1
|
Lu H, Dong XX, Li DL, Nie XY, Wang P, Pan CW. Multimorbidity patterns and health-related quality of life among community-dwelling older adults: evidence from a rural town in Suzhou, China. Qual Life Res 2024; 33:1335-1346. [PMID: 38353890 DOI: 10.1007/s11136-024-03608-0] [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] [Accepted: 01/11/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE The high prevalence of multimorbidity in aging societies has posed tremendous challenges to the healthcare system. The aim of our study was to comprehensively assess the association of multimorbidity patterns and health-related quality of life (HRQOL) among rural Chinese older adults. METHODS This was a cross-sectional study. Data from 4,579 community-dwelling older adults aged 60 years and above was collected by the clinical examination and questionnaire survey. Information on 10 chronic conditions was collected and the 3-Level EQ-5D (EQ-5D-3L) was adopted to measure the HRQOL of older adults. An exploratory factor analysis was performed to determine multimorbidity patterns. Regression models were fitted to explore the associations of multimorbidity patterns with specific health dimensions and overall HRQOL. RESULTS A total of 2,503 (54.7%) participants suffered from multimorbidity, and they reported lower HRQOL compared to those without multimorbidity. Three kinds of multimorbidity patterns were identified including cardiovascular-metabolic diseases, psycho-cognitive diseases and organic diseases. The associations between psycho-cognitive diseases/organic diseases and overall HRQOL assessed by EQ-5D-3L index score were found to be significant (β = - 0.097, 95% CI - 0.110, - 0.084; β = - 0.030, 95% CI - 0.038, - 0.021, respectively), and psycho-cognitive diseases affected more health dimensions. The impact of cardiovascular-metabolic diseases on HRQOL was largely non-significant. CONCLUSION Multimorbidity was negatively associated with HRQOL among older adults from rural China. The presence of the psycho-cognitive diseases pattern or the organic diseases pattern contributed to worse HRQOL. The remarkable negative impact of psycho-cognitive diseases on HRQOL necessiates more attention and relevant medical assistance to older rural adults.
Collapse
Affiliation(s)
- Heng Lu
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xing-Xuan Dong
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Dan-Lin Li
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xin-Yi Nie
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Pei Wang
- School of Public Health, Fudan University, Shanghai, China.
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, China.
| | - Chen-Wei Pan
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.
| |
Collapse
|
2
|
Vega-Cabello V, Struijk EA, Caballero FF, Yévenes-Briones H, Ortolá R, Calderón-Larrañaga A, Lana A, Rodríguez-Artalejo F, Lopez-Garcia E. Diet Quality and Multimorbidity in Older Adults: A Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2024; 79:glad285. [PMID: 38157322 DOI: 10.1093/gerona/glad285] [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: 08/15/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND The role of diet quality in the accumulation of multiple chronic conditions is mostly unknown. This study examined diet quality in association with the number of chronic conditions and the rate of multimorbidity development among community-dwelling older adults. METHODS We used data from 2 784 adults aged ≥65 years from the Seniors-ENRICA 2 cohort. Diet quality was assessed at baseline (2015-17) with the Alternate Healthy Eating Index-2010 (AHEI-2010) and the Mediterranean Diet Adherence Screener (MEDAS). Information on medical diagnoses was obtained from electronic clinical records up to 2021. RESULTS Higher adherence to the AHEI-2010 was associated with a lower number of total chronic conditions (β [95% CI] quartile 4 vs 1: -0.57 [-0.86 to 0.27], p trend < .001] and cardiometabolic conditions (-0.30 [-0.44 to -0.17], p trend < .001) at baseline, while higher adherence to the MEDAS was associated with a lower number of total chronic conditions (-0.30 [-0.58 to -0.02], p trend = .01) and neuropsychiatric and neurodegenerative conditions (-0.09 [-0.17 to -0.01], p trend = .01). After a median follow-up of 5.2 years (range: 0.1-6.1 years) higher adherence to the AHEI-2010 was associated with a lower increase in chronic conditions (β [95% confidence interval] quartile 4 vs 1: -0.16 [-0.30 to -0.01], p trend = .04) and with lower rate of chronic disease accumulation. CONCLUSIONS Higher diet quality, as measured by the AHEI-2010, was associated with a lower number of chronic health conditions and a lower rate of multimorbidity development over time.
Collapse
Affiliation(s)
- Veronica Vega-Cabello
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/CIBERESP (CIBER of Epidemiology and Public Health); Madrid, Spain
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/CIBERESP (CIBER of Epidemiology and Public Health); Madrid, Spain
| | - Francisco Felix Caballero
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/CIBERESP (CIBER of Epidemiology and Public Health); Madrid, Spain
| | - Humberto Yévenes-Briones
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/CIBERESP (CIBER of Epidemiology and Public Health); Madrid, Spain
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/CIBERESP (CIBER of Epidemiology and Public Health); Madrid, Spain
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Alberto Lana
- Department of Medicine, School of Medicine and Health Sciences. Universidad de Oviedo/ISPA; Oviedo, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/CIBERESP (CIBER of Epidemiology and Public Health); Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC; Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/CIBERESP (CIBER of Epidemiology and Public Health); Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC; Madrid, Spain
| |
Collapse
|
3
|
Lim A, Benjasirisan C, Liu X, Ogungbe O, Himmelfarb CD, Davidson P, Koirala B. Social determinants of health and emergency department visits among older adults with multimorbidity: insight from 2010 to 2018 National Health Interview Survey. BMC Public Health 2024; 24:1153. [PMID: 38658873 DOI: 10.1186/s12889-024-18613-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Multimorbidity is prevalent among older adults and is associated with adverse health outcomes, including high emergency department (ED) utilization. Social determinants of health (SDoH) are associated with many health outcomes, but the association between SDoH and ED visits among older adults with multimorbidity has received limited attention. This study aimed to examine the association between SDoH and ED visits among older adults with multimorbidity. METHODS A cross-sectional analysis was conducted among 28,917 adults aged 50 years and older from the 2010 to 2018 National Health Interview Survey. Multimorbidity was defined as the presence of two or more self-reported diseases among 10 common chronic conditions, including diabetes, hypertension, asthma, stroke, cancer, arthritis, chronic obstructive pulmonary disease, and heart, kidney, and liver diseases. The SDoH assessed included race/ethnicity, education level, poverty income ratio, marital status, employment status, insurance status, region of residence, and having a usual place for medical care. Logistic regression models were used to examine the association between SDoH and one or more ED visits. RESULTS Participants' mean (± SD) age was 68.04 (± 10.66) years, and 56.82% were female. After adjusting for age, sex, and the number of chronic conditions in the logistic regression model, high school or less education (adjusted odds ratio [AOR]: 1.10, 95% confidence interval [CI]: 1.02-1.19), poverty income ratio below the federal poverty level (AOR: 1.44, 95% CI: 1.31-1.59), unmarried (AOR: 1.19, 95% CI: 1.11-1.28), unemployed status (AOR: 1.33, 95% CI: 1.23-1.44), and having a usual place for medical care (AOR: 1.46, 95% CI 1.18-1.80) was significantly associated with having one or more ED visits. Non-Hispanic Black individuals had higher odds (AOR: 1.28, 95% CI: 1.19-1.38), while non-Hispanic Asian individuals had lower odds (AOR: 0.71, 95% CI: 0.59-0.86) of one or more ED visits than non-Hispanic White individuals. CONCLUSION SDoH factors are associated with ED visits among older adults with multimorbidity. Systematic multidisciplinary team approaches are needed to address social disparities affecting not only multimorbidity prevalence but also health-seeking behaviors and emergent healthcare access.
Collapse
Affiliation(s)
- Arum Lim
- Johns Hopkins University School of Nursing, 525 N. Wolfe St, Baltimore, MD, USA.
| | | | - Xiaoyue Liu
- University of New York Rory Meyers College of Nursing, 433 1st Ave, NY, USA
| | - Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, 525 N. Wolfe St, Baltimore, MD, USA
| | | | - Patricia Davidson
- University of Wollongong, Northfields Ave, Wollongong, NSW, Australia
| | - Binu Koirala
- Johns Hopkins University School of Nursing, 525 N. Wolfe St, Baltimore, MD, USA
| |
Collapse
|
4
|
Feng Y, Su M, Liu Y, Peng J, Sun X. Health-related quality of life among cancer survivors: pre-existing chronic conditions are to be given priority. Support Care Cancer 2024; 32:124. [PMID: 38252273 DOI: 10.1007/s00520-024-08315-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE This study aimed to describe the health-related quality of life (HRQoL) of cancer survivors in China by the five-level EuroQol-5-dimension (EQ-5D-5L) questionnaire and to explore the impact of the comorbidity of pre-existing chronic conditions on HRQoL in cancer survivors. METHODS Data on cancer survivors were obtained from two cross-sectional surveys conducted in Shandong Province, China. The data of the Chinese general population, the Chinese diabetes population, the Chinese hypertension population, and the Chinese urban population from the published studies were used as the controls. The χ2 test was conducted to compare the incidence of five-dimensional problems between the study and control populations. The non-parametric Mann-Whitney U test and Kruskal-Wallis test were performed to examine the differences in EQ-5D-5L utility scores. Besides, the Tobit regression model was used to examine the variables influencing the EQ-5D-5L utility score. RESULTS One thousand fifty-one adult cancer survivors were included. Cancer survivors had significantly lower EQ-5D-5L utility scores (Z = - 15.939, P < 0.001) and EQ-VAS scores (Z = - 11.156, P < 0.001) than the general adult population. The average EQ-5D-5L utility score of hypertensive cancer survivors was lower than that of the hypertensive population (Z = - 1.610, P = 0.107), but the difference was not statistically significant. CONCLUSION Compared to the general population, the HRQoL of cancer survivors was extremely poor in all dimensions of the EQ-5D-5L. Pre-existing chronic conditions had significant antecedent effects on the HRQoL of cancer survivors. Therefore, more attention should be paid to chronic diseases, and effective interventions should be adopted based on this.
Collapse
Affiliation(s)
- Yujia Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Mingzhu Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Yanxiu Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Jiaqi Peng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China.
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China.
| |
Collapse
|
5
|
Burke L. Medicare Advantage Disenrollment Among Beneficiaries With Chronic Conditions. JAMA 2023; 330:2215-2216. [PMID: 38085319 DOI: 10.1001/jama.2023.20364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
|
6
|
Raver E, Jung J, Xu WY. Medicare Advantage Disenrollment Among Beneficiaries With Chronic Conditions-Reply. JAMA 2023; 330:2216. [PMID: 38085316 DOI: 10.1001/jama.2023.20367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Eli Raver
- College of Public Health, The Ohio State University, Columbus
| | - Jeah Jung
- College of Public Health, George Mason University, Fairfax, Virginia
| | - Wendy Y Xu
- College of Public Health, The Ohio State University, Columbus
| |
Collapse
|
7
|
Mahuela L, Oliván-Blázquez B, Lear-Claveras A, Méndez-López F, Samper-Pardo M, León-Herrera S, Magallón-Botaya R, Sánchez-Calavera MA. Use of health services and medication use, new comorbidities, and mortality in patients with chronic diseases who did not contract COVID-19 during the first year of the pandemic: a retrospective study and comparison by sex. BMC Health Serv Res 2023; 23:1364. [PMID: 38057878 PMCID: PMC10698932 DOI: 10.1186/s12913-023-10158-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/16/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND The restrictions introduced to stop the spread of the COVID-19 virus have also had a direct impact on people with chronic diseases and especially on diseases to which lifestyles are relevant in their control and management, such as diabetes, hypertension, chronic obstructive pulmonary disease (COPD), etc. The purpose of this paper is to conduct a longitudinal analysis of new comorbidities, mortality, medication use, and the use of health resources in patients with chronic diseases who did not contract COVID-19, comparing the six months before the strict lockdown to the 12 months following the end of the strict lockdown. METHOD An observational real world data pre-post study of 668,974 people was undertaken. The patients studied were over 16 years of age, had been receiving care from the Aragon Health Service (Northeastern Spain), were diagnosed with one or more chronic diseases, and had not contracted COVID-19. Sociodemographic, comorbidity, pharmacological and health resource use variables were collected during the six months before the onset of the lockdown and during the six and 12 months following the end of the lockdown. The comparisons by sex were carried out using a Student T-test or chi-squared test to analyse differences. RESULTS Dyslipidaemia (42.1%) followed by hypertension (35.1%) and anxiety and depression (34.6%) were the most prevalent chronic diseases among the study population. 78.% of patients had between one and four chronic illnesses. There was a decrease in new diagnoses of other chronic comorbidities in this population and a decrease in medications prescribed and the use of health services. Although women received more diagnoses of chronic diseases, the number of medications dispensed was lower, but the use of health services was higher. These figures were maintained throughout the pandemic. CONCLUSION Our results suggest an underdiagnosis of new chronic comorbidities and a decrease in mortality rates from causes unrelated to COVID-19 due to the closure of health centres in Aragón (Spain) during the lockdown. This trend was exacerbated in women. The underdiagnosis of new chronic comorbidities during confinement can cause the disease to worsen, with the consequent increase in symptoms and the worsening of chronic pathologies in patients with a severe evolution.
Collapse
Affiliation(s)
- Liliana Mahuela
- Institute for Health Research Aragon (IISAragon), Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Institute for Health Research Aragon (IISAragon), Zaragoza, Spain
- Aragones Group of Research in Primary Health Care (GAIAP), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Ana Lear-Claveras
- Aragones Group of Research in Primary Health Care (GAIAP), Zaragoza, Spain
| | - Fátima Méndez-López
- Institute for Health Research Aragon (IISAragon), Zaragoza, Spain.
- Aragones Group of Research in Primary Health Care (GAIAP), Zaragoza, Spain.
- Department of Medicine, University of Zaragoza, Zaragoza, Spain.
| | | | - Sandra León-Herrera
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Rosa Magallón-Botaya
- Institute for Health Research Aragon (IISAragon), Zaragoza, Spain
- Aragones Group of Research in Primary Health Care (GAIAP), Zaragoza, Spain
- Department of Medicine, University of Zaragoza, Zaragoza, Spain
| | - María Antonia Sánchez-Calavera
- Aragones Group of Research in Primary Health Care (GAIAP), Zaragoza, Spain
- Department of Medicine, University of Zaragoza, Zaragoza, Spain
| |
Collapse
|
8
|
Huguet N, Hodes T, Liu S, Marino M, Schmidt TD, Voss RW, Peak KD, Quiñones AR. Impact of Health Insurance Patterns on Chronic Health Conditions Among Older Patients. J Am Board Fam Med 2023; 36:839-850. [PMID: 37704394 PMCID: PMC10662026 DOI: 10.3122/jabfm.2023.230106r1] [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: 03/17/2023] [Revised: 05/25/2023] [Accepted: 06/05/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Patients have varying levels of chronic conditions and health insurance patterns as they become Medicare age-eligible. Understanding these dynamics will inform policies and reforms that direct capacity and resources for primary care clinics to care for these aging patients. This study 1) determined changes in chronic condition rates following Medicare age eligibility among patients with different insurance patterns and 2) estimated the number of chronically ill patients who remain inadequately insured post-Medicare eligibility among patients receiving care in community health centers. METHOD We used retrospective electronic health record data from 45,527 patients aged 62 to 68 from 990 community health centers in 25 states in 2014 to 2019. Insurance patterns (continuously insured, continuously uninsured, uninsured/discontinuously insured who gained insurance after age 65, lost insurance after age 65, discontinuously insured) and diagnosis of chronic conditions were defined at each visit pre- and post-Medicare eligibility. Difference-in-differences Poisson GEE models estimated changes of chronic condition rates by insurance groups pre- to post-Medicare age eligibility. RESULTS Post-Medicare eligibility, 72% patients were continuously insured, 14% gained insurance; and 14% were uninsured or discontinuously insured. The prevalence of multimorbidity (≥2 chronic conditions) was 77%. Those who gained insurance had a significantly larger increase in the rate of documented chronic conditions from pre- to post-Medicare (DID: 1.06, 95%CI:1.05-1.07) compared with the continuously insured group. CONCLUSIONS Post-Medicare age eligibility, a significant proportion of patients were diagnosed with new conditions leading to high burden of disease. One in 4 older adults continue to have inadequate health care coverage in their older age.
