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Harris E. Deaths From Excessive Drinking Rose in the US During Pandemic. JAMA 2024; 331:1355. [PMID: 38578618 DOI: 10.1001/jama.2024.4499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
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Thomson J, Hall M, Nelson K, Flores JC, Garrity B, DeCourcey DD, Agrawal R, Goodman DM, Feinstein JA, Coller RJ, Cohen E, Kuo DZ, Antoon JW, Houtrow AJ, Bastianelli L, Berry JG. Timing of Co-occurring Chronic Conditions in Children With Neurologic Impairment. Pediatrics 2021; 147:e2020009217. [PMID: 33414236 PMCID: PMC7849195 DOI: 10.1542/peds.2020-009217] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Accepted: 10/28/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Children with neurologic impairment (NI) are at risk for developing co-occurring chronic conditions, increasing their medical complexity and morbidity. We assessed the prevalence and timing of onset for those conditions in children with NI. METHODS This longitudinal analysis included 6229 children born in 2009 and continuously enrolled in Medicaid through 2015 with a diagnosis of NI by age 3 in the IBM Watson Medicaid MarketScan Database. NI was defined with an existing diagnostic code set encompassing neurologic, genetic, and metabolic conditions that result in substantial functional impairments requiring subspecialty medical care. The prevalence and timing of co-occurring chronic conditions was assessed with the Agency for Healthcare Research and Quality Chronic Condition Indicator system. Mean cumulative function was used to measure age trends in multimorbidity. RESULTS The most common type of NI was static (56.3%), with cerebral palsy (10.0%) being the most common NI diagnosis. Respiratory (86.5%) and digestive (49.4%) organ systems were most frequently affected by co-occurring chronic conditions. By ages 2, 4, and 6 years, the mean (95% confidence interval [CI]) numbers of co-occurring chronic conditions were 3.7 (95% CI 3.7-3.8), 4.6 (95% CI 4.5-4.7), and 5.1 (95% CI 5.1-5.2). An increasing percentage of children had ≥9 co-occurring chronic conditions as they aged: 5.3% by 2 years, 10.0% by 4 years, and 12.8% by 6 years. CONCLUSIONS Children with NI enrolled in Medicaid have substantial multimorbidity that develops early in life. Increased attention to the timing and types of multimorbidity in children with NI may help optimize their preventive care and case management health services.
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Affiliation(s)
- Joanna Thomson
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio;
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Katherine Nelson
- Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Juan Carlos Flores
- Division of Pediatrics, Pontificia Universidad Católica de Chile and Hospital Sotero del Rio, Santiago, Chile
| | | | - Danielle D DeCourcey
- Medical Critical Care, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Rishi Agrawal
- Divisions of Hospital Based Medicine and
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Denise M Goodman
- Critical Care
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James A Feinstein
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado
| | - Ryan J Coller
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Eyal Cohen
- Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Dennis Z Kuo
- Department of Pediatrics, University at Buffalo, Buffalo, New York
| | - James W Antoon
- Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee; and
| | - Amy J Houtrow
- Departments of Physical Medicine and Rehabilitation and Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
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Chen YH, Karimi M, Rutten-van Mölken MPMH. The disease burden of multimorbidity and its interaction with educational level. PLoS One 2020; 15:e0243275. [PMID: 33270760 PMCID: PMC7714131 DOI: 10.1371/journal.pone.0243275] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 01/30/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Policies to adequately respond to the rise in multimorbidity have top-priority. To understand the actual burden of multimorbidity, this study aimed to: 1) estimate the trend in prevalence of multimorbidity in the Netherlands, 2) study the association between multimorbidity and physical and mental health outcomes and healthcare cost, and 3) investigate how the association between multimorbidity and health outcomes interacts with socio-economic status (SES). Methods Prevalence estimates were obtained from a nationally representative pharmacy database over 2007–2016. Impact on costs was estimated in a fixed effect regression model on claims data over 2009–2015. Data on physical and mental health and SES were obtained from the National Health Survey in 2017, in which the Katz-10 was used to measure limitations in activities of daily living (ADL) and the Mental Health Inventory (MHI) to measure mental health. SES was approximated by the level of education. Generalized linear models (2-part models for ADL) were used to analyze the health data. In all models an indicator variable for the presence or absence of multimorbidity was included or a categorical variable for the number of chronic conditions. Interactions terms of multimorbidity and educational level were added into the previously mentioned models. Results Over the past ten years, there was an increase of 1.6%-point in the percentage of people with multimorbidity. The percentage of people with three or more conditions increased with +2.1%-point. People with multimorbidity had considerably worse physical and mental health outcomes than people without multimorbidity. For the ADL, the impact of multimorbidity was three times greater in the lowest educational level than in the highest educational level. For the MHI, the impact of multimorbidity was two times greater in the lowest than in the highest educational level. Each additional chronic condition was associated with a greater worsening in health outcomes. Similarly, for costs, where there was no evidence of a diminishing impact of additional conditions either. In patients with multimorbidity total healthcare costs were on average €874 higher than in patients with a single morbidity. Conclusion The impact of multimorbidity on health and costs seems to be greater in the sicker and lower educated population.
