: -0.06 per 1000 person-days, 95%-CI: -0.08 to -0.04 per 1000 person-days, p < 0.0001); emergency room visits for any reason (rate difference: -0.26 per 1000 person-days, 95%-CI: -0.46 to -0.05 per 1000 person-days, p = 0.0131; and hospitalizations due to COVID-19 (rate difference: -8.47 × 10-3 per 1000 person-days, 95%-CI: -0.02 to -1.05 × 10-3 per 1000 person-days, p = 0.0253). Appropriately powered studies of longer duration are recommended for replication of these utilization findings and analysis of cost differences.
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Affiliation(s)
- Patrick J. LaRiccia
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
- Center for Clinical Epidemiology and Biostatistics Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Teresa Cafaro
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
- Department of Anesthesiology, Cooper University Health Care, Camden, NJ 08103, USA;
- Cooper Research Institute, Cooper University Health Care, Camden, NJ 08103, USA; (D.J.); (K.H.)
| | - Dibato John
- Cooper Research Institute, Cooper University Health Care, Camden, NJ 08103, USA; (D.J.); (K.H.)
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.R.); (A.T.)
| | - Noud van Helmond
- Department of Anesthesiology, Cooper University Health Care, Camden, NJ 08103, USA;
| | - Ludmil V. Mitrev
- Department of Anesthesiology, Cooper University Health Care, Camden, NJ 08103, USA;
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.R.); (A.T.)
| | - Brigid Bandomer
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
| | - Tracy L. Brobyn
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.R.); (A.T.)
- The Chung Institute of Integrative Medicine, Moorestown, NJ 08057, USA
- Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, USA
| | - Krystal Hunter
- Cooper Research Institute, Cooper University Health Care, Camden, NJ 08103, USA; (D.J.); (K.H.)
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.R.); (A.T.)
| | - Satyajeet Roy
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.R.); (A.T.)
- Division of General Internal Medicine, Cooper University Health Care, Camden, NJ 08103, USA
| | - Kevin Q. Ng
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
- The Chung Institute of Integrative Medicine, Moorestown, NJ 08057, USA
- Division of Infectious Disease, Cooper University Health Care, Camden, NJ 08103, USA
| | - Helen Goldstein
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
| | - Alan Tsai
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.R.); (A.T.)
| | - Denise Thwing
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
| | - Mary Ann Maag
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
| | - Myung K. Chung
- Won Sook Chung Foundation, Moorestown, NJ 08057, USA; (P.J.L.); (T.C.); (B.B.); (T.L.B.); (K.Q.N.); (H.G.); (D.T.); (M.A.M.); (M.K.C.)
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.R.); (A.T.)
- The Chung Institute of Integrative Medicine, Moorestown, NJ 08057, USA
- Department of Family Medicine, Cooper University Health Care, Camden, NJ 08103, USA
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Peng LN, Hsiao FY, Lee WJ, Huang ST, Chen LK. Comparisons Between Hypothesis- and Data-Driven Approaches for Multimorbidity Frailty Index: A Machine Learning Approach. J Med Internet Res 2020; 22:e16213. [PMID: 32525481 PMCID: PMC7317629 DOI: 10.2196/16213] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 09/11/2019] [Revised: 12/17/2019] [Accepted: 01/24/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Using big data and the theory of cumulative deficits to develop the multimorbidity frailty index (mFI) has become a widely accepted approach in public health and health care services. However, constructing the mFI using the most critical determinants and stratifying different risk groups with dose-response relationships remain major challenges in clinical practice. OBJECTIVE This study aimed to develop the mFI by using machine learning methods that select variables based on the optimal fitness of the model. In addition, we aimed to further establish 4 entities of risk using a machine learning approach that would achieve the best distinction between groups and demonstrate the dose-response relationship. METHODS In this study, we used Taiwan's National Health Insurance Research Database to develop a machine learning multimorbidity frailty index (ML-mFI) using the theory of cumulative diseases/deficits of an individual older person. Compared to the conventional mFI, in which the selection of diseases/deficits is based on expert opinion, we adopted the random forest method to select the most influential diseases/deficits that predict adverse outcomes for older people. To ensure that the survival curves showed a dose-response relationship with overlap during the follow-up, we developed the distance index and coverage index, which can be used at any time point to classify the ML-mFI of all subjects into the categories of fit, mild frailty, moderate frailty, and severe frailty. Survival analysis was conducted to evaluate the ability of the ML-mFI to predict adverse outcomes, such as unplanned hospitalizations, intensive care unit (ICU) admissions, and mortality. RESULTS The final ML-mFI model contained 38 diseases/deficits. Compared with conventional mFI, both indices had similar distribution patterns by age and sex; however, among people aged 65 to 69 years, the mean mFI and ML-mFI were 0.037 (SD 0.048) and 0.0070 (SD 0.0254), respectively. The difference may result from discrepancies in the diseases/deficits selected in the mFI and the ML-mFI. A total of 86,133 subjects aged 65 to 100 years were included in this study and were categorized into 4 groups according to the ML-mFI. Both the Kaplan-Meier survival curves and Cox models showed that the ML-mFI significantly predicted all outcomes of interest, including all-cause mortality, unplanned hospitalizations, and all-cause ICU admissions at 1, 5, and 8 years of follow-up (P<.01). In particular, a dose-response relationship was revealed between the 4 ML-mFI groups and adverse outcomes. CONCLUSIONS The ML-mFI consists of 38 diseases/deficits that can successfully stratify risk groups associated with all-cause mortality, unplanned hospitalizations, and all-cause ICU admissions in older people, which indicates that precise, patient-centered medical care can be a reality in an aging society.
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Affiliation(s)
- Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ju Lee
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Lan, Taiwan
| | - Shih-Tsung Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
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