Collapse
Affiliation(s)
- Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Tahlia Hodes
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Shuling Liu
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR
| | | | | | - Katherine D. Peak
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Ana R. Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR
| |
Collapse
|
9
|
Feng X, Sarma H, Seubsman SA, Sleigh A, Kelly M. The Impact of Multimorbidity on All-Cause Mortality: A Longitudinal Study of 87,151 Thai Adults. Int J Public Health 2023; 68:1606137. [PMID: 37881771 PMCID: PMC10594150 DOI: 10.3389/ijph.2023.1606137] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/21/2023] [Indexed: 10/27/2023] Open
Abstract
Objectives: To investigate associations between multimorbidity, socio-demographic and health behaviour factors, and their interactions (multimorbidity and these factors) with all-cause mortality among Thai adults. Methods: Associations between multimorbidity (coexistence of two + chronic diseases) and mortality between 2005 and 2019 were investigated among Thai Cohort Study (TCS) participants (n = 87,151). Kaplan-Meier survival curves estimated and compared survival times. Multivariate Cox proportional hazards models examined associations between risk factors, and interactions between multimorbidity, these factors, and survival. Results: 1,958 cohort members died between 2005 and 2019. The risk of death was 43% higher for multimorbid people. In multivariate Cox proportional hazard models, multimorbidity/number of chronic conditions, age, long sleep duration, smoking and drinking were all independent factors that increased mortality risk. Women, urbanizers, university education, over 20,000-baht personal monthly income and soybean products consumption lowered risk. The interactions between multimorbidity and these variables (except for female, urbanizers and soybeans intake) also had significant (p < 0.05) impact on all-cause mortality. Conclusion: The results emphasise the importance of healthy lifestyle and reduced intake of alcohol and tobacco, in reducing premature mortality, especially when suffering from multimorbidity.
Collapse
Affiliation(s)
- Xiyu Feng
- National Centre of Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Haribondhu Sarma
- National Centre of Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Sam-Ang Seubsman
- School of Human Ecology, Sukhothai Thammathirat Open University, Pak Kret, Thailand
| | - Adrian Sleigh
- National Centre of Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Matthew Kelly
- National Centre of Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| |
Collapse
|
10
|
Wu XC, Yu Q, Yi Y, Maniscalco LS, Hsieh MC, Gruber D, Mendoza L, Subbiah S, Sokol T, Shrestha P, Chen VW, Mederos ET, Ochoa A. Effect of chronic disease on racial difference in COVID-19-associated hospitalization among cancer patients. J Natl Cancer Inst 2023; 115:1204-1212. [PMID: 37697664 PMCID: PMC10560601 DOI: 10.1093/jnci/djad150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Research indicates that Black cancer patients have higher rates of COVID-19 hospitalization than their White counterparts. However, the extent to which chronic diseases contribute to racial disparities remains uncertain. We aimed to quantify the effect of chronic diseases on racial disparity in COVID-19-associated hospitalization among cancer patients. METHODS We linked Louisiana Tumor Registry's data with statewide COVID-19 data and hospital in-patient discharge data to identify patients diagnosed with cancer in 2015-2019 who tested positive for COVID-19 in 2020 and those with COVID-19-associated hospitalization. Multivariable logistic regression and mediation methods based on linear structural equations were employed to assess the effects of the number of chronic diseases (0, 1-2, ≥3) and individual chronic diseases. RESULTS Of 6381 cancer patients who tested positive for COVID-19, 31.6% were non-Hispanic Black cancer patients. Compared with non-Hispanic White cancer patients, non-Hispanic Black cancer patients had a higher prevalence of chronic diseases (79.5% vs 66.0%) and higher COVID-19-associated hospitalization (27.2% vs 17.2%). The odds of COVID-19-associated hospitalization were 80% higher for non-Hispanic Black cancer patients than non-Hispanic White cancer patients (odds ratio = 1.80, 95% confidence interval = 1.59 to 2.04). After adjusting for age, sex, insurance, poverty, obesity, and cancer type, number of chronic diseases explained 37.8% of the racial disparity in COVID-19-associated hospitalization, and hypertension, diabetes, and chronic renal disease were the top 3 chronic diseases explaining 9.6%, 8.9%, and 7.3% of the racial disparity, respectively. CONCLUSION Chronic diseases played a substantial role in the racial disparity in COVID-19-associated hospitalization among cancer patients, especially hypertension, diabetes, and renal disease. Understanding and addressing the root causes are crucial for targeted interventions, policies, and health-care strategies to reduce racial disparity.
Collapse
Affiliation(s)
- Xiao-Cheng Wu
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - Qingzhao Yu
- Biostatistics Program, School of Public Health, LSU Health, New Orleans, LA, USA
| | - Yong Yi
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - Lauren S Maniscalco
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - DeAnn Gruber
- Bureau of Infectious Diseases, Office of Public Health, Louisiana Department of Health, New Orleans, LA, USA
| | - Lee Mendoza
- Bureau of Health Informatics, Office of Public Health, Louisiana Department of Health, New Orleans, LA, USA
| | - Suki Subbiah
- Section of Hematology-Oncology, School of Medicine, LSU Health, New Orleans, LA, USA
| | - Theresa Sokol
- Bureau of Infectious Diseases, Office of Public Health, Louisiana Department of Health, New Orleans, LA, USA
| | - Pratibha Shrestha
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - Vivien W Chen
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University (LSU) Health, New Orleans, LA, USA
| | - Eileen T Mederos
- LSU-LCMC Health Cancer Center, Department of Interdisciplinary Oncology, LSU Health, New Orleans, LA, USA
| | - Augusto Ochoa
- LSU-LCMC Health Cancer Center, Department of Interdisciplinary Oncology, LSU Health, New Orleans, LA, USA
| |
Collapse
|
11
|
Graves N, Ganesan G, Tan KB, Goh OQ, Ho J, Chong TT, Bishnoi P, Carmody D, Yuh AS, Ng YZ, Lo Z, Enming Y, Abu Bakar Aloweni F, Zifei W, Harding K. Chronic wounds in a multiethnic Asian population: a cost of illness study. BMJ Open 2023; 13:e065692. [PMID: 37723106 PMCID: PMC10510887 DOI: 10.1136/bmjopen-2022-065692] [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: 06/17/2022] [Accepted: 08/30/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE To estimate the 'cost of illness' arising from chronic wounds in Singapore. DESIGN Incidence-based cost of illness study using evidence from a range of sources. SETTING Singapore health services. PARTICIPANTS We consider 3.49 million Singapore citizens and permanent residents. There are 16 752 new individuals with a chronic wound in 2017, with 598 venous ulcers, 2206 arterial insufficiency ulcers, 6680 diabetic ulcers and 7268 pressure injuries.Primary outcome measures expressed in monetary terms are the value of all hospital bed days lost for the population; monetary value of quality-adjusted life years (QALYs) lost in the population; costs of all outpatient visits; and costs of all poly clinic, use of Community Health Assist Scheme (CHAS) and emergency departments (EDs) visits. Intermediate outcomes that inform the primary outcomes are also estimated. RESULTS Total annual cost of illness was $350 million (range $72-$1779 million). With 168 503 acute bed days taken up annually (range 141 966-196 032) that incurred costs of $139 million (range 117-161 million). Total costs to health services were $184 million (range $120-$1179 million). Total annual costs of lost health outcomes were 2077 QALYs (range -2657 to 29 029) valued at $166 million (range -212 to 2399 million). CONCLUSIONS The costs of chronic wounds are large to Singapore. Costs can be reduced by making positive investments for comprehensive wound prevention and treatment programmes.
Collapse
Affiliation(s)
- Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Ganga Ganesan
- Health Services Research, Ministry of Health, Singapore
| | - Kelvin Bryan Tan
- SingHealth Duke-NUSGlobal Health Institute, Duke-NUS Medical School, Singapore
| | - Orlanda Qm Goh
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Jackie Ho
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Priya Bishnoi
- A*STAR Skin Research Labs (A*SRL), Agency for Science, Technology and Research (A*STAR), Singapore
| | - David Carmody
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Ang Shin Yuh
- Nursing Division, Singapore General Hospital, Singapore
| | - Yi Zhen Ng
- A*STAR Skin Research Labs (A*SRL), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Zhiwen Lo
- Department of Surgery, Vascular Surgery Woodlands Health, Singapore
| | - Yong Enming
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Wang Zifei
- Skin Research Institute of Singapore (SRIS), Singapore
| | - Keith Harding
- Skin Research Institute of Singapore (SRIS), Singapore
| |
Collapse
|
12
|
Cook WK, Kerr WC, Tam CC, Li L. Risky drinking and other drug use in adults with chronic conditions in the United States: differential associations by race/ethnicity. Alcohol Alcohol 2023; 58:523-531. [PMID: 37258041 PMCID: PMC10656882 DOI: 10.1093/alcalc/agad024] [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: 09/15/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 06/02/2023] Open
Abstract
Co-use of multiple drugs may prolong or increase heavy drinking, even for individuals with health conditions adversely affected by it. Patterns of alcohol and drug use may vary across racial/ethnic groups, with differential implications for health. This study examines racial/ethnic differences in the associations between risky drinking and other drug use in adults with diabetes, hypertension, heart disease, or cancer. Multiple logistic regression modeling, stratified by condition, was performed using a nationally representative sample of adults drawn from the 2015 to 2019 National Survey on Drug and Health. The outcome was risky drinking (consuming more than 7/14 drinks weekly). Other drugs considered were tobacco, marijuana, illicit drugs, and non-medical prescription drugs. Covariates included age, sex, education, income, marital/cohabitation status, health insurance coverage, and self-rated health status. Each drug category was positively associated with risky drinking across all four conditions. Racial/ethnic minority adults were less likely than White adults to engage in risky drinking, with this pattern most consistent for those with hypertension. Other drug use in minority adults (i.e. tobacco and illicit drug use in Black and Hispanic adults, and marijuana and prescription drug use in Asian adults) was associated with disproportionately greater odds of risky drinking compared with White adults. This pattern was more prominent for those with a heart condition, and not found for those with cancer. Future interventions might address co-use of alcohol and other drugs in adults with chronic conditions, with special attention to racial/ethnic minority adults.
Collapse
Affiliation(s)
- Won Kim Cook
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St. Suite 450, Emeryville, CA 94608, United States
| | - William C Kerr
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St. Suite 450, Emeryville, CA 94608, United States
| | - Christina C Tam
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St. Suite 450, Emeryville, CA 94608, United States
| | - Libo Li
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St. Suite 450, Emeryville, CA 94608, United States
| |
Collapse
|
13
|
Gao M, Park S, Lee C. Social Participation and Persistent Smoking Among Older Chinese With Smoking-Related Morbidity. J Gerontol B Psychol Sci Soc Sci 2023; 78:1572-1580. [PMID: 37210675 DOI: 10.1093/geronb/gbad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Indexed: 05/22/2023] Open
Abstract
OBJECTIVES Chronic diseases are common in midlife and old age and smoking can pose more health and longevity challenges for older people with chronic illnesses. In China where smoking is highly prevalent, older adults are likely to continue smoking even after developing severe chronic diseases. We examined the national prevalence of persistent smoking among older adults. We also investigated the sociodemographic characteristics of persistent smoking among ever-smokers with chronic diseases and its association with social participation (of various types). METHODS We used data from a nationally representative sample of older adults aged 45-80 in the China Health and Retirement Longitudinal Study (2011-2018). Multinomial logistic and multilevel logistic models were fitted. RESULTS The national prevalence of persistent smoking was around 24% of older men and 3% of older women. Among those with a history of smoking and chronic illness, younger, nonmarried/partnered, nonretired, or less educated individuals are more likely to continue smoking. Social participation is significantly associated with persistent smoking among those with chronic diseases, but the association differs across different forms of activities. Although the most popular but sedentary activities in China (playing Mahjong, chess, or cards) are associated with an elevated risk of persistent smoking, physical social activities (community-organized dancing, fitness, and qigong) are associated with a reduced risk of persistent smoking. DISCUSSION Given the enormous burden of persistent smoking on individuals and society, public smoking cessation inventions should address sociocultural factors of persistent smoking and target older adults who participate in specific social activities.
Collapse
Affiliation(s)
- Manjing Gao
- Department of Sociology, University of California, Riverside, Riverside, California, USA
| | - Soojin Park
- Graduate School of Education, University of California, Riverside, Riverside, California, USA
| | - Chioun Lee
- Department of Sociology, University of California, Riverside, Riverside, California, USA
| |
Collapse
|
14
|
Niebuur J, Vonk JM, Du Y, de Bock GH, Lunter G, Krabbe PFM, Alizadeh BZ, Snieder H, Smidt N, Boezen M, Corpeleijn E. Lifestyle factors related to prevalent chronic disease multimorbidity: A population-based cross-sectional study. PLoS One 2023; 18:e0287263. [PMID: 37486939 PMCID: PMC10365307 DOI: 10.1371/journal.pone.0287263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 06/02/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Multimorbidity is associated with poor quality of life, polypharmacy, health care costs and mortality, with those affected potentially benefitting from a healthy lifestyle. We assessed a comprehensive set of lifestyle factors in relation to multimorbidity with major chronic diseases. METHODS This cross-sectional study utilised baseline data for adults from the prospective Lifelines Cohort in the north of the Netherlands (N = 79,345). We defined multimorbidity as the co-existence of two or more chronic diseases (i.e. cardiovascular disease, cancer, respiratory disease, type 2 diabetes) and evaluated factors in six lifestyle domains (nutrition, physical (in)activity, substance abuse, sleep, stress, relationships) among groups by the number of chronic diseases (≥2, 1, 0). Multinomial logistic regression models were created, adjusted for appropriate confounders, and odds ratios (OR) with 95% confidence intervals (95%CI) were reported. RESULTS 3,712 participants had multimorbidity (4.7%, age 53.5 ± 12.5 years), and this group tended to have less healthy lifestyles. Compared to those without chronic diseases, those with multimorbidity reported physical inactivity more often (OR, 1.15; 95%CI, 1.06-1.25; not significant for one condition), chronic stress (OR, 2.14; 95%CI, 1.92-2.38) and inadequate sleep (OR, 1.70; 95%CI, 1.41-2.06); as expected, they more often watched television (OR, 1.70; 95%CI, 1.42-2.04) and currently smoked (OR, 1.91; 95%CI, 1.73-2.11), but they also had lower alcohol intakes (OR, 0.66; 95%CI, 0.59-0.74). CONCLUSIONS Chronic stress and poor sleep, in addition to physical inactivity and smoking, are lifestyle factors of great concern in patients with multimorbidity.
Collapse
Affiliation(s)
- Jacobien Niebuur
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Judith M. Vonk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yihui Du
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerton Lunter
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul F. M. Krabbe
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Behrooz Z. Alizadeh
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nynke Smidt
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marike Boezen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
15
|
Hodges CB, Steinberg JL, Zuniga EA, Ma L, Bjork JM, Moeller FG. Chronic Cocaine Use and White Matter Coherence: A Diffusion Tensor Imaging Study. J Stud Alcohol Drugs 2023; 84:585-597. [PMID: 36971714 PMCID: PMC10488304 DOI: 10.15288/jsad.21-00410] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/09/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE Chronic substance use and its effects on brain function and structure has long been of interest to clinicians and researchers. Prior cross-sectional comparisons of diffusion tensor imaging (DTI) metrics have suggested deleterious effects of chronic substance use (i.e., cocaine use) on white matter coherence. However, it is unclear how these effects may replicate across geographic regions when examined with similar technologies. In this study, we sought to conduct a replication of previous work in this area and determine whether there are any patterns of persistent differences in white matter microstructure between individuals with a history of cocaine use disorder (CocUD, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and healthy controls. METHOD A total of 46 participants (21 healthy controls, 25 chronic cocaine users) were recruited from the Richmond, Virginia metropolitan area. Information regarding past and current substance use was collected from all participants. Participants also completed structural and DTI scans. RESULTS Consistent with previous DTI studies, significant differences were found between fractional anisotropy (FA) and axial diffusivity (AD) CocUD and controls, with CocUD showing lower FA and AD in the right inferior and superior longitudinal fasciculus, the genu, body, and splenium of the corpus callosum, and the anterior, posterior, and superior corona radiata, among several other regions. These differences were not significant for other diffusivity metrics. Lifetime alcohol consumption was greater in the CocUD group, but lifetime alcohol consumption did not show a significant linear relationship with any of the DTI metrics in within-group regression analyses. CONCLUSIONS These data align with previously reported declines in white matter coherence in chronic cocaine users. However, it is less clear whether comorbid alcohol consumption results in an additive deleterious effect on white matter microstructure.