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Affiliation(s)
- Yi Hsuan Chen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Milad Karimi
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maureen P. M. H. Rutten-van Mölken
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Saqib MAN, Siddiqui S, Qasim M, Jamil MA, Rafique I, Awan UA, Ahmad H, Afzal MS. Effect of COVID-19 lockdown on patients with chronic diseases. Diabetes Metab Syndr 2020; 14:1621-1623. [PMID: 32889403 PMCID: PMC7450263 DOI: 10.1016/j.dsx.2020.08.028] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [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: 08/16/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS We sought to measure the effect of lockdown, implemented to contain COVID-19 infection, on routine living and health of patients with chronic diseases and challenges faced by them. METHODS A semi-structured online questionnaire was generated using "Google forms" and sent to the patients with chronic diseases using WhatsApp. Data were retrieved and analyzed using SPSS. RESULTS Out of 181 participants, 98% reported effect of lockdown on their routine living while 45% reported an effect on their health. The key challenges due to lockdown were to do daily exercise, missed routine checkup/lab testing and daily health care. CONCLUSION It is important to strategize the plan for patients with chronic diseases during pandemic or lockdown.
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Affiliation(s)
- Muhammad Arif Nadeem Saqib
- Pakistan Health Research Council, Head Office, Islamabad, Pakistan; Department of Life Sciences, University of Management & Technology (UMT), Lahore, Pakistan.
| | - Shajee Siddiqui
- Department of Medicine, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Muhammad Qasim
- Department of Economics, Finance and Statistics, Jönköping University, Jönköping, Sweden
| | - Muhammad Azhar Jamil
- Department of Medicine, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Ibrar Rafique
- Pakistan Health Research Council, Head Office, Islamabad, Pakistan
| | - Usman Ayub Awan
- Department of Life Sciences, University of Management & Technology (UMT), Lahore, Pakistan; Department of Medical Laboratory Technology, University of Haripur, Haripur, Pakistan
| | - Haroon Ahmad
- Department of Biosciences, COMSATS University Islamabad (CUI), Islamabad, Pakistan
| | - Muhammad Sohail Afzal
- Department of Life Sciences, University of Management & Technology (UMT), Lahore, Pakistan
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Abstract
Hospital admissions in the US fell dramatically with the onset of the coronavirus disease 2019 (COVID-19) pandemic. However, little is known about differences in admissions patterns among patient groups or the extent of the rebound. In this study of approximately one million medical admissions from a large, nationally representative hospitalist group, we found that declines in non-COVID-19 admissions from February to April 2020 were generally similar across patient demographic subgroups and exceeded 20 percent for all primary admission diagnoses. By late June/early July 2020, overall non-COVID-19 admissions had rebounded to 16 percent below prepandemic baseline volume (8 percent including COVID-19 admissions). Non-COVID-19 admissions were substantially lower for patients residing in majority-Hispanic neighborhoods (32 percent below baseline) and remained well below baseline for patients with pneumonia (-44 percent), chronic obstructive pulmonary disease/asthma (-40 percent), sepsis (-25 percent), urinary tract infection (-24 percent), and acute ST-elevation myocardial infarction (-22 percent). Health system leaders and public health authorities should focus on efforts to ensure that patients with acute medical illnesses can obtain hospital care as needed during the pandemic to avoid adverse outcomes.