Collapse
Affiliation(s)
- Cooper B. Hodges
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Joel L. Steinberg
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Edward A. Zuniga
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia
| | - Liangsuo Ma
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - James M. Bjork
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia
| | - F. Gerard Moeller
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, Virginia
| |
Collapse
|
16
|
Li Q, Douglas JA, Subica AM. Examining neighbourhood-level disparities in Black, Latina/o, Asian, and White physical health, mental health, chronic conditions, and social disadvantage in California. Glob Public Health 2023; 18:2273425. [PMID: 37902041 DOI: 10.1080/17441692.2023.2273425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023]
Abstract
Racial/ethnic minority individuals in the U.S. experience numerous health disparities versus Whites, often due to differences in social determinants. Yet, limited large-scale research has examined these differences at the neighbourhood level. We merged 2021 PLACES Project and 2020 American Community Survey data across 3,211 census tracts (neighbourhoods) defined as majority (>50%) Black, Latina/o, Asian or White. T-tests and hierarchical linear regressions were used to examine differences and associations between neighbourhoods on key health (general health, mental health, obesity, diabetes, cancer, coronary heart disease, chronic obstructive pulmonary disease, stroke), and social outcomes (income, unemployment, age, population density). Results indicated that minority neighbourhoods in California exhibited stark health and social disparities versus White neighbourhoods, displaying worse outcomes on nearly every social and health variable/condition examined; particularly for Black and Latina/o neighbourhoods. Moreover, regression findings revealed that, after considering income, unemployment, and population density, (1) fair/poor mental health and higher percentages of Black, Latina/o and Asian residents in neighbourhoods independently associated with greater neighbourhood fair/poor physical health, and (2) fair/poor mental health significantly associated with greater prevalence of obesity and COPD. This study thus underscores the need to address the profound health and social disparities experienced by minority neighbourhoods for more equitable neighbourhoods.
Collapse
Affiliation(s)
- Qiuxi Li
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, CA, USA
| | - Jason A Douglas
- Department of Health, Society, and Behavior, Program in Public Health, Center for Environmental Health Disparities Research, University of California, Irvine, CA, USA
| | - Andrew M Subica
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, CA, USA
| |
Collapse
|
17
|
Liang B, Shang XJ, Pei LJ. [Association between chronic diseases and possible sarcopenia in middle-aged and older Chinese men: A prospective cohort study]. Zhonghua Nan Ke Xue 2023; 29:10-18. [PMID: 37846826] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
OBJECTIVE To investigate the association between chronic diseases and the risk of possible sarcopenia among middle-aged and older Chinese males. METHODS This prospective cohort study included the data collected from the China Health and Retirement Longitudinal Study on 4 878 males aged over 45 years without possible sarcopenia as the baseline population in 2011 and 2013, and all were followed up until 2015. Possible sarcopenia was determined by measuring the grip strength and the time of five successive sit-ups. The Cox proportional risk model was used to analyze the relationship of the type and number of chronic diseases with the risk of possible sarcopenia in males. RESULTS The risk of possible sarcopenia in the middle-aged and older men with prostatic disease, cognitive impairment or depression was increased by 16% (HR = 1.16, 95% CI: 1.01-1.33), 23% (HR = 1.23, 95% CI: 1.10-1.38) and 12% (HR = 1.12, 95% CI: 1.01-1.24), respectively. The risk in those with one, two or three or more chronic diseases was raised by 22% (HR = 1.22, 95% CI: 1.04-1.42), 20% (HR = 1.20, 95% CI: 1.02-1.42) and 46% (HR = 1.46, 95% CI: 1.25-1.71), respectively, compared with those without chronic diseases, and it was increased in a dose-dependent manner (P < 0.01) Conclusion: Prostatic disease, cognitive impairment and depression increase the risk of possible sarcopenia in middle-aged and older Chinese males, and the risk rises with the increased number of chronic comorbidities.
Collapse
Affiliation(s)
- Bo Liang
- Institute of Population Research / China Center for Population Health and Development, Peking University, Beijing 100871, China
| | - Xue-Jun Shang
- Department of Urology, Jinling Hospital, Nanjing University School of Medicine / General Hospital of Eastern Theater Command, Nanjing, Jiangsu 210002, China
| | - Li-Jun Pei
- Institute of Population Research / China Center for Population Health and Development, Peking University, Beijing 100871, China
| |
Collapse
|
18
|
Hong JY, Kim YJ, Bae S, Kim MK. Associations of daily diet-related greenhouse gas emissions with the incidence and mortality of chronic diseases: a systematic review and meta-analysis of epidemiological studies. Epidemiol Health 2022; 45:e2023011. [PMID: 36596731 PMCID: PMC10581893 DOI: 10.4178/epih.e2023011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/30/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Although the entire process extending from food production to dietary consumption makes a large contribution to total greenhouse gas (GHG) emissions, little and inconsistent evidence exists on the epidemiological associations of daily diet-related GHG emissions with chronic disease risk or all-cause mortality. This systematic review and meta-analysis explored the observational epidemiological relationship between daily diet-related GHG emissions and health outcomes, including the risk of chronic diseases and all-cause mortality. METHODS Original articles published in English until May 2022 were identified by searching PubMed, Ovid-Embase, Web of Science, CINAHL, and Google Scholar. The extracted data were pooled using both fixed-effects and random-effects meta-analyses and presented as hazard and risk ratios (RRs) with 95% confidence intervals (CIs). RESULTS In total, 7 cohort studies (21 study arms) were included for qualitative synthesis and meta-analysis. The GHG emissions of dietary consumption showed a significant positive association with the risk of chronic disease incidence and mortality in both fixed-effects and random-effects models (fixed: RR, 1.04; 95% CI, 1.03 to 1.05; random: RR, 1.04; 95% CI, 1.02 to 1.06). This positive association was robust regardless of how daily diet-related GHG emissions were grouped. More strongly animal- based diets showed higher GHG emissions. However, there were only a few studies on specific chronic diseases, and the subgroup analysis showed insignificant results. There was no evidence of publication bias among the studies (Egger test: p=0.79). CONCLUSIONS A higher GHG-emission diet was found to be associated with a greater risk of all-cause mortality.
Collapse
Affiliation(s)
- Jee Yeon Hong
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Young Jun Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Sanghyuk Bae
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Kyung Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Institute for Health and Society, Hanyang University, Seoul, Korea
| |
Collapse
|
19
|
Gartlehner G, Patel SV, Reddy S, Rains C, Schwimmer M, Kahwati L. Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Persons: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 328:1747-1765. [PMID: 36318128 DOI: 10.1001/jama.2022.18324] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
IMPORTANCE It is uncertain whether hormone therapy should be used for the primary prevention of chronic conditions such as heart disease, osteoporosis, or some types of cancers. OBJECTIVE To update evidence for the US Preventive Services Task Force on the benefits and harms of hormone therapy in reducing risks for chronic conditions. DATA SOURCES PubMed/MEDLINE, Cochrane Library, EMBASE, and trial registries from January 1, 2016, through October 12, 2021; surveillance through July 2022. STUDY SELECTION English-language randomized clinical trials and prospective cohort studies of fair or good quality. DATA EXTRACTION AND SYNTHESIS Dual review of abstracts, full-text articles, and study quality; meta-analyses when at least 3 similar studies were available. MAIN OUTCOMES AND MEASURES Morbidity and mortality related to chronic conditions; health-related quality of life. RESULTS Twenty trials (N = 39 145) and 3 cohort studies (N = 1 155 410) were included. Participants using estrogen only compared with placebo had significantly lower risks for diabetes over 7.1 years (1050 vs 903 cases; 134 fewer [95% CI, 18-237]) and fractures over 7.2 years (1024 vs 1413 cases; 388 fewer [95% CI, 277-489]) per 10 000 persons. Risks per 10 000 persons were statistically significantly increased for gallbladder disease over 7.1 years (1113 vs 737 cases; 377 more [95% CI, 234-540]), stroke over 7.2 years (318 vs 239 cases; 79 more [95% CI, 15-159]), venous thromboembolism over 7.2 years (258 vs 181 cases; 77 more [95% CI, 19-153]), and urinary incontinence over 1 year (2331 vs 1446 cases; 885 more [95% CI, 659-1135]). Participants using estrogen plus progestin compared with placebo experienced significantly lower risks, per 10 000 persons, for colorectal cancer over 5.6 years (59 vs 93 cases; 34 fewer [95% CI, 9-51]), diabetes over 5.6 years (403 vs 482 cases; 78 fewer [95% CI, 15-133]), and fractures over 5 years (864 vs 1094 cases; 230 fewer [95% CI, 66-372]). Risks, per 10 000 persons, were significantly increased for invasive breast cancer (242 vs 191 cases; 51 more [95% CI, 6-106]), gallbladder disease (723 vs 463 cases; 260 more [95% CI, 169-364]), stroke (187 vs 135 cases; 52 more [95% CI, 12-104]), and venous thromboembolism (246 vs 126 cases; 120 more [95% CI, 68-185]) over 5.6 years; probable dementia (179 vs 91 cases; 88 more [95% CI, 15-212]) over 4.0 years; and urinary incontinence (1707 vs 1145 cases; 562 more [95% CI, 412-726]) over 1 year. CONCLUSIONS AND RELEVANCE Use of hormone therapy in postmenopausal persons for the primary prevention of chronic conditions was associated with some benefits but also with an increased risk of harms.
Collapse
Affiliation(s)
- Gerald Gartlehner
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Austria
| | - Sheila V Patel
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
| | - Shivani Reddy
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
| | - Caroline Rains
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
| | | | - Leila Kahwati
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
| |
Collapse
|
20
|
Zheng C, Pettinger M, Gowda GAN, Lampe JW, Raftery D, Tinker LF, Huang Y, Navarro SL, O'Brien DM, Snetselaar L, Liu S, Wallace RB, Neuhouser ML, Prentice RL. Biomarker-Calibrated Red and Combined Red and Processed Meat Intakes with Chronic Disease Risk in a Cohort of Postmenopausal Women. J Nutr 2022; 152:1711-1720. [PMID: 35289908 PMCID: PMC9258528 DOI: 10.1093/jn/nxac067] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 01/04/2022] [Revised: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The associations of red and processed meat with chronic disease risk remain to be clarified, in part because of measurement error in self-reported diet. OBJECTIVES We sought to develop metabolomics-based biomarkers for red and processed meat, and to evaluate associations of biomarker-calibrated meat intake with chronic disease risk among postmenopausal women. METHODS Study participants were women who were members of the Women's Health Initiative (WHI) study cohorts. These participants were postmenopausal women aged 50-79 y when enrolled during 1993-1998 at 40 US clinical centers with embedded human feeding and nutrition biomarker studies. Literature reports of metabolomics correlates of meat consumption were used to develop meat intake biomarkers from serum and 24-h urine metabolites in a 153-participant feeding study (2010-2014). Resulting biomarkers were used in a 450-participant biomarker study (2007-2009) to develop linear regression calibration equations that adjust FFQ intakes for random and systematic measurement error. Biomarker-calibrated meat intakes were associated with cardiovascular disease, cancer, and diabetes incidence among 81,954 WHI participants (1993-2020). RESULTS Biomarkers and calibration equations meeting prespecified criteria were developed for consumption of red meat and red plus processed meat combined, but not for processed meat consumption. Following control for nondietary confounding factors, hazard ratios were calculated for a 40% increment above the red meat median intake for coronary artery disease (HR: 1.10; 95% CI: 1.07, 1.14), heart failure (HR: 1.26; 95% CI: 1.20, 1.33), breast cancer (HR: 1.10; 95% CI: 1.07, 1.13) for, total invasive cancer (HR: 1.07; 95% CI: 1.05, 1.09), and diabetes (HR: 1.37; 95% CI: 1.34, 1.39). HRs for red plus processed meat intake were similar. HRs were close to the null, and mostly nonsignificant following additional control for dietary potential confounding factors, including calibrated total energy consumption. CONCLUSIONS A relatively high-meat dietary pattern is associated with somewhat higher chronic disease risks. These elevations appear to be largely attributable to the dietary pattern, rather than to consumption of red or processed meat per se.
Collapse
Affiliation(s)
- Cheng Zheng
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mary Pettinger
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - G A Nagana Gowda
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Johanna W Lampe
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Daniel Raftery
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ying Huang
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Sandi L Navarro
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Diane M O'Brien
- Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
| | - Linda Snetselaar
- College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Simin Liu
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Robert B Wallace
- College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- School of Public Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
21
|
Edmonson MB, Zhao Q, Francis DO, Kelly MM, Sklansky DJ, Shadman KA, Coller RJ. Association of Patient Characteristics With Postoperative Mortality in Children Undergoing Tonsillectomy in 5 US States. JAMA 2022; 327:2317-2325. [PMID: 35727278 PMCID: PMC9214584 DOI: 10.1001/jama.2022.8679] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE The rate of postoperative death in children undergoing tonsillectomy is uncertain. Mortality rates are not separately available for children at increased risk of complications, including young children (aged <3 y) and those with sleep-disordered breathing or complex chronic conditions. OBJECTIVE To estimate postoperative mortality following tonsillectomy in US children, both overall and in relation to recognized risk factors for complications. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study based on longitudinal analysis of linked records in state ambulatory surgery, inpatient, and emergency department discharge data sets distributed by the Healthcare Cost and Utilization Project for 5 states covering 2005 to 2017. Participants included 504 262 persons younger than 21 years for whom discharge records were available to link outpatient or inpatient tonsillectomy with at least 90 days of follow-up. EXPOSURES Tonsillectomy with or without adenoidectomy. MAIN OUTCOME AND MEASURES Postoperative death within 30 days or during a surgical stay lasting more than 30 days. Modified Poisson regression with sample weighting was used to estimate postoperative mortality per 100 000 operations, both overall and in relation to age group, sleep-disordered breathing, and complex chronic conditions. RESULTS The 504 262 children in the cohort underwent a total of 505 182 tonsillectomies (median [IQR] patient age, 7 [4-12] years; 50.6% females), of which 10.1% were performed in young children, 28.9% in those with sleep-disordered breathing, and 2.8% in those with complex chronic conditions. There were 36 linked postoperative deaths, which occurred a median (IQR) of 4.5 (2-20.5) days after surgical admission, and most of which (19/36 [53%]) occurred after surgical discharge. The unadjusted mortality rate was 7.04 (95% CI, 4.97-9.98) deaths per 100 000 operations. In multivariable models, neither age younger than 3 years nor sleep-disordered breathing was significantly associated with mortality, but children with complex chronic conditions had significantly higher mortality (16 deaths/14 299 operations) than children without these conditions (20 deaths/490 883 operations) (117.22 vs 3.87 deaths per 100 000 operations; adjusted rate difference, 113.55 [95% CI, 51.45-175.64] deaths per 100 000 operations; adjusted rate ratio, 29.39 [95% CI, 13.37-64.62]). Children with complex chronic conditions accounted for 2.8% of tonsillectomies but 44% of postoperative deaths. Most deaths associated with complex chronic conditions occurred in children with neurologic/neuromuscular or congenital/genetic disorders. CONCLUSIONS AND RELEVANCE Among children undergoing tonsillectomy, the rate of postoperative death was 7 per 100 000 operations overall and 117 per 100 000 operations among children with complex chronic conditions. These findings may inform decision-making for pediatric tonsillectomy.
Collapse
Affiliation(s)
- M. Bruce Edmonson
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Qianqian Zhao
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison
| | - David O. Francis
- Division of Otolaryngology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
| | - Michelle M. Kelly
- Division of Hospital Medicine, Department of Pediatrics, University of Wisconsin, Madison
| | - Daniel J. Sklansky
- Division of Hospital Medicine, Department of Pediatrics, University of Wisconsin, Madison
| | - Kristin A. Shadman
- Division of Hospital Medicine, Department of Pediatrics, University of Wisconsin, Madison
| | - Ryan J. Coller
- Division of Hospital Medicine, Department of Pediatrics, University of Wisconsin, Madison
| |
Collapse
|
22
|
Bergstra AD, Been JV, Burdorf A. The association of specific industry-related air pollution with occurrence of chronic diseases: A register-based study. Environ Res 2022; 209:112872. [PMID: 35131328 DOI: 10.1016/j.envres.2022.112872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
Air pollution may contribute to onset and progression of chronic diseases such as cardiovascular and respiratory diseases. Most studies have focused on the contribution of traffic-related exposure to PM10 or PM2.5. Our aim was to investigate the association of different components of industry-related air pollution on the occurrence of chronic diseases. A register-based repeated cross-sectional study was conducted among 89,714 subjects (2012) with 536,599 annual observations (2012-2017) living in the vicinity of a large industrial area in the Netherlands. Information from the dispensed medication registration was linked with a dispersion model to characterize annual individual-level exposure of all subjects at place of residence. Associations between annual exposure (concentration and duration) to particulate matter (PM10), nitrogen oxides (NOX), sulphur dioxide (SO2), and volatile organic compounds (VOC) with annual dispensed medication for cardiovascular diseases, respiratory diseases, diabetes mellitus, and inflammatory conditions were investigated by multivariate logistic regression analysis with generalized estimating equations (GEE) while controlling for confounders. Exposure to PM10 and to NOX (per μg/m3) were significantly associated with medication for cardiovascular diseases (OR 1.06, 95CI% 1.06-1.06 and OR 1.01, 95%CI 1.01-1.01 respectively). Exposures to PM10 and SO2 (per μg/m3) were significantly associated with medication for inflammatory conditions (OR 1.05, 95%CI 1.00-1.09 and OR 1.07, 95%CI 1.01-1.14 respectively). Exposure to SO2 was inversely associated with respiratory diseases (OR 0.91, 95%CI 0.86-0.97). Except for inflammatory conditions, exposure duration (years) was significantly associated with the other three chronic diseases (OR varying from 1.01 to 1.03). This study indicates that specific air pollution components caused by industry may contribute to the occurrence of cardiovascular diseases, respiratory diseases, diabetes mellitus, and inflammatory conditions.
Collapse
Affiliation(s)
- Arnold D Bergstra
- Department of Public Health, Erasmus MC, University Medical Centre, PO Box 2040, 3000CA, Rotterdam, the Netherlands; The Zeeland Public Health Service, PO Box 345, 4460AS, Goes, the Netherlands.
| | - Jasper V Been
- Department of Public Health, Erasmus MC, University Medical Centre, PO Box 2040, 3000CA, Rotterdam, the Netherlands; Department of Paediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, PO Box 2060, 3000CB, Rotterdam, the Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus MC, University Medical Centre, PO Box 2040, 3000CA, Rotterdam, the Netherlands
| |
Collapse
|
23
|
Wu C, Liu YX, Liu TJ, Yan XL, Zhao YX, Zeng H, Zhou T, Rao P, Sun LY, Jiao Y, Xi JN. Investigation and influencing factors about well-being level of elderly chronic patients during COVID-19 postpandemic period in Beijing. Medicine (Baltimore) 2022; 101:e28976. [PMID: 35244066 PMCID: PMC8896424 DOI: 10.1097/md.0000000000028976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 02/06/2022] [Indexed: 01/04/2023] Open
Abstract
The Corona Virus Disease 2019 (COVID-19) pandemic has huge impacts on the world, including human health and economic decline. The COVID-19 has severe infectivity, especially the elderly with chronic diseases will cause various complications after infection and accelerate the disease process. In addition, COVID-19 will also affect their mental health. Therefore, the mental health of elderly patients with chronic diseases cannot be ignored. The aim of this study was to investigate the well-being level of elderly people with chronic disease during COVID-19 postpandemic period in Beijing and analysis related influencing factors, so as to provide a basis for improving the well-being level of elderly chronic patients during the postpandemic period.Elderly patients with chronic diseases who met the inclusion criteria in 5 different administrative regions in Beijing were selected to carry out a questionnaire survey. The contents of the questionnaire included general data, the Memorial University of Newfoundland Happiness scale and the awareness situation of the COVID-19 pandemic. A total of 500 questionnaires were distributed by WeChat and 486 valid questionnaires were collected. The t test and one-way analysis of variance were used to compare Memorial University of Newfoundland Happiness scores between 2 or more groups, multiple linear regression analysis was used to conduct multiple factor analysis to explore the related factors about well-being level of elderly chronic patients.A total of 109 cases (22.43%) were evaluated high well-being level, 319 cases (65.64%) were evaluated moderate well-being level and 58 cases (11.93%) were evaluated low well-being according to the Memorial University of Newfoundland Happiness (MUNSH) scores rating. The multiple linear regression indicated that the education level, number of chronic diseases, medical expenses, frequency of children's visits, taking care of grandchildren or not, and group activity frequency significantly affected the well-being of patients with chronic diseases during COVID-19 postpandemic period in Beijing (P < .05).Most elderly patients with chronic diseases had moderate or above sense of well-being during postpandemic period, but we should still pay attention to the mental health of those elderly chronic patients with low education level, much comorbidity, more medical expenses, less visits by children, not take care of grandchildren and never participate in group activities.
Collapse
Affiliation(s)
- Chen Wu
- Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Yu-Xuan Liu
- Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Tie-Jun Liu
- Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Xu-Ling Yan
- Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Yu-Xi Zhao
- Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Hong Zeng
- Beijing Municipal Health Commission, Beijing, China
| | - Tian Zhou
- Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Ping Rao
- Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | | | - Yang Jiao
- Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Jia-Ning Xi
- Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| |
Collapse
|
24
|
Kaur S, Kaur M, Kumar R. Health promotion intervention to prevent risk factors of chronic diseases: Protocol for a cluster randomized controlled trial among adolescents in school settings of Chandigarh (India). PLoS One 2022; 17:e0263584. [PMID: 35176046 PMCID: PMC8853575 DOI: 10.1371/journal.pone.0263584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 01/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Chronic diseases like diabetes, cardiovascular diseases and cancers are on the rise. Most of the risk factors of these diseases commence in Adolescence. Therefore, a cluster randomised controlled trial is designed to evaluate the effect of school-based health promotion intervention on the risk factors of chronic diseases.
Methodology
Considering school as a cluster, twelve schools will be randomly selected from the public schools of Chandigarh, a city in India. After baseline assessment, six schools will be randomly allocated to intervention and six to the control arm. Study participants will be students of 8th grade (age 10–16 years), their parents and teachers. A sample of 360 students (12 clusters x 30 students) has been estimated to provide statistically valid inference. The PRECEDE PROCEED Model will be used to develop health promotion interventions to prevent the use of an unbalanced diet, physical inactivity, alcohol, and tobacco. Interventions will be implemented for six-months in the school setting. For students, the intervention will comprise interactive learning sessions of 30 minutes duration per week and physical activity sessions of 30 minutes duration four times every week. Educational sessions will be conducted for parents and teachers for 30 minutes, four times during the intervention period. Primary outcomes will be changes in the prevalence of behavioural risk factors from pre- to post-intervention. Changes in anthropometric, physiological, and biochemical measures will be the secondary outcomes. The difference-in-difference (DID) method will be used to measure the net change in the outcomes.
Discussion
It is essential to understand whether health promotion interventions implemented in the school setting simultaneously targeting adolescents, teachers, and parents are effective. Using the PRECEDE-PROCEED model for planning, implementing, and evaluating the intervention as part of a cluster Randomized Controlled Trial design with DID analysis, could objectively assess the impact.
Collapse
Affiliation(s)
- Sandeep Kaur
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
- * E-mail:
| | - Rajesh Kumar
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| |
Collapse
|
25
|
Cohen K, Ren S, Heath K, Dasmariñas MC, Jubilo KG, Guo Y, Lipsitch M, Daugherty SE. Risk of persistent and new clinical sequelae among adults aged 65 years and older during the post-acute phase of SARS-CoV-2 infection: retrospective cohort study. BMJ 2022; 376:e068414. [PMID: 35140117 PMCID: PMC8828141 DOI: 10.1136/bmj-2021-068414] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To characterize the risk of persistent and new clinical sequelae in adults aged ≥65 years after the acute phase of SARS-CoV-2 infection. DESIGN Retrospective cohort study. SETTING UnitedHealth Group Clinical Research Database: deidentified administrative claims and outpatient laboratory test results. PARTICIPANTS Individuals aged ≥65 years who were continuously enrolled in a Medicare Advantage plan with coverage of prescription drugs from January 2019 to the date of diagnosis of SARS-CoV-2 infection, matched by propensity score to three comparison groups that did not have covid-19: 2020 comparison group (n=87 337), historical 2019 comparison group (n=88 070), and historical comparison group with viral lower respiratory tract illness (n=73 490). MAIN OUTCOME MEASURES The presence of persistent and new sequelae at 21 or more days after a diagnosis of covid-19 was determined with ICD-10 (international classification of diseases, 10th revision) codes. Excess risk for sequelae caused by infection with SARS-CoV-2 was estimated for the 120 days after the acute phase of the illness with risk difference and hazard ratios, calculated with 95% Bonferroni corrected confidence intervals. The incidence of sequelae after the acute infection was analyzed by age, race, sex, and whether patients were admitted to hospital for covid-19. RESULTS Among individuals who were diagnosed with SARS-CoV-2, 32% (27 698 of 87 337) sought medical attention in the post-acute period for one or more new or persistent clinical sequelae, which was 11% higher than the 2020 comparison group. Respiratory failure (risk difference 7.55, 95% confidence interval 7.18 to 8.01), fatigue (5.66, 5.03 to 6.27), hypertension (4.43, 2.27 to 6.37), memory difficulties (2.63, 2.23 to 3.13), kidney injury (2.59, 2.03 to 3.12), mental health diagnoses (2.50, 2.04 to 3.04), hypercoagulability 1.47 (1.2 to 1.73), and cardiac rhythm disorders (2.19, 1.76 to 2.57) had the greatest risk differences compared with the 2020 comparison group, with similar findings to the 2019 comparison group. Compared with the group with viral lower respiratory tract illness, however, only respiratory failure, dementia, and post-viral fatigue had increased risk differences of 2.39 (95% confidence interval 1.79 to 2.94), 0.71 (0.3 to 1.08), and 0.18 (0.11 to 0.26) per 100 patients, respectively. Individuals with severe covid-19 disease requiring admission to hospital had a markedly increased risk for most but not all clinical sequelae. CONCLUSIONS The results confirm an excess risk for persistent and new sequelae in adults aged ≥65 years after acute infection with SARS-CoV-2. Other than respiratory failure, dementia, and post-viral fatigue, the sequelae resembled those of viral lower respiratory tract illness in older adults. These findings further highlight the wide range of important sequelae after acute infection with the SARS-CoV-2 virus.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Marc Lipsitch
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | |
Collapse
|
26
|
Affiliation(s)
- Andrew M Luks
- From the Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (A.M.L.); and the Altitude Research Center, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (P.H.H.)
| | - Peter H Hackett
- From the Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle (A.M.L.); and the Altitude Research Center, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (P.H.H.)
| |
Collapse
|
27
|
Abstract
OBJECTIVES To examine the relationship between health literacy and multimorbidity. DESIGN Nationwide cross-sectional study. SETTING Community settings across Japan. PARTICIPANTS Community-dwelling participants aged 20 years or older were selected based on a quota sampling method that adjusted for age, sex and residential area. In total, 3678 participants from the Health Diary Study, with a mean age of 52.3 years (SD, 18.2 years; 1943 (52.8%) female participants), were included. PRIMARY OUTCOME MEASURE Multimorbidity, the primary outcome measure, was defined as the presence of two or more chronic diseases. RESULTS Of the 3678 participants, 824 (22.4%) had multimorbidity. The mean functional health literacy (FHL) and communicative and critical health literacy (CCHL) scores were 3.2 (SD, 0.7) and 3.6 (SD, 0.9), respectively. In the univariable analysis, both scores were associated with multimorbidity (p<0.001). However, in the multivariable modified Poisson regression analysis, only the FHL score was significantly associated with multimorbidity (per 1-point increase, 0.91; 95% CI 0.84 to 0.99). CONCLUSIONS After adjusting for confounding variables, FHL, not CCHL, was significantly related to the presence of multimorbidity. Further longitudinal studies are required to examine the causal relationship between health literacy and multimorbidity.
Collapse
Affiliation(s)
- Shiori Tomita
- Department of General Internal Medicine, St Luke's International University, Chuo-ku, Tokyo, Japan
- Division of Clinical Epidemiology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takuya Aoki
- Division of Clinical Epidemiology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- Department of Community Medicine, Kyoto University, Kyoto, Japan
| | - Sachiko Ohde
- Graduate School of Public Health, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Osamu Takahashi
- Graduate School of Public Health, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Takeshi Kimura
- Center for Preventive Medicine, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| |
Collapse
|
28
|
Mattei J, Tamez M, O’Neill J, Haneuse S, Mendoza S, Orozco J, Lopez-Cepero A, Ríos-Bedoya CF, Falcón LM, Tucker KL, Rodríguez-Orengo JF. Chronic Diseases and Associated Risk Factors Among Adults in Puerto Rico After Hurricane Maria. JAMA Netw Open 2022; 5:e2139986. [PMID: 35019984 PMCID: PMC8756309 DOI: 10.1001/jamanetworkopen.2021.39986] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE As public health emergencies become more prevalent, it is crucial to identify adverse physical and mental health conditions that may be triggered by natural disasters. There is a lack of data on whether Hurricane Maria in 2017 influenced the disease burden of adults in Puerto Rico. OBJECTIVE To estimate the prevalence of chronic diseases and their associated risk factors among adults living in Puerto Rico before and after Hurricane Maria in 2017. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from 2 previous cross-sectional studies, including the pre-Hurricane Maria Puerto Rico Assessment on Diet, Lifestyles and Disease (PRADLAD) study, conducted in 2015, and the post-Hurricane Maria Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT), conducted in 2019. Participants included adults aged 30 to 75 years residing in Puerto Rico. Data were analyzed from April to October 2020. EXPOSURES Self-reported data were obtained on sociodemographic, lifestyle, and psychosocial factors and medically diagnosed conditions using validated questionnaires. Anthropometrics were measured in triplicate. MAIN OUTCOMES AND MEASURES Data were obtained using similar protocols in both studies. Characteristics were contrasted for all participants across studies and for 87 PRADLAD participants who returned to PROSPECT. RESULTS A total of 825 participants from both cohorts were included, with 380 PRADLAD participants and 532 PROSPECT participants. In the 2019 PROSPECT study, the mean (SD) age was 53.7 (10.8) years, and 363 participants (68.2%) were assigned female at birth and 169 participants (31.8%) were assigned male at birth. In the 2019 cohort, 360 participants (67.7%) had college education or higher, 205 participants (38.5%) reported annual income greater than $20 001, and 263 participants (49.5%) were employed. Most sociodemographic variables were similar between studies, except for higher income and employment after the hurricane. In the main analysis, participants in 2019, compared with participants in 2015, had higher abdominal obesity (389 participants [73.2%] vs 233 participants [61.3%]), sedentarism (236 participants [44.4%] vs 136 participants [35.8%]), binge drinking (95 participants [17.9%] vs 46 participants [12.1%]), and social support (mean [SD] score, 26.9 [7.2] vs 24.7 [7.1]) but lower depressive symptoms (169 participants [31.7%] vs 200 participants [52.6%]) and perceived stress (mean [SD] score, 19.3 [9.5] vs 21.7 [7.7]). In 2019, compared with 2015, there were higher rates of hypertension (252 participants [47.3%] vs 149 participants [39.2%]), arthritis (172 participants [32.3%] vs 97 participants [25.6%]), high cholesterol (194 participants [36.4%] vs 90 participants [23.8%]), high triglycerides (123 participants [23.1%] vs 56 participants [14.7%]), eye disease (94 participants [17.6%] vs 48 participants [12.7%]), fatty liver disease (68 participants [12.8%] vs 29 participants [7.5%]), and osteoporosis (74 participants [13.9%] vs 20 participants [5.2%]). Secondary analysis for the 87 returning participants showed similar results. CONCLUSIONS AND RELEVANCE In this cross-sectional study, a higher prevalence of unhealthy behaviors and chronic conditions was noted among adults in Puerto Rico after Hurricane Maria, warranting long-term studies. Psychosocial factors were better, but still need attention. As natural disasters intensify, efforts should focus on continuous surveillance of health outcomes and promoting healthy behaviors, positive emotional health, and disease control, particularly in populations with higher risk for poor health.