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Affiliation(s)
- John D Birkmeyer
- John D. Birkmeyer is chief clinical officer of Sound Physicians, in Tacoma, Washington, and an adjunct professor for health policy and clinical practice, Geisel School of Medicine at Dartmouth, in Lebanon, New Hampshire
| | - Amber Barnato
- Amber Barnato is a professor at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth
| | - Nancy Birkmeyer
- Nancy Birkmeyer is principal research scientist at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth
| | | | - Jonathan Skinner
- Jonathan Skinner is the James O. Freedman Presidential Professor in Economics at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth
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Weeks WB, Huynh G, Cao SY, Smith J, Weinstein JN. Assessment of Year-to-Year Patient-Specific Comorbid Conditions Reported in the Medicare Chronic Conditions Data Warehouse. JAMA Netw Open 2020; 3:e2018176. [PMID: 33001199 PMCID: PMC7530630 DOI: 10.1001/jamanetworkopen.2020.18176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
This cross-sectional study evaluates the persistence of chronic condition flags for 51 conditions over single-year and multiyear periods.
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Affiliation(s)
| | - Grace Huynh
- Microsoft Research, Microsoft, Redmond, Washington
| | | | - Jeremy Smith
- White River Junction VA Outcomes Group, White River Junction, Vermont
| | - James N. Weinstein
- Microsoft Research, Microsoft, Redmond, Washington
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
- Kellogg School of Management, Northwestern University, Evanston, Illinois
- Tuck School of Business, Dartmouth College, Hanover, New Hampshire
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Nomura S, Yoneoka D, Tanaka S, Ishizuka A, Ueda P, Nakamura K, Uneyama H, Hayashi N, Shibuya K. Forecasting disability-adjusted life years for chronic diseases: reference and alternative scenarios of salt intake for 2017-2040 in Japan. BMC Public Health 2020; 20:1475. [PMID: 32993606 PMCID: PMC7526266 DOI: 10.1186/s12889-020-09596-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/18/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In Japan, a high-sodium diet is the most important dietary risk factor and is known to cause a range of health problems. This study aimed to forecast Japan's disability-adjusted life year (DALYs) for chronic diseases that would be associated with high-sodium diet in different future scenarios of salt intake. We modelled DALY forecast and alternative future scenarios of salt intake for cardiovascular diseases (CVDs), chronic kidney diseases (CKDs), and stomach cancer (SC) from 2017 to 2040. METHODS We developed a three-component model of disease-specific DALYs: a component on the changes in major behavioural and metabolic risk predictors including salt intake; a component on the income per person, educational attainment, and total fertility rate under 25 years; and an autoregressive integrated moving average model to capture the unexplained component correlated over time. Data on risk predictors were obtained from Japan's National Health and Nutrition Surveys and from the Global Burden of Disease Study 2017. To generate a reference forecast of disease-specific DALY rates for 2017-2040, we modelled the three diseases using the data for 1990-2016. Additionally, we generated better, moderate, and worse scenarios to evaluate the impact of change in salt intake on the DALY rate for the diseases. RESULTS In our reference forecast, the DALY rates across all ages were predicted to be stable for CVDs, continuously increasing for CKDs, and continuously decreasing for SC. Meanwhile, the age group-specific DALY rates for these three diseases were forecasted to decrease, with some exceptions. Except for the ≥70 age group, there were remarkable differences in DALY rates between scenarios, with the best scenario having the lowest DALY rates in 2040 for SC. This represents a wide scope of future trajectories by 2040 with a potential for tremendous decrease in SC burden. CONCLUSIONS The gap between scenarios provides some quantification of the range of policy impacts on future trajectories of salt intake. Even though we do not yet know the policy mix used to achieve these scenarios, the result that there can be differences between scenarios means that policies today can have a significant impact on the future DALYs.
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Affiliation(s)
- Shuhei Nomura
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
| | - Daisuke Yoneoka
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Shiori Tanaka
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Aya Ishizuka
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Peter Ueda
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Keiji Nakamura
- Graduate School of Environmental and Information Studies, Tokyo City University, Yokohama, Japan
- Ajinomoto Co., Inc., Tokyo, Japan
| | | | - Naoki Hayashi
- Ajinomoto Co., Inc., Tokyo, Japan
- Department of Applied Biological Chemistry, Graduate School of Agriculture and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Institute for Population Health, King's College London, London, UK
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Abstract
The original pediatric complex chronic conditions (CCC) classification system developed in 2000/2001 is the gold standard in classifying children with life-limiting illnesses. It was significantly modified in 2014; yet the two systems have not been evaluated. The objective of this study was to evaluate the agreement and validity of the original versus the modified CCC classification systems. Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) data from 2012 was used with a sample of infant decedents less than 1 years. The agreement (i.e., Cohen's Kappa Statistic) and validity (i.e., sensitivity, specificity, and positive predictive value [PPV]) statistics were calculated. Among the 10,175 infants that were classified, the modified system performed well in identifying infants who had a CCC, and it captured infants that the original classification did not. The modified system represents an improvement over the original, but additional testing is warranted.
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Affiliation(s)
- Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, Knoxville, TN, USA
| | - Melanie J Cozad
- Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia, SC, USA
| | - Christine A Fortney
- Martha S. Pitzer Center for Women, Children Youth, College of Nursing, The Ohio State University, Columbus, OH, USA
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Grabovac I, Smith L, Yang L, Soysal P, Veronese N, Turan Isik A, Forwood S, Jackson S. The relationship between chronic diseases and number of sexual partners: an exploratory analysis. BMJ Sex Reprod Health 2020; 46:100-107. [PMID: 32054661 DOI: 10.1136/bmjsrh-2019-200352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/14/2019] [Revised: 12/08/2019] [Accepted: 12/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND We investigated sex-specific associations between lifetime number of sexual partners and several health outcomes in a large sample of older adults in England. METHODS We used cross-sectional data from 2537 men and 3185 women aged ≥50 years participating in the English Longitudinal Study of Ageing. Participants reported the number of sexual partners they had had in their lifetime. Outcomes were self-rated health and self-reported limiting long-standing illness, cancer, coronary heart disease, and stroke. We used logistic regression to analyse associations between lifetime number of sexual partners and health outcomes, adjusted for relevant sociodemographic and health-related covariates. RESULTS Having had 10 or more lifetime sexual partners was associated with higher odds of reporting a diagnosis of cancer than having had 0-1 sexual partners in men (OR 1.69, 95% CI 1.01 to 2.83) and women (OR 1.91, 95% CI 1.04 to 3.51), respectively. Women who had 10 or more lifetime sexual partners also had higher odds of reporting a limiting long-standing illness (OR 1.64, 95% CI 1.15 to 2.35). No other statistically significant associations were observed. CONCLUSIONS A higher lifetime number of sexual partners is associated with increased odds of reported cancer. Longitudinal research is required to establish causality. Understanding the predictive value of lifetime number of sexual partners as a behavioural risk factor may improve clinical assessment of cancer risk in older adults.
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Affiliation(s)
- Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University Vienna, Vienna, Austria
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Lin Yang
- Alberta Health Services, Calgary, Alberta, Canada
| | - Pinar Soysal
- Department of Geriatric Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Nicola Veronese
- Neuroscience Institute, Aging Branch, National Research Council, Padua, Italy
| | - Ahmet Turan Isik
- Department of Geriatric Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Suzanna Forwood
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | - Sarah Jackson
- Department of Behavioural Science and Health, University College London, London, UK
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Gandhi K, Lim E, Davis J, Chen JJ. Racial-ethnic disparities in self-reported health status among US adults adjusted for sociodemographics and multimorbidities, National Health and Nutrition Examination Survey 2011-2014. Ethn Health 2020; 25:65-78. [PMID: 29092622 PMCID: PMC6117214 DOI: 10.1080/13557858.2017.1395812] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/16/2017] [Indexed: 06/07/2023]
Abstract
Objective: To investigate racial-ethnic disparities in self-reported health status adjusting for sociodemographic factors and multimorbidities.Design: A total of 9499 adult participants aged 20 years and older from the United States (US); reported by the National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey - for years 2011-2014. The main outcome measure was self-reported health status categorized as excellent/very good, good (moderate), and fair/poor.Results: Of the NHANES participants, 40.7% reported excellent/very good health, 37.2% moderate health and 22.1% fair/poor health. There were 42.8% who were non-Hispanic whites, 20.2% were Hispanic, 23.8% were non-Hispanic blacks, and 13.2% were non-Hispanic Asians. Compared to non-Hispanic whites, Hispanics [Odds Ratio (OR) = 2.91, 95% Confidence Interval (CI) = 2.28-3.71] and non-Hispanic blacks [OR = 1.51, 95% CI = 1.26-1.83] were more likely to report fair/poor health, whereas, non-Hispanic Asians [OR = 1.42, 95% CI = 1.14-1.76] were more likely to report moderate health than excellent/very good health. Compared to those with no chronic conditions, participants with two or three chronic conditions [OR = 9.35, 95% CI = 7.26-12.00] and with four or more chronic conditions [OR = 38.10, 95% CI = 26.50-54.90] were more likely to report fair/poor health than excellent/very good health status.Conclusion: The racial-ethnic differences in self-reported health persisted even after adjusting for sociodemographics and number of multimorbidities. The findings highlight the potential importance of self-reported health status and the need to increase health awareness through health assessment and health-promotional programs among the vulnerable minority US adults.