Collapse
Affiliation(s)
- Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Martha Tamez
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - June O’Neill
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | - Andrea Lopez-Cepero
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Carlos F. Ríos-Bedoya
- FDI Clinical Research of Puerto Rico, San Juan
- McLaren Health Care, Graduate Medical Education, Grand Blanc, Michigan
| | - Luis M. Falcón
- College of Fine Arts, Humanities and Social Sciences, University of Massachusetts, Lowell
| | - Katherine L. Tucker
- Department of Biomedical and Nutritional Sciences and Center for Population Health, University of Massachusetts, Lowell
| | - José F. Rodríguez-Orengo
- FDI Clinical Research of Puerto Rico, San Juan
- Department of Biochemistry, University of Puerto Rico Medical Sciences Campus, San Juan
| |
Collapse
|
29
|
Lavergne MR, King C, Peterson S, Simon L, Hudon C, Loignon C, McCracken RK, Brackett A, McGrail K, Strumpf E. Patient characteristics associated with enrolment under voluntary programs implemented within fee-for-service systems in British Columbia and Quebec: a cross-sectional study. CMAJ Open 2022; 10:E64-E73. [PMID: 35105683 PMCID: PMC8812717 DOI: 10.9778/cmajo.20210043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a paucity of information on patient characteristics associated with enrolment under voluntary programs (e.g. incentive payments) implemented within fee-for-service systems. We explored patient characteristics associated with enrolment under these programs in British Columbia and Quebec. METHODS We used linked administrative data and a cross-sectional design to compare people aged 40 years or more enrolled under voluntary programs to those who were eligible but not enrolled. We examined 2 programs in Quebec (enrolment of vulnerable patients with qualifying conditions [implemented in 2003] and enrolment of the general population [2009]) and 3 in BC (Chronic disease incentive [2003], Complex care incentive [2007] and enrolment of the general population [A GP for Me, 2013]). We used logistic regression to estimate the odds of enrolment by neighbourhood income, rural versus urban residence, previous treatment for mental illness, previous treatment for substance use disorder and use of health care services before program implementation, controlling for characteristics linked to program eligibility. RESULTS In Quebec, we identified 1 569 010 people eligible for the vulnerable enrolment program (of whom 505 869 [32.2%] were enrolled within the first 2 yr of program implementation) and 2 394 923 for the general enrolment program (of whom 352 380 [14.7%] were enrolled within the first 2 yr). In BC, we identified 133 589 people eligible for the Chronic disease incentive, 47 619 for the Complex care incentive and 1 349 428 for A GP for Me; of these, 60 764 (45.5%), 28 273 (59.4%) and 1 066 714 (79.0%), respectively, were enrolled within the first 2 years. The odds of enrolment were higher in higher-income neighbourhoods for programs without enrolment criteria (adjusted odds ratio [OR] comparing highest to lowest quintiles 1.21 [95% confidence interval (CI) 1.20-1.23] in Quebec and 1.67 [95% CI 1.64-1.69] in BC) but were similar across neighbourhood income quintiles for programs with health-related eligibility criteria. The odds of enrolment by urban versus rural location varied by program. People treated for substance use disorders had lower odds of enrolment in all programs (adjusted OR 0.60-0.72). Compared to people eligible but not enrolled, those enrolled had similar or higher numbers of primary care visits and longitudinal continuity of care in the year before enrolment. INTERPRETATION People living in lower-income neighbourhoods and those treated for substance use disorders were less likely than people in higher-income neighbourhoods and those not treated for such disorders to be enrolled in programs without health-related eligibility criteria. Other strategies are needed to promote equitable access to primary care.
Collapse
Affiliation(s)
- M Ruth Lavergne
- Department of Family Medicine (Lavergne), Dalhousie University, Halifax, NS; Department of Epidemiology, Biostatistics and Occupational Health (King, Simon, Strumpf), McGill University, Montréal, Que.; Institut national d'excellence en santé et en services sociaux (King), Québec, Que.; Centre for Health Services and Policy Research (Peterson, McGrail), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Hudon) and Faculty of Medicine and Health Sciences (Loignon), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Practice (McCracken), University of British Columbia; Department of Family Medicine (McCracken), Providence Health Care; Patient Voices Network (Brackett), Vancouver, BC; Department of Economics (Strumpf), McGill University, Montréal, Que.
| | - Caroline King
- Department of Family Medicine (Lavergne), Dalhousie University, Halifax, NS; Department of Epidemiology, Biostatistics and Occupational Health (King, Simon, Strumpf), McGill University, Montréal, Que.; Institut national d'excellence en santé et en services sociaux (King), Québec, Que.; Centre for Health Services and Policy Research (Peterson, McGrail), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Hudon) and Faculty of Medicine and Health Sciences (Loignon), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Practice (McCracken), University of British Columbia; Department of Family Medicine (McCracken), Providence Health Care; Patient Voices Network (Brackett), Vancouver, BC; Department of Economics (Strumpf), McGill University, Montréal, Que
| | - Sandra Peterson
- Department of Family Medicine (Lavergne), Dalhousie University, Halifax, NS; Department of Epidemiology, Biostatistics and Occupational Health (King, Simon, Strumpf), McGill University, Montréal, Que.; Institut national d'excellence en santé et en services sociaux (King), Québec, Que.; Centre for Health Services and Policy Research (Peterson, McGrail), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Hudon) and Faculty of Medicine and Health Sciences (Loignon), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Practice (McCracken), University of British Columbia; Department of Family Medicine (McCracken), Providence Health Care; Patient Voices Network (Brackett), Vancouver, BC; Department of Economics (Strumpf), McGill University, Montréal, Que
| | - Leora Simon
- Department of Family Medicine (Lavergne), Dalhousie University, Halifax, NS; Department of Epidemiology, Biostatistics and Occupational Health (King, Simon, Strumpf), McGill University, Montréal, Que.; Institut national d'excellence en santé et en services sociaux (King), Québec, Que.; Centre for Health Services and Policy Research (Peterson, McGrail), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Hudon) and Faculty of Medicine and Health Sciences (Loignon), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Practice (McCracken), University of British Columbia; Department of Family Medicine (McCracken), Providence Health Care; Patient Voices Network (Brackett), Vancouver, BC; Department of Economics (Strumpf), McGill University, Montréal, Que
| | - Catherine Hudon
- Department of Family Medicine (Lavergne), Dalhousie University, Halifax, NS; Department of Epidemiology, Biostatistics and Occupational Health (King, Simon, Strumpf), McGill University, Montréal, Que.; Institut national d'excellence en santé et en services sociaux (King), Québec, Que.; Centre for Health Services and Policy Research (Peterson, McGrail), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Hudon) and Faculty of Medicine and Health Sciences (Loignon), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Practice (McCracken), University of British Columbia; Department of Family Medicine (McCracken), Providence Health Care; Patient Voices Network (Brackett), Vancouver, BC; Department of Economics (Strumpf), McGill University, Montréal, Que
| | - Christine Loignon
- Department of Family Medicine (Lavergne), Dalhousie University, Halifax, NS; Department of Epidemiology, Biostatistics and Occupational Health (King, Simon, Strumpf), McGill University, Montréal, Que.; Institut national d'excellence en santé et en services sociaux (King), Québec, Que.; Centre for Health Services and Policy Research (Peterson, McGrail), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Hudon) and Faculty of Medicine and Health Sciences (Loignon), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Practice (McCracken), University of British Columbia; Department of Family Medicine (McCracken), Providence Health Care; Patient Voices Network (Brackett), Vancouver, BC; Department of Economics (Strumpf), McGill University, Montréal, Que
| | - Rita K McCracken
- Department of Family Medicine (Lavergne), Dalhousie University, Halifax, NS; Department of Epidemiology, Biostatistics and Occupational Health (King, Simon, Strumpf), McGill University, Montréal, Que.; Institut national d'excellence en santé et en services sociaux (King), Québec, Que.; Centre for Health Services and Policy Research (Peterson, McGrail), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Hudon) and Faculty of Medicine and Health Sciences (Loignon), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Practice (McCracken), University of British Columbia; Department of Family Medicine (McCracken), Providence Health Care; Patient Voices Network (Brackett), Vancouver, BC; Department of Economics (Strumpf), McGill University, Montréal, Que
| | - Austyn Brackett
- Department of Family Medicine (Lavergne), Dalhousie University, Halifax, NS; Department of Epidemiology, Biostatistics and Occupational Health (King, Simon, Strumpf), McGill University, Montréal, Que.; Institut national d'excellence en santé et en services sociaux (King), Québec, Que.; Centre for Health Services and Policy Research (Peterson, McGrail), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Hudon) and Faculty of Medicine and Health Sciences (Loignon), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Practice (McCracken), University of British Columbia; Department of Family Medicine (McCracken), Providence Health Care; Patient Voices Network (Brackett), Vancouver, BC; Department of Economics (Strumpf), McGill University, Montréal, Que
| | - Kim McGrail
- Department of Family Medicine (Lavergne), Dalhousie University, Halifax, NS; Department of Epidemiology, Biostatistics and Occupational Health (King, Simon, Strumpf), McGill University, Montréal, Que.; Institut national d'excellence en santé et en services sociaux (King), Québec, Que.; Centre for Health Services and Policy Research (Peterson, McGrail), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Hudon) and Faculty of Medicine and Health Sciences (Loignon), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Practice (McCracken), University of British Columbia; Department of Family Medicine (McCracken), Providence Health Care; Patient Voices Network (Brackett), Vancouver, BC; Department of Economics (Strumpf), McGill University, Montréal, Que
| | - Erin Strumpf
- Department of Family Medicine (Lavergne), Dalhousie University, Halifax, NS; Department of Epidemiology, Biostatistics and Occupational Health (King, Simon, Strumpf), McGill University, Montréal, Que.; Institut national d'excellence en santé et en services sociaux (King), Québec, Que.; Centre for Health Services and Policy Research (Peterson, McGrail), University of British Columbia, Vancouver, BC; Department of Family Medicine and Emergency Medicine (Hudon) and Faculty of Medicine and Health Sciences (Loignon), Université de Sherbrooke, Sherbrooke, Que.; Department of Family Practice (McCracken), University of British Columbia; Department of Family Medicine (McCracken), Providence Health Care; Patient Voices Network (Brackett), Vancouver, BC; Department of Economics (Strumpf), McGill University, Montréal, Que
| |
Collapse
|
30
|
Chamberlain AM, St Sauver JL, Finney Rutten LJ, Fan C, Jacobson DJ, Wilson PM, Boyd CM, Rocca WA. Associations of Neighborhood Socioeconomic Disadvantage With Chronic Conditions by Age, Sex, Race, and Ethnicity in a Population-Based Cohort. Mayo Clin Proc 2022; 97:57-67. [PMID: 34996566 PMCID: PMC8775356 DOI: 10.1016/j.mayocp.2021.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 12/30/2020] [Accepted: 09/07/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine the association of socioeconomic status at the census block group level with chronic conditions and to determine whether the associations differ by age, sex, race, or ethnicity. METHODS Adults aged 20 years and older on April 1, 2015, from 7 counties in southern Minnesota were identified using the Rochester Epidemiology Project records-linkage system. We estimated the prevalence of 19 chronic conditions (7 cardiometabolic, 7 other somatic, and 5 mental health conditions) at the individual level and a composite measure of neighborhood socioeconomic disadvantage (the area deprivation index [ADI]) at the census block group level (n=249). RESULTS Among the 197,578 persons in our study, 46.7% (92,373) were male, 49.5% (97,801) were aged 50 years and older, 12.3% (24,316) were of non-White race, and 5.3% (10,546) were Hispanic. The risk of most chronic conditions increased with increasing ADI. For each cardiometabolic condition and most other somatic and mental health conditions, the pattern of increasing risk across ADI quintiles was attenuated, or there was no association across quintiles of ADI in the oldest age group (aged ≥70 years). Stronger associations between ADI and several cardiometabolic, other somatic, and mental health conditions were observed in women. CONCLUSION Higher ADI was associated with increased risk of most chronic conditions, with more pronounced associations in younger persons. For some chronic conditions, the associations were stronger in women. Our findings underscore the importance of recognizing the overall and potentially differential impact of area-level deprivation on chronic disease outcomes for diverse populations.
Collapse
Affiliation(s)
- Alanna M Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
| | - Jennifer L St Sauver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Lila J Finney Rutten
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Chun Fan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Debra J Jacobson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Patrick M Wilson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD
| | - Walter A Rocca
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN; Women's Health Research Center, Mayo Clinic, Rochester, MN
| |
Collapse
|
31
|
DeClercq V, Nearing JT, Langille MGI. Investigation of the impact of commonly used medications on the oral microbiome of individuals living without major chronic conditions. PLoS One 2021; 16:e0261032. [PMID: 34882708 PMCID: PMC8659300 DOI: 10.1371/journal.pone.0261032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Commonly used medications produce changes in the gut microbiota, however, the impact of these medications on the composition of the oral microbiota is understudied. METHODS Saliva samples were obtained from 846 females and 368 males aged 35-69 years from a Canadian population cohort, the Atlantic Partnership for Tomorrow's Health (PATH). Samples were analyzed by 16S rRNA gene sequencing and differences in microbial community compositions between nonusers, single-, and multi-drug users as well as the 3 most commonly used medications (thyroid hormones, statins, and proton pump inhibitors (PPI)) were examined. RESULTS Twenty-six percent of participants were taking 1 medication and 21% were reported taking 2 or more medications. Alpha diversity indices of Shannon diversity, Evenness, Richness, and Faith's phylogenetic diversity were similar among groups, likewise beta diversity as measured by Bray-Curtis dissimilarity (R2 = 0.0029, P = 0.053) and weighted UniFrac distances (R2 = 0.0028, P = 0.161) were non-significant although close to our alpha value threshold (P = 0.05). After controlling for covariates (sex, age, BMI), six genera (Saprospiraceae uncultured, Bacillus, Johnsonella, Actinobacillus, Stenotrophomonas, and Mycoplasma) were significantly different from non-medication users. Thyroid hormones, HMG-CoA reductase inhibitors (statins) and PPI were the most reported medications. Shannon diversity differed significantly among those taking no medication and those taking only thyroid hormones, however, there were no significant difference in other measures of alpha- or beta diversity with single thyroid hormone, statin, or PPI use. Compared to participants taking no medications, the relative abundance of eight genera differed significantly in participants taking thyroid hormones, six genera differed in participants taking statins, and no significant differences were observed with participants taking PPI. CONCLUSION The results from this study show negligible effect of commonly used medications on microbial diversity and small differences in the relative abundance of specific taxa, suggesting a minimal influence of commonly used medication on the salivary microbiome of individuals living without major chronic conditions.
Collapse
Affiliation(s)
- Vanessa DeClercq
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- * E-mail:
| | - Jacob T. Nearing
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Morgan G. I. Langille
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
32
|
Levine CG, Casiano RR, Lee DJ, Mantero A, Liu XZ, Palacio AM. Chronic Rhinosinusitis Disease Disparity in the South Florida Hispanic Population. Laryngoscope 2021; 131:2659-2665. [PMID: 34254684 DOI: 10.1002/lary.29664] [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] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/28/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS The role of social determinants of health in chronic rhinosinusitis (CRS) is poorly characterized. Limited research examining CRS health disparities indicates that minority status is associated with worse CRS. However, many of these studies are retrospective or performed in populations without substantial ethnic minorities. Rhinologists need to characterize existing CRS disease disparities to develop targeted strategies for improving care in these populations. This prospective study assesses preoperative CRS disease burden in South Florida (SFL) Hispanic and non-Hispanic patients and examines potential factors contributing CRS disease disparities. STUDY DESIGN Prospective cohort study. METHODS The prospective cohort study included consecutive patients having primary endoscopic sinus surgery (ESS) for CRS between September 2019 and February 2020 with complete preoperative data. Data were collected in clinic and surgery. Descriptive statistics compare Hispanic and non-Hispanic cohorts. Linear regression adjusts for confounders. Relative risk (RR) compared CRS severity markers. RESULTS Thirty-eight Hispanic and 56 non-Hispanic patients met inclusion criteria. Age, sex, CT scores, insurance payer, and comorbidities were similar between cohorts. Hispanics presented with worse 22-item Sinonasal Outcome Test (SNOT-22) (55; SD = 18) compared to non-Hispanics (37; SD = 22) (P < .001). Hispanics tended to have a higher risk of severe CRS markers, including nasal polyps RR = 2.5 (95% CI: 1.0-5.9), neo-osteogenesis RR = 1.6 (95% CI: 0.5-4.7), extended procedures (i.e., draft III) RR = 2.97 (95% CI: 1.0-9.1), and tissue eosinophilia RR = 1.46 (95% CI: 0.6-3.5). Hispanics reported longer sinonasal symptom duration. CONCLUSIONS SFL hispanic patients presenting for primary ESS have worse sinonasal disease burden. SFL Hispanics have markers of greater CRS severity and report longer delays before receiving CRS care. These factors may contribute to increased sinonasal disease burden in Hispanic patients. LEVEL OF EVIDENCE 3 Laryngoscope, 131:2659-2665, 2021.
Collapse
Affiliation(s)
- Corinna G Levine
- Department of Otolaryngology- Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Roy R Casiano
- Department of Otolaryngology- Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - David J Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Alejandro Mantero
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Xue Zhong Liu
- Department of Otolaryngology- Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Ana M Palacio
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| |
Collapse
|
33
|
Ocier K, Abdelaziz S, Kim S, Rowe K, Snyder J, Deshmukh VG, Newman M, Fraser A, Smith KR, Porucznik CA, Shoaf K, Stanford JB, Lee CJ, Hashibe M. Age-Related Disease Risks in Younger versus Older B-Cell Non-Hodgkin's Lymphoma Survivors. Cancer Epidemiol Biomarkers Prev 2021; 30:2268-2277. [PMID: 34732401 PMCID: PMC9894530 DOI: 10.1158/1055-9965.epi-21-0190] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/05/2021] [Accepted: 09/03/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Younger cancer survivors may develop age-related diseases due to the cancer treatment that they undergo. The aim of this population-based study is to estimate incidence of age-related diseases besides cardiovascular disease among younger versus older B-cell non-Hodgkin's lymphoma (B-NHL) survivors compared with their respective general population cohorts. METHODS Survivors of B-NHL were diagnosed between 1997 and 2015 from the Utah Cancer Registry. Using the Utah Population Database, up to 5 cancer-free individuals from the general population were matched with a B-NHL survivor on sex, birth year, and state of birth. Hazard ratios (HR) for age-related disease outcomes, which were identified from medical records and statewide health care facility data, were estimated using Cox Proportional Hazards models for B-NHL survivors diagnosed at <65 years versus ≥65 years at least 5 years since B-NHL diagnosis. RESULTS Comparing 2,129 B-NHL survivors with 8,969 individuals from the general population, younger B-NHL survivors had higher relative risks of acute renal failure [HR, 2.24; 99% confidence interval (CI), 1.48-3.39; P heterogeneity = 0.017), pneumonia (HR, 2.42; 99% CI, 1.68-3.49; P heterogeneity = 0.055), and nutritional deficiencies (HR, 2.08; 99% CI, 1.48-2.92; P heterogeneity = 0.051) ≥5 years after cancer diagnosis. CONCLUSION Younger B-NHL survivors had higher relative risks of acute renal failure, pneumonia, and nutritional deficiencies than older B-NHL survivors compared with their respective general population cohorts, ≥5 years after cancer diagnosis.
Collapse
Affiliation(s)
- Krista Ocier
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Seungmin Kim
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, Utah
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, Utah
| | | | - Michael Newman
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Alison Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Ken R Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Christina A Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Kimberley Shoaf
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Joseph B Stanford
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Catherine J Lee
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
- Huntsman Cancer Institute, Salt Lake City, Utah
- Utah Cancer Registry, University of Utah, Salt Lake City, Utah
| |
Collapse
|
34
|
Zhang YL, Wu BJ, Chen P, Guo Y. The self-rated health status and key influencing factors in middle-aged and elderly: Evidence from the CHARLS. Medicine (Baltimore) 2021; 100:e27772. [PMID: 34797304 PMCID: PMC8601322 DOI: 10.1097/md.0000000000027772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/28/2021] [Indexed: 01/05/2023] Open
Abstract
To evaluate the self-rate health (SRH) status and explore influence factors of middle-aged and elderly in China.China Health and Retirement Longitudinal Survey was conducted in 2011, 2013, 2015 and 2018. Data of the China Health and Retirement Longitudinal Survey in 2018 was used in our study and a total of 17898 participants were included. SRH status was graded as "very good, good, average, bad, very bad." Participants who answered "very good" and "good" were regarded as self-rated good health and who answered "average," "bad" and "very bad" were regarded as self-rated poor health. Odds ratio and 95% confidence interval of Logistics regression were calculated to evaluate the correlation between SRH and chronic diseases, demographic characteristics and lifestyle of middle-aged and elderly participants.A total of 4476 (25.01%) participants reported they had good health, and 13422 (74.99%) reported they had poor health. 9975 participants self-rated they had no chronic disease (55.73%), and 7923 (44.27%) participants self-rated they suffered from one and above chronic diseases. The prevalence of chronic diseases showed significant odds ratio and trend with SRH poor rate of participants. The more kinds of chronic diseases they suffered from, the poorer SRH was reported in middle-aged and elderly participants. Except for the chronic diseases, participants with higher age, living in rural, with high Center for Epidemiological Survey-Depression Scale score of depression and fewer time of physical activities also correlated with higher SRH (poor) rate.The SRH (good) rate was very low in middle-aged and elderly, participants who accompanied with more kinds of chronic diseases, fewer physical activities, higher age and living in the rural had a worse health status. A more comprehensive and integrated health framework should be strengthened to improve the health of middle-aged and elderly in China.
Collapse
Affiliation(s)
- Yu-Ling Zhang
- Department of Public Health, Jiangsu College of Nursing, Huai’an, Jiangsu Province, China
| | - Bin-Jiang Wu
- Department of Public Health, Jiangsu College of Nursing, Huai’an, Jiangsu Province, China
| | - Pei Chen
- Department of Basic Medicine, Jiangsu College of Nursing, Huai’an, Jiangsu Province, China
| | - Ying Guo
- Department of Medical Laboratory, Huai’an Maternal and Child Health Hospital, Jiangsu Province, China
| |
Collapse
|
35
|
Keramat SA, Alam K, Rana RH, Chowdhury R, Farjana F, Hashmi R, Gow J, Biddle SJH. Obesity and the risk of developing chronic diseases in middle-aged and older adults: Findings from an Australian longitudinal population survey, 2009-2017. PLoS One 2021; 16:e0260158. [PMID: 34784404 PMCID: PMC8594821 DOI: 10.1371/journal.pone.0260158] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Overweight and obesity impose a significant health burden in Australia, predominantly the middle-aged and older adults. Studies of the association between obesity and chronic diseases are primarily based on cross-sectional data, which is insufficient to deduce a temporal relationship. Using nationally representative panel data, this study aims to investigate whether obesity is a significant risk factor for type 2 diabetes, heart diseases, asthma, arthritis, and depression in Australian middle-aged and older adults. Methods Longitudinal data comprising three waves (waves 9, 13 and 17) of the Household, Income and Labour Dynamics in Australia (HILDA) survey were used in this study. This study fitted longitudinal random-effect logistic regression models to estimate the between-person differences in the association between obesity and chronic diseases. Results The findings indicated that obesity was associated with a higher prevalence of chronic diseases among Australian middle-aged and older adults. Obese adults (Body Mass Index [BMI] ≥ 30) were at 12.76, 2.05, 1.97, 2.25, and 1.96, times of higher risks of having type 2 diabetes (OR: 12.76, CI 95%: 8.88–18.36), heart disease (OR: 2.05, CI 95%: 1.54–2.74), asthma (OR: 1.97, CI 95%: 1.49–2.62), arthritis (OR: 2.25, 95% CI: 1.90–2.68) and depression (OR: 1.96, CI 95%: 1.56–2.48), respectively, compared with healthy weight counterparts. However, the study did not find any evidence of a statistically significant association between obesity and cancer. Besides, gender stratified regression results showed that obesity is associated with a higher likelihood of asthma (OR: 2.64, 95% CI: 1.84–3.80) among female adults, but not in the case of male adults. Conclusion Excessive weight is strongly associated with a higher incidence of chronic disease in Australian middle-aged and older adults. This finding has clear public health implications. Health promotion programs and strategies would be helpful to meet the challenge of excessive weight gain and thus contribute to the prevention of chronic diseases.
Collapse
Affiliation(s)
- Syed Afroz Keramat
- Economics Discipline, Social Science School, Khulna University, Khulna, Bangladesh
- School of Business, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
- * E-mail:
| | - Khorshed Alam
- School of Business, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Rezwanul Hasan Rana
- School of Business, University of Southern Queensland, Toowoomba, QLD, Australia
- The Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
| | - Rupok Chowdhury
- Economics Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Fariha Farjana
- Economics Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Rubayyat Hashmi
- School of Business, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Jeff Gow
- School of Business, University of Southern Queensland, Toowoomba, QLD, Australia
- School of Accounting, Economics, and Finance, University of KwaZulu-Natal, Durban, South Africa
| | - Stuart J. H. Biddle
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| |
Collapse
|
36
|
Papazoglou DD, Baretella O, Feller M, Del Giovane C, Moutzouri E, Aujesky D, Schwenkglenks M, O’Mahony D, Knol W, Dalleur O, Rodondi N, Baumgartner C. Cross-sectional study on the prevalence of influenza and pneumococcal vaccination and its association with health conditions and risk factors among hospitalized multimorbid older patients. PLoS One 2021; 16:e0260112. [PMID: 34784405 PMCID: PMC8594840 DOI: 10.1371/journal.pone.0260112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Older adults with chronic conditions are at high risk of complications from influenza and pneumococcal infections. Evidence about factors associated with influenza and pneumococcal vaccination among older multimorbid persons in Europe is limited. The aim of this study was to investigate the prevalence and determinants of these vaccinations in this population. METHODS Multimorbid patients aged ≥70 years with polypharmacy were enrolled in 4 European centers in Switzerland, Belgium, the Netherlands, and Ireland. Data on vaccinations, demographics, health care contacts, and comorbidities were obtained from self-report, general practitioners and medical records. The association of comorbidities or medical contacts with vaccination status was assessed using multivariable adjusted log-binomial regression models. RESULTS Among 1956 participants with available influenza vaccination data (median age 79 years, 45% women), 1314 (67%) received an influenza vaccination within the last year. Of 1400 patients with available pneumococcal vaccination data (median age 79 years, 46% women), prevalence of pneumococcal vaccination was 21% (n = 291). The prevalence of vaccination remained low in high-risk populations with chronic respiratory disease (34%) or diabetes (24%), but increased with an increasing number of outpatient medical contacts. Chronic respiratory disease was independently associated with the receipt of both influenza and pneumococcal vaccinations (prevalence ratio [PR] 1.09, 95% confidence interval [CI] 1.03-1.16; and PR 2.03, 95%CI 1.22-3.40, respectively), as was diabetes (PR 1.06, 95%CI 1.03-1.08; PR 1.24, 95%CI 1.16-1.34, respectively). An independent association was found between number of general practitioner visits and higher prevalence of pneumococcal vaccination (p for linear trend <0.001). CONCLUSION Uptake of influenza and particularly of pneumococcal vaccination in this population of European multimorbid older inpatients remains insufficient and is determined by comorbidities and number and type of health care contacts, especially outpatient medical visits. Hospitalization may be an opportunity to promote vaccination, particularly targeting patients with few outpatient physician contacts.
Collapse
Affiliation(s)
- Dimitrios David Papazoglou
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Oliver Baretella
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Denis O’Mahony
- Department of Medicine Cork, University College Cork National University of Ireland, Munster, IE, Ireland
- Department of Geriatric Medicine Cork, Cork University Hospital Group, Munster, IE, Ireland
| | - Wilma Knol
- Department of Geriatrics and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Olivia Dalleur
- Louvain Drug Research Institute, and Pharmacy Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| |
Collapse
|
37
|
Brettel JH, Manuwald U, Hornstein H, Kugler J, Rothe U. Chronic-Care-Management Programs for Multimorbid Patients with Diabetes in Europe: A Scoping Review with the Aim to Identify the Best Practice. J Diabetes Res 2021; 2021:6657718. [PMID: 34796236 PMCID: PMC8595013 DOI: 10.1155/2021/6657718] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 10/20/2021] [Indexed: 11/29/2022] Open
Abstract
AIM This scoping review is aimed at providing a current descriptive overview of care programs based on the chronic care model (CCM) according to E. H. Wagner. The evaluation is carried out within Europe and assesses the methodology and comparability of the studies. METHODS A systematic search in the databases PubMed, Embase, and MEDLINE via OVID was conducted. In the beginning, 2309 articles were found and 48 full texts were examined, 19 of which were incorporated. Included were CCM-based programs from Belgium, Cyprus, Germany, Italy, Switzerland, and the Netherlands. All 19 articles were presented descriptively whereof 11 articles were finally evaluated in a checklist by Rothe et al. (2020). In this paper, the studies were tabulated and evaluated conforming to the same criteria. RESULTS Due to the complexity of the CCM and the heterogeneity of the studies in terms of setting and implementation, a direct comparison proved difficult. Nevertheless, the review shows that CCM was successfully implemented in various care situations and also can be useful in single practices, which often dominate the primary care sector in many European health systems. The present review was able to provide a comprehensive overview of the current care situation of chronically ill patients with multimorbidities. CONCLUSIONS A unified nomenclature concerning the distinction between disease management programs and CCM-based programs should be aimed for. Similarly, homogeneous quality standards and a Europe-wide evaluation strategy would be necessary to identify best practice models and to provide better care for the steadily growing number of chronically multimorbid patients.
Collapse
Affiliation(s)
- Julia Heike Brettel
- Technische Universität Dresden, Faculty of Medicine “Carl Gustav Carus”, IPAS/Health Sciences/Public Health, Fetscherstraße 74, 01307 Dresden, Germany
| | - Ulf Manuwald
- Technische Universität Dresden, Faculty of Medicine “Carl Gustav Carus”, IPAS/Health Sciences/Public Health, Fetscherstraße 74, 01307 Dresden, Germany
| | - Henriette Hornstein
- Technische Universität Dresden, Faculty of Medicine “Carl Gustav Carus”, IPAS/Health Sciences/Public Health, Fetscherstraße 74, 01307 Dresden, Germany
| | - Joachim Kugler
- Technische Universität Dresden, Faculty of Medicine “Carl Gustav Carus”, IPAS/Health Sciences/Public Health, Fetscherstraße 74, 01307 Dresden, Germany
| | - Ulrike Rothe
- Technische Universität Dresden, Faculty of Medicine “Carl Gustav Carus”, IPAS/Health Sciences/Public Health, Fetscherstraße 74, 01307 Dresden, Germany
| |
Collapse
|
38
|
Foley H, Steel A, McIntyre E, Harnett J, Sibbritt D, Adams J. Disclosure of conventional and complementary medicine use to medical doctors and complementary medicine practitioners: A survey of rates and reasons amongst those with chronic conditions. PLoS One 2021; 16:e0258901. [PMID: 34735474 PMCID: PMC8568289 DOI: 10.1371/journal.pone.0258901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/08/2021] [Indexed: 11/18/2022] Open
Abstract
Chronic conditions are prolonged and complex, leading patients to seek multiple forms of care alongside conventional treatment, including complementary medicine (CM). These multiple forms of care are often used concomitantly, requiring patient-provider communication about treatments used in order to manage potential risks. In response, this study describes rates and reasons for disclosure/non-disclosure of conventional medicine use to CM practitioners, and CM use to medical doctors, by individuals with chronic conditions. A survey was conducted online in July and August 2017 amongst the Australian adult population. Participants with chronic conditions were asked about their disclosure-related communication with CM practitioners (massage therapist, chiropractor, acupuncturist, naturopath) and medical doctors. Patients consulting different professions reported varying disclosure rates and reasons. Full disclosure (disclosed ALL) to medical doctors was higher (62.7%-79.5%) than full disclosure to CM practitioners (41.2%-56.9%). The most strongly reported reason for disclosing to both MDs and CM practitioners was I wanted them to fully understand my health status, while for non-disclosure it was They did not ask me about my CM/medicine use. Reasons regarding concerns or expectations around the consultation or patient-provider relationship were also influential. The findings suggest that patient disclosure of treatment use in clinical consultation for chronic conditions may be improved through patient education about its importance, direct provider inquiry, and supportive patient-provider partnerships. Provision of optimal patient care for those with chronic conditions requires greater attention to patient-provider communication surrounding patients’ wider care and treatment use.