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Affiliation(s)
- Krupa Gandhi
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Eunjung Lim
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - James Davis
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - John J Chen
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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Nagata JM, Palar K, Gooding HC, Garber AK, Bibbins-Domingo K, Weiser SD. Food Insecurity and Chronic Disease in US Young Adults: Findings from the National Longitudinal Study of Adolescent to Adult Health. J Gen Intern Med 2019; 34:2756-2762. [PMID: 31576509 PMCID: PMC6854148 DOI: 10.1007/s11606-019-05317-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [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: 12/21/2018] [Revised: 06/07/2019] [Accepted: 07/23/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Food insecurity, or the limited or uncertain access to food resulting from inadequate financial resources, is associated with a higher prevalence of chronic disease in adulthood. Little is known about these relationships specifically in young adulthood, an important time for the development of chronic disease. OBJECTIVE To determine the association between food insecurity and chronic disease including diabetes, hypertension, obesity, and obstructive airway disease in a nationally representative sample of US young adults. DESIGN Cross-sectional nationally representative data collected from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health was analyzed using multiple logistic regression models. PARTICIPANTS US young adults ages 24-32 years old MAIN MEASURES: Food insecurity and general health; self-reported diabetes, hypertension, hyperlipidemia, "very overweight," and obstructive airway disease; measured obesity derived from body mass index; and inadequate disease control (hemoglobin A1c ≥ 7.0%, blood pressure ≥ 140/90 mmHg) among those with reported diabetes and hypertension. KEY RESULTS Of the 14,786 young adults in the sample, 11% were food insecure. Food-insecure young adults had greater odds of self-reported poor health (2.63, 95% confidence interval (CI) 1.63-4.24), diabetes (1.67, 95% CI 1.18-2.37), hypertension (1.40, 95% CI 1.14-1.72), being "very overweight" (1.30, 95% CI 1.08-1.57), and obstructive airway disease (1.48, 95% CI 1.22-1.80) in adjusted models compared with young adults who were food secure. Food insecurity was not associated with inadequate disease control among those with diabetes or hypertension. CONCLUSIONS Food insecurity is associated with several self-reported chronic diseases and obesity in young adulthood. Health care providers should screen for food insecurity in young adults and provide referrals when appropriate. Future research should evaluate the impact of early interventions to combat food insecurity on the prevention of downstream health effects in later adulthood.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA.