Collapse
Affiliation(s)
- Hope Foley
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- * E-mail:
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Erica McIntyre
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Joanna Harnett
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| |
Collapse
|
39
|
St Sauver JL, Lopes GS, Rocca WA, Prasad K, Majerus MR, Limper AH, Jacobson DJ, Fan C, Jacobson RM, Rutten LJ, Norman AD, Vachon CM. Factors Associated With Severe COVID-19 Infection Among Persons of Different Ages Living in a Defined Midwestern US Population. Mayo Clin Proc 2021; 96:2528-2539. [PMID: 34538426 PMCID: PMC8255113 DOI: 10.1016/j.mayocp.2021.06.023] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To identify risk factors associated with severe COVID-19 infection in a defined Midwestern US population overall and within different age groups. PATIENTS AND METHODS We used the Rochester Epidemiology Project research infrastructure to identify persons residing in a defined 27-county Midwestern region who had positive results on polymerase chain reaction tests for COVID-19 between March 1, 2020, and September 30, 2020 (N=9928). Age, sex, race, ethnicity, body mass index, smoking status, and 44 chronic disease categories were considered as possible risk factors for severe infection. Severe infection was defined as hospitalization or death caused by COVID-19. Associations between risk factors and severe infection were estimated using Cox proportional hazard models overall and within 3 age groups (0 to 44, 45 to 64, and 65+ years). RESULTS Overall, 474 (4.8%) persons developed severe COVID-19 infection. Older age, male sex, non-White race, Hispanic ethnicity, obesity, and a higher number of chronic conditions were associated with increased risk of severe infection. After adjustment, 36 chronic disease categories were significantly associated with severe infection. The risk of severe infection varied significantly across age groups. In particular, persons 0 to 44 years of age with cancer, chronic neurologic disorders, hematologic disorders, ischemic heart disease, and other endocrine disorders had a greater than 3-fold increased risk of severe infection compared with persons of the same age without those conditions. Associations were attenuated in older age groups. CONCLUSION Older persons are more likely to experience severe infections; however, severe cases occur in younger persons as well. Our data provide insight regarding younger persons at especially high risk of severe COVID-19 infection.
Collapse
Affiliation(s)
- Jennifer L St Sauver
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
| | - Guilherme S Lopes
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Walter A Rocca
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN
| | | | | | - Andrew H Limper
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Debra J Jacobson
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Chun Fan
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Lila J Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Aaron D Norman
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Celine M Vachon
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| |
Collapse
|
40
|
Lin L, Wang HH, Lu C, Chen W, Guo VY. Adverse Childhood Experiences and Subsequent Chronic Diseases Among Middle-aged or Older Adults in China and Associations With Demographic and Socioeconomic Characteristics. JAMA Netw Open 2021; 4:e2130143. [PMID: 34694390 PMCID: PMC8546496 DOI: 10.1001/jamanetworkopen.2021.30143] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Associations between adverse childhood experiences (ACEs) and chronic diseases among middle-aged or older Chinese individuals have not been well documented. In addition, whether demographic and socioeconomic characteristics modify any such associations has been underexplored. OBJECTIVES To examine associations between ACEs and subsequent chronic diseases and to assess whether age, sex, educational level, annual per capita household expenditure level, and childhood economic hardship modify these associations. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study used data from the China Health and Retirement Longitudinal Study (CHARLS), a survey of residents aged 45 years or older in 28 provinces across China; specifically, the study used data from the CHARLS life history survey conducted from June 1 to December 31, 2014, and a CHARLS follow-up health survey conducted from July 1 to September 30, 2015. The study population included 11 972 respondents aged 45 years or older who had data on at least 1 of 14 specified chronic diseases and information on all 12 of the ACE indicators included in this study. Data analysis was performed from December 1 to 30, 2020. EXPOSURES Any of 12 ACEs (physical abuse, emotional neglect, household substance abuse, household mental illness, domestic violence, incarcerated household member, parental separation or divorce, unsafe neighborhood, bullying, parental death, sibling death, and parental disability), measured by indicators on a questionnaire. The number of ACEs per participant was summed and categorized into 1 of 5 cumulative-score groups: 0, 1, 2, 3, and 4 or more. MAIN OUTCOMES AND MEASURES Hypertension, dyslipidemia, diabetes, heart disease, stroke, chronic lung disease, asthma, liver disease, cancer, digestive disease, kidney disease, arthritis, psychiatric disease, and memory-related disease were defined by self-reported physician diagnoses or in combination with health assessment and medication data. Multimorbidity was defined as the presence of 2 or more of these 14 chronic diseases. Logistic regression models were used to assess associations of the 12 ACEs with the 14 chronic diseases and with multimorbidity. Modification of the associations by demographic and socioeconomic characteristics was assessed by stratified analyses and tests for interaction. RESULTS Of the 11 972 individuals included (mean [SD] age, 59.85 [9.56] years; 6181 [51.6%] were females), 80.9% had been exposed to at least 1 ACE and 18.0% reported exposure to 4 or more ACEs. Compared with those without ACE exposure, participants who experienced 4 or more ACEs had increased risks of dyslipidemia, chronic lung disease, asthma, liver disease, digestive disease, kidney disease, arthritis, psychiatric disease, memory-related disease, and multimorbidity. The estimated odds ratios (ORs) ranged from 1.27 (95% CI, 1.02-1.59) for dyslipidemia to 2.59 (95% CI, 2.16-3.11) for digestive disease. A dose-response association was also observed between the number of ACEs and the risk of most of the chronic diseases (excluding hypertension, diabetes, and cancer) (eg, chronic lung disease for ≥4 ACEs vs none: OR, 2.01; 95% CI, 1.59-2.55; P < .001 for trend) and of multimorbidity (for individuals among the overall study population with ≥4 ACEs vs none: OR, 2.03; 95% CI, 1.70-2.41; P < .001 for trend). The demographic or socioeconomic characteristics of age, sex, educational level, annual per capita household expenditure level, or childhood economic hardship were not shown to significantly modify the associations between ACEs and multimorbidity. CONCLUSIONS AND RELEVANCE In this population-based, cross-sectional study of adults in China, exposure to ACEs was associated with higher risks of chronic diseases regardless of demographic and socioeconomic characteristics during childhood or adulthood. These findings suggest a need to prevent ACEs and a need for a universal life-course public health strategy to reduce potential adverse health outcomes later in life among individuals who experience them.
Collapse
Affiliation(s)
- Li Lin
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | | | - Ciyong Lu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Weiqing Chen
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Vivian Yawei Guo
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
41
|
Lago-Hernandez C, Nguyen NH, Khera R, Loomba R, Asrani SK, Singh S. Cost-Related Nonadherence to Medications Among US Adults With Chronic Liver Diseases. Mayo Clin Proc 2021; 96:2639-2650. [PMID: 34120754 PMCID: PMC8492496 DOI: 10.1016/j.mayocp.2021.02.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/17/2020] [Revised: 02/16/2021] [Accepted: 02/24/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate the prevalence, risk factors, and consequences of cost-related medication nonadherence (CRN) in individuals with chronic liver diseases (CLDs) in the United States. PATIENTS AND METHODS Using the National Health Interview Survey from January 1, 2014, to December 31, 2018, we identified individuals with CLDs. Using complex weighted survey analysis, we obtained national estimates and risk factors for CRN and its association with cost-reducing behaviors and measures of financial toxicity. We evaluated the association of CRN with unplanned health care use, adjusting for age, sex, race/ethnicity, insurance, income, education, and comorbid conditions. RESULTS Of 3237 respondents (representing 4.6 million) US adults with CLDs, 813 (representing 1.2 million adults, or 25%; 95% CI, 23% to 27%) reported CRN, of whom 68% (n=554/813) reported maladaptive cost-reducing behaviors. Younger age, female sex, low income, and multimorbidity were associated with a higher prevalence of CRN. Compared with patients without CRN, patients experiencing CRN had 5.1 times higher odds of financial hardship from medical bills (adjusted odds ratio [aOR], 5.05; 95% CI, 3.73 to 6.83) and 2.9 times higher odds of food insecurity (aOR, 2.85; 95% CI, 2.02 to 4.01). The CRN was also associated with 1.5 times higher odds of emergency department visits (aOR, 1.46; 95% CI, 1.11 to 1.94). CONCLUSION We observed a high prevalence of CRN and associated consequences such as high financial distress, financial hardship from medical bills, food insecurity, engagement in maladaptive cost-reducing strategies, increased health care use, and work absenteeism among patients with CLD. These financial determinants of health have important implications in the context of value-based care.
Collapse
Affiliation(s)
- Carlos Lago-Hernandez
- Division of Hospital Medicine, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Nghia H Nguyen
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
| | - Rohit Loomba
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA; NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, CA
| | | | - Siddharth Singh
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA.
| |
Collapse
|
42
|
Niksic M, Redondo-Sanchez D, Chang YL, Rodriguez-Barranco M, Exposito-Hernandez J, Marcos-Gragera R, Oliva-Poch E, Bosch-Barrera J, Sanchez MJ, Luque-Fernandez MA. The role of multimorbidity in short-term mortality of lung cancer patients in Spain: a population-based cohort study. BMC Cancer 2021; 21:1048. [PMID: 34556072 PMCID: PMC8461961 DOI: 10.1186/s12885-021-08801-9] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/09/2021] [Indexed: 01/25/2023] Open
Abstract
AIM Chronic diseases often occur simultaneously and tend to be associated with adverse health outcomes, but limited research has been undertaken to understand their role in lung cancer mortality. Therefore, this study aims to describe the prevalence and patterns of having one (comorbidity) or ≥ 2 chronic diseases (multimorbidity) among lung cancer patients in Spain, and to examine the association between comorbidity or multimorbidity and short-term mortality risk at six months after cancer diagnosis. METHODS In this population-based cohort study, data were drawn from two Spanish population-based cancer registries, Girona and Granada, and electronic health records. We identified 1259 adult lung cancer patients, diagnosed from 1st January 2011 to 31st December 2012. We identified the most common patterns of individual comorbidities and their pairwise correlations. We used a flexible parametric modelling approach to assess the overall short-term mortality risk 6 months after cancer diagnosis by levels of comorbidity after adjusting for age, sex, smoking status, province of residence, surgery, cancer stage, histology, and body mass index. RESULTS We found high prevalence of comorbidity in lung cancer patients, especially among the elderly, men, those diagnosed with advanced-stage tumours, smokers, and obese patients. The most frequent comorbidities were chronic obstructive pulmonary disease (36.6%), diabetes (20.7%) and heart failure (16.8%). The strongest pairwise correlation was the combination of heart failure with renal disease (r = 0.20, p < 0.01), and heart failure with diabetes (r = 0.16, p < 0.01). Patients with either one or two or more comorbidities had 40% higher overall mortality risk than those without comorbidities (aHR for comorbidity: 1.4, 95%CI: 1.1-1.7; aHR for multimorbidity: 1.4, 95%CI: 1.1-1.8), when relevant confounding factors were considered. CONCLUSIONS The presence of comorbid diseases, rather than the number of comorbidities, was associated with increasing the risk of short-term lung cancer mortality in Spain. Comorbidity was a consistent and independent predictor of mortality among lung cancer patients, six months after diagnosis. The most common comorbid conditions were age-, obesity- and tobacco-related diseases. Our findings highlight the need to develop targeted preventive interventions and more personalised clinical guidelines to address the needs of lung cancer patients with one or more comorbidities in Spain.
Collapse
Affiliation(s)
- Maja Niksic
- Department of Non-Communicable Disease Epidemiology, Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniel Redondo-Sanchez
- Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), Granada, Spain
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Andalusian School of Public Health (EASP), Granada Cancer Registry, Granada, Spain
| | - Yoe-Ling Chang
- Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), Granada, Spain
- Andalusian School of Public Health (EASP), Granada Cancer Registry, Granada, Spain
| | - Miguel Rodriguez-Barranco
- Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), Granada, Spain
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Andalusian School of Public Health (EASP), Granada Cancer Registry, Granada, Spain
| | - Jose Exposito-Hernandez
- Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), Granada, Spain
- Department of Oncology, HU Virgen de las Nieves, Granada, Spain
| | - Rafael Marcos-Gragera
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- Department of Medical Oncology, Institut Català d'Oncologia Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Catalan Institute of Oncology, Girona, Spain
| | - Ester Oliva-Poch
- Radiation Oncology Department, Catalan Institute of Oncology, Hospital Trueta, Girona, Spain
| | - Joaquim Bosch-Barrera
- Department of Medical Oncology, Institut Català d'Oncologia Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Maria-Jose Sanchez
- Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), Granada, Spain
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Andalusian School of Public Health (EASP), Granada Cancer Registry, Granada, Spain
- Department of Public Health and Preventive Medicine, University of Granada, Granada, Spain
| | - Miguel Angel Luque-Fernandez
- Department of Non-Communicable Disease Epidemiology, Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, London, UK.
- Non-Communicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), Granada, Spain.
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
- Andalusian School of Public Health (EASP), Granada Cancer Registry, Granada, Spain.
| |
Collapse
|
43
|
Ghazaryan A, Carlson A, Rhone AY, Roy K. Association between the Nutritional Quality of Household At-Home Food Purchases and Chronic Diseases and Risk Factors in the United States, 2015. Nutrients 2021; 13:nu13093260. [PMID: 34579136 PMCID: PMC8468462 DOI: 10.3390/nu13093260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
Lower diet quality is a leading preventable risk factor for obesity and chronic diseases. This study assesses differences in the nutritional quality of at-home food purchases, using the Healthy Eating Index (HEI)-2015 and its components, among households with and without a member reporting type 2 diabetes (T2D), cardiovascular disease (CVD), obesity, and/or smoking. We use the 2015 IRI Consumer Network nationally representative household food purchase scanner data, combined with the IRI MedProfiler and the USDA’s Purchase-to-Plate Crosswalk datasets. For each/multiple condition(s), the difference in mean HEI score adjusted for covariates is tested for equivalence with the respective score against households without any member with the condition(s). The HEI score is higher for households without a member with reported T2D (2.4% higher), CVD (3.2%), obesity (3.3%), none of the three conditions (6.1%, vs. all three conditions), and smoking (10.5%) than for those with a member with the respective condition. Households with a member with T2D score better on the added sugar component than those with no member reporting T2D. We found that the average food purchase quality is lower than the recommended levels, especially for households with at least one member reporting a chronic condition(s).