| | - Kartika Palar
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Holly C Gooding
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrea K Garber
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Kirsten Bibbins-Domingo
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Humphries C, Jaganathan S, Panniyammakal J, Singh SK, Goenka S, Dorairaj P, Gill P, Greenfield S, Lilford R, Manaseki-Holland S. Patient and healthcare provider knowledge, attitudes and barriers to handover and healthcare communication during chronic disease inpatient care in India: a qualitative exploratory study. BMJ Open 2019; 9:e028199. [PMID: 31719070 PMCID: PMC6858202 DOI: 10.1136/bmjopen-2018-028199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES 1) To investigate patient and healthcare provider (HCP) knowledge, attitudes and barriers to handover and healthcare communication during inpatient care. 2) To explore potential interventions for improving the storage and transfer of healthcare information. DESIGN Qualitative study comprising 41 semi-structured, individual interviews and a thematic analysis using the Framework Method with analyst triangulation. SETTING Three public hospitals in Himachal Pradesh and Kerala, India. PARTICIPANTS Participants included 20 male (n=10) and female (n=10) patients with chronic non-communicable disease (NCD) and 21 male (n=15) and female (n=6) HCPs. Purposive sampling was used to identify patients with chronic NCDs (cardiovascular disease, chronic respiratory disease, diabetes or hypertension) and HCPs. RESULTS Patient themes were (1) public healthcare service characteristics, (2) HCP to patient communication and (3) attitudes regarding medical information. HCP themes were (1) system factors, (2) information exchange practices and (3) quality improvement strategies. Both patients and HCPs recognised public healthcare constraints that increased pressure on hospitals and subsequently limited consultation times. Systemic issues reported by HCPs were a lack of formal handover systems, training and accessible hospital-based records. Healthcare management communication during admission was inconsistent and lacked patient-centredness, evidenced by varying reports of patient information received and some dissatisfaction with lifestyle advice. HCPs reported that the duty of writing discharge notes was passed from senior doctors to interns or nurses during busy periods. A nurse reported providing predominantly verbal discharge instructions to patients. Patient-held medical documents facilitated information exchange between HCPs, but doctors reported that they were not always transported. HCPs and patients expressed positive views towards the idea of introducing patient-held booklets to improve the organisation and transfer of medical documents. CONCLUSIONS Handover and healthcare communication during chronic NCD inpatient care is currently suboptimal. Structured information exchange systems and HCP training are required to improve continuity and safety of care during critical transitions such as referral and discharge. Our findings suggest that patient-held booklets may also assist in enhancing handover and patient-centred practices.
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Affiliation(s)
- Claire Humphries
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Suganthi Jaganathan
- Centre for Chronic Disease Control, Gurgaon, Haryana, India
- Public Health Foundation of India, New Delhi, India
| | - Jeemon Panniyammakal
- Centre for Chronic Disease Control, Gurgaon, Haryana, India
- Public Health Foundation of India, New Delhi, India
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | | | - Shifalika Goenka
- Centre for Chronic Disease Control, Gurgaon, Haryana, India
- Public Health Foundation of India, New Delhi, India
| | - Prabhakaran Dorairaj
- Centre for Chronic Disease Control, Gurgaon, Haryana, India
- Public Health Foundation of India, New Delhi, India
| | - Paramjit Gill
- Academic Unit of Primary Care, University of Warwick, Coventry, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard Lilford
- Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
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Zhao M, Liu B, Shan L, Li C, Wu Q, Hao Y, Chen Z, Lan L, Kang Z, Liang L, Ning N, Jiao M. Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China. BMC Health Serv Res 2019; 19:654. [PMID: 31500617 PMCID: PMC6734466 DOI: 10.1186/s12913-019-4480-8] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 08/28/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Integration of medical insurance schemes has been prioritized as one of the key strategies to address inequity in China's health system. The first pilot attempt to integrate started in 2003 and later expanded nationwide. This study aims to assess its intended impact on inequity in inpatient service utilization and identify the main determinants contributing to its ineffectiveness. METHODS A total of 49,365 respondents in the pilot integrated area and 77,165 respondents in the non-integration area were extracted from the Fifth National Health Services Survey. A comparative analysis was conducted between two types of areas. We calculate a concentration index (CI) and horizontal inequity index (HI) in inpatient service utilization and decompose the two indices. RESULTS Insurance integration played a positive role in reducing inequality in inpatient service utilization to some extent. A 13.23% lower in HI, a decrease in unmet inpatient care and financial barriers to inpatient care in the pilot integrated area compared with the non-integration area; decomposition analysis showed that the Urban-Rural Residents Basic Medical Insurance, a type of integrated insurance, contributed 37.49% to reducing inequality in inpatient service utilization. However, it still could not offset the strong negative effect of income and other insurance schemes that have increased inequality. CONCLUSIONS The earlier pilot attempt for integrating medical insurance was not enough to counteract the influence of factors which increased the inequality in inpatient service utilization. Further efforts to address the inequality should focus on widening access to financing, upgrading the risk pool, reducing gaps within and between insurance schemes, and providing broader chronic disease benefit packages. Social policies that target the needs of the poor with coordinated efforts from various levels and agencies of the government are urgently