Collapse
Affiliation(s)
- Armen Ghazaryan
- Office of the Director (OD), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30341, USA
| | - Andrea Carlson
- Economic Research Service (ERS), United States Department of Agriculture (USDA), Washington, DC 20024, USA
| | - Alana Y Rhone
- Economic Research Service (ERS), United States Department of Agriculture (USDA), Washington, DC 20024, USA
| | - Kakoli Roy
- Office of the Director (OD), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30341, USA
| |
Collapse
|
44
|
Al Mutair A, Al Mutairi A, Alhumaid S, Maaz Abdullah S, Zia Zaidi AR, Rabaan AA, Al-Omari A. Examining and investigating the impact of demographic characteristics and chronic diseases on mortality of COVID-19: Retrospective study. PLoS One 2021; 16:e0257131. [PMID: 34506551 PMCID: PMC8432755 DOI: 10.1371/journal.pone.0257131] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 08/25/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Epidemiological features characterization of COVID-19 is highly important for developing and implementing effective control measures. In Saudi Arabia mortality rate varies between 0.6% to 1.26%. The purpose of the study was to investigate whether demographic characteristics (age and gender) and non-communicable diseases (Hypertension and Diabetes mellitus) have a significant association with mortality in COVID-19 patients. METHODS Prior to data collection, an expedite approval was obtained from Institutional Review Board (IRB Log No: RC. RC20.09.10) in Al Habib Research Center at Dr. Sulaiman Al-Habib Medical Group, Riyadh, Saudi Arabia. This is a retrospective design where we used descriptive and inferential analysis to analyse the data. Binary logistic regression was done to study the association between comorbidities and mortality of COVID-19. RESULTS 43 (86%) of the male patients were non-survivors while 7 (14%) of the female patients were survivors. The odds of non-survivors among hypertensive patients are 3.56 times higher than those who are not having a history of Hypertension (HTN). The odds of non-survivors among diabetic patients are 5.17 times higher than those who are not having a history of Diabetes mellitus (DM). The odds of non-survivors are 2.77 times higher among those who have a history of HTN and DM as compared to those who did not have a history of HTN and DM. CONCLUSIONS Those patients that had a history of Hypertension and Diabetes had a higher probability of non-survival in contrast to those who did not have a history of Diabetes and hypertension. Further studies are required to study the association of comorbidities with COVID-19 and mortality.
Collapse
Affiliation(s)
- Abbas Al Mutair
- Research Center Director, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia
- College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh, Saudi Arabia
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Alya Al Mutairi
- Mathematics Department, Taibah University, Medina, Saudi Arabia
| | - Saad Alhumaid
- Drug Information and Research Department, Administration of Pharmaceutical Care, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Syed Maaz Abdullah
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | | | - Ali A. Rabaan
- Molecular Diagnostics Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Awad Al-Omari
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| |
Collapse
|
45
|
Owusu AY, Kushitor SB, Ofosu AA, Kushitor MK, Ayi A, Awoonor-Williams JK. Institutional mortality rate and cause of death at health facilities in Ghana between 2014 and 2018. PLoS One 2021; 16:e0256515. [PMID: 34496000 PMCID: PMC8425528 DOI: 10.1371/journal.pone.0256515] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The epidemiological transition, touted as occurring in Ghana, requires research that tracks the changing patterns of diseases in order to capture the trend and improve healthcare delivery. This study examines national trends in mortality rate and cause of death at health facilities in Ghana between 2014 and 2018. METHODS Institutional mortality data and cause of death from 2014-2018 were sourced from the Ghana Health Service's District Health Information Management System. The latter collates healthcare service data routinely from government and non-governmental health institutions in Ghana yearly. The institutional mortality rate was estimated using guidelines from the Ghana Health Service. Percent change in mortality was examined for 2014 and 2018. In addition, cause of death data were available for 2017 and 2018. The World Health Organisation's 11th International Classification for Diseases (ICD-11) was used to group the cause of death. RESULTS Institutional mortality decreased by 7% nationally over the study period. However, four out of ten regions (Greater Accra, Volta, Upper East, and Upper West) recorded increases in institutional mortality. The Upper East (17%) and Volta regions (13%) recorded the highest increase. Chronic non-communicable diseases (NCDs) were the leading cause of death in 2017 (25%) and 2018 (20%). This was followed by certain infectious and parasitic diseases (15% for both years) and respiratory infections (10% in 2017 and 13% in 2018). Among the NCDs, hypertension was the leading cause of death with 2,243 and 2,472 cases in 2017 and 2018. Other (non-ischemic) heart diseases and diabetes were the second and third leading NCDs. Septicaemia, tuberculosis and pneumonia were the predominant infectious diseases. Regional variations existed in the cause of death. NCDs showed more urban-region bias while infectious diseases presented more rural-region bias. CONCLUSIONS This study examined national trends in mortality rate and cause of death at health facilities in Ghana. Ghana recorded a decrease in institutional mortality throughout the study. NCDs and infections were the leading causes of death, giving a double-burden of diseases. There is a need to enhance efforts towards healthcare and health promotion programmes for NCDs and infectious diseases at facility and community levels as outlined in the 2020 National Health Policy of Ghana.
Collapse
Affiliation(s)
- Adobea Yaa Owusu
- Institute of Statistical, Social and Economic Research (ISSER), College of Humanities, University of Ghana, Legon, Ghana
- * E-mail: ,
| | | | | | - Mawuli Komla Kushitor
- Department of Health, Policy Planning, and Management, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Atsu Ayi
- Ghana Health Service, Accra, Ghana
| | | |
Collapse
|
46
|
Lu J, Hu Y, Li M, Liu X, Wang R, Mao D, Yang X, Yang L. Zinc Nutritional Status and Risk Factors of Elderly in the China Adult Chronic Disease and Nutrition Surveillance 2015. Nutrients 2021; 13:3086. [PMID: 34578963 PMCID: PMC8470551 DOI: 10.3390/nu13093086] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To analyze the serum zinc nutrition status of the Chinese elderly, and to assess the risk factor for zinc deficiency. METHODS 3727 elderly people over 60 years old were randomly selected from 302 monitoring points in 31 provinces of China Adult Chronic Disease and Nutrition Surveillance (CACDNS) 2015. Blood samples were selected from the biological sample bank of CACDNS 2015 and the basic information were collected by questionnaires. The criteria of serum zinc deficiency recommended by the International Zinc Nutrition Consulting Group (IZiNCG) were adopted, and the related factors were also analyzed. RESULTS The median serum zinc concentration of Chinese elderly was 99.2 (84.3~118.7) μg/dL. The overall adjusted prevalence of zinc deficiency was 8.68%, with a 95% confidence interval (CI) of 7.74% and 9.61%. Significant differences were found in different sex, age groups, Body Mass Index (BMI), residence region, race and education level in terms of serum zinc status in the elderly (p < 0.05). Participants who are males, aged above 70y, with BMIs of less than 18.5 kg/m2, living in rural areas, minority, and with the lowest income had a higher prevalence of zinc deficiency in the subgroups under different classifications. The risk of zinc deficiency in the elderly over 70y was 1.44 higher than those aged 60-69y (OR = 1.44, 95%CI 1.14-1.82), and the minority elderly has a 1.39 higher risk than Han nationality (OR = 1.39, 95%CI 1.01-1.91), while overweight/obesity and female elderly were at lower risk (OR < 1, p < 0.05). CONCLUSIONS The overall prevalence of zinc deficiency in the elderly was highest in all adults in the CACDNS. It is recommended that the male elderly, over 70 years, and the minority elderly should pay more attention to the zinc nutrition status of their own.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Lichen Yang
- Key Laboratory of Trace Element Nutrition, National Health Commission of the People’s Republic of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.L.); (Y.H.); (M.L.); (X.L.); (R.W.); (D.M.); (X.Y.)
| |
Collapse
|
47
|
Moonga G, Böse-O’Reilly S, Berger U, Harttgen K, Michelo C, Nowak D, Siebert U, Yabe J, Seiler J. Modelling chronic malnutrition in Zambia: A Bayesian distributional regression approach. PLoS One 2021; 16:e0255073. [PMID: 34347795 PMCID: PMC8336812 DOI: 10.1371/journal.pone.0255073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 07/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background The burden of child under-nutrition still remains a global challenge, with greater severity being faced by low- and middle-income countries, despite the strategies in the Sustainable Development Goals (SDGs). Globally, malnutrition is the one of the most important risk factors associated with illness and death, affecting hundreds of millions of pregnant women and young children. Sub-Saharan Africa is one of the regions in the world struggling with the burden of chronic malnutrition. The 2018 Zambia Demographic and Health Survey (ZDHS) report estimated that 35% of the children under five years of age are stunted. The objective of this study was to analyse the distribution, and associated factors of stunting in Zambia. Methods We analysed the relationships between socio-economic, and remote sensed characteristics and anthropometric outcomes in under five children, using Bayesian distributional regression. Georeferenced data was available for 25,852 children from two waves of the ZDHS, 31% observation were from the 2007 and 69% were from the 2013/14. We assessed the linear, non-linear and spatial effects of covariates on the height-for-age z-score. Results Stunting decreased between 2007 and 2013/14 from a mean z-score of 1.59 (credible interval (CI): -1.63; -1.55) to -1.47 (CI: -1.49; -1.44). We found a strong non-linear relationship for the education of the mother and the wealth of the household on the height-for-age z-score. Moreover, increasing levels of maternal education above the eighth grade were associated with a reduced variation of stunting. Our study finds that remote sensed covariates alone explain little of the variation of the height-for-age z-score, which highlights the importance to collect socio-economic characteristics, and to control for socio-economic characteristics of the individual and the household. Conclusions While stunting still remains unacceptably high in Zambia with remarkable regional inequalities, the decline is lagging behind goal two of the SDGs. This emphasises the need for policies that help to reduce the share of chronic malnourished children within Zambia.
Collapse
Affiliation(s)
- Given Moonga
- Center for International Health, Ludwig Maximilian University of Munich, Munich, Germany
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia
- * E-mail:
| | - Stephan Böse-O’Reilly
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Centre of the Ludwig Maximilian University of Munich, Munich, Germany
| | - Ursula Berger
- Institute for medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Kenneth Harttgen
- Department of Humanities, Social and Political Sciences, ETH Zurich, Zurich, Switzerland
| | - Charles Michelo
- Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Centre of the Ludwig Maximilian University of Munich, Munich, Germany
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - John Yabe
- School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Johannes Seiler
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Department of Statistics, University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
48
|
Young EH, Pan S, Yap AG, Reveles KR, Bhakta K. Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016. PLoS One 2021; 16:e0255642. [PMID: 34343225 PMCID: PMC8330900 DOI: 10.1371/journal.pone.0255642] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/20/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/OBJECTIVES With an aging population suffering from increased prevalence of chronic conditions in the United States (U.S.), a large portion of these patients are on multiple medications. High-risk medications can increase the risk for drug-drug interactions and medication nonadherence. This study aims to describe the prevalence of polypharmacy and high-risk medication prescribing in U.S. physician offices. METHODS This was a cross-sectional study of the Centers for Disease Control and Prevention's National Ambulatory Medical Care Survey from 2009 to 2016. All patients over 65 years old were included. Polypharmacy was categorized as no polypharmacy (< 2 medications), minor polypharmacy (2-3 medications), moderate polypharmacy (4-5 medications), and major polypharmacy (>5 medications). Medications were further categorized into high-risk medication categories (anticholinergics, cardiovascular agents, central nervous system (CNS) medications, pain medications, and other). Comparisons between the degrees of polypharmacy were performed utilizing chi-square or Wilcoxon rank-sum tests with JMP Pro 14® (SAS Institute, Cary, NC). RESULTS Over 2 billion patient visits were included. Overall, Polypharmacy was common (65.1%): minor polypharmacy (16.2%), moderate polypharmacy (12.1%), and major polypharmacy (36.8%). Patients with major polypharmacy were older compared to those with moderate or minor polypharmacy (75 vs. 73 years, respectively) and were most frequently prescribed pain medications (477.3 per 1,000 total visits). NSAIDs were the most frequently prescribed, with 232.4 per 1,000 total visits resulting in one high-risk NSAID prescription, while 21.9 per 1,000 total visits resulted in two or more high-risk NSAIDs. CONCLUSION Most patients over 65 years experienced some degree of polypharmacy, with many experiencing major polypharmacy. This indicates an increased need for expanded pharmacist roles through medication therapy management and safety monitoring in this patient population.
Collapse
Affiliation(s)
- Eric H. Young
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, United States of America
- Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas, United States of America
| | - Samantha Pan
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, United States of America
- Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas, United States of America
| | - Alex G. Yap
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, United States of America
- Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas, United States of America
| | - Kelly R. Reveles
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, United States of America
- Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas, United States of America
| | - Kajal Bhakta
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, United States of America
- Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas, United States of America
| |
Collapse
|
49
|
Nunes da Costa EAP, Victória C, Fortaleza CMCB. Predictors of development of cardiac and digestive disorders among patients with indeterminate chronic Chagas Disease. PLoS Negl Trop Dis 2021; 15:e0009680. [PMID: 34388146 PMCID: PMC8386853 DOI: 10.1371/journal.pntd.0009680] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/25/2021] [Accepted: 07/26/2021] [Indexed: 11/18/2022] Open
Abstract
American trypanosomiasis (Chagas disease, CD) affects circa 7 million persons worldwide. While of those persons present the asymptomatic, indeterminate chronic form (ICF), many will eventually progress to cardiac or digestive disorders. We studied a nonconcurrent (retrospective) cohort of patients attending an outpatient CD clinic in Southeastern Brazil, who were admitted while presenting the ICF in the period from 1998 through 2018 and followed until 2019. The outcomes of interest were the progression to cardiac or digestive CD forms. We were also interested in analyzing the impact of Benznidazole therapy on the progression of the disease. Extensive review of medical charts and laboratory files was conducted, collecting data up to year 2019. Demographics (upon inclusion), body mass index, comorbidities (including the Charlson index) and use of Benznidazole were recorded. The outcomes were defined by abnormalities in those test that could not be attributed to other causes. Statistical analysis included univariate and multivariable Cox regression models. Among 379 subjects included in the study, 87 (22.9%) and 100 (26.4%) progressed to cardiac and digestive forms, respectively. In the final multivariable model, cardiac disorders were positively associated with previous coronary syndrome (Hazzard Ratio [HR], 2.42; 95% Confidence Interval [CI], 1.53-3.81) and negatively associated with Benznidazole therapy (HR, 0.26; 95%CI, 0.11-0.60). On the other hand, female gender was the only independent predictor of progression to digestive forms (HR, 1.56; 95%CI, 1.03-2.38). Our results point to the impact of comorbidities on progression do cardiac CD, with possible benefit of the use of Benznidazole.
Collapse
Affiliation(s)
| | - Cassiano Victória
- Department of Zoonosis, Faculty of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), City of Botucatu, Brazil
| | | |
Collapse
|
50
|
PALO SUBRATAKUMAR, KANUNGO SRIKANTA, SAMAL MOUSUMI, PRIYADARSHINI SUBHADRA, SAHOO DEBADUTTA, PATI SANGHAMITRA. Water, Sanitation, and Hygiene (WaSH) practices and morbidity status in a rural community: findings from a cross-sectional study in Odisha, India. J Prev Med Hyg 2021; 62:E392-E398. [PMID: 34604579 PMCID: PMC8451357 DOI: 10.15167/2421-4248/jpmh2021.62.2.1503] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/26/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Global evidence indicates an association between poor WaSH practice and inferior health outcomes. In rural areas, this practice is predominantly compromised with limited access to safe drinking water, knowledge gaps, and unhealthy socio-behavioural practices. Suboptimal WaSH practice leads to increased vulnerability of various infections, thereby posing a challenge to the primary health care system. METHODS A community based cross-sectional study was conducted among 879 participants of two villages in Tigiria block, Cuttack district, Odisha, India. Information pertaining to socio-demography, WaSH practices and self-reported morbidities were captured and analysed. Bi-variate analysis was done to assess the association between WaSH practices and any acute illnesses. Differences were considered statistically significant if p-value was less than 0.05. RESULTS Tube well was the main source of drinking water (49.3%) followed by dug well (46.6%). Only 7.1% of participants reported to purify drinking water and around 40% were still practicing open defecation. The prevalence of acute and chronic illnesses was 9.2% and 19.1% respectively. Major acute illnesses were respiratory diseases, diarrhoeal disorders, and musculoskeletal problems, while major chronic illnesses were gastrointestinal problems, musculoskeletal problems, and hypertension. After adjusting for age, gender, and education, a significant odds ratio of 3.79 [CI = (1.23-11.70)] was observed between drinking water source (surface water Vs tube well water) for acute illnesses. CONCLUSIONS Poor WaSH practices among rural people make them vulnerable to acute and chronic morbidities. Health awareness and socio behavioural changes pertaining to WaSH practices need utmost priority to ensure better health for rural people of Odisha.
Collapse
Affiliation(s)
- SUBRATA KUMAR PALO
- ICMR-RMRCBhubaneswar
- Correspondence: Subrata Kumar Palo, Scientist-D, ICMR-RMRC Bhubaneswar - E-mail:
| | | | | | | | | | | |
Collapse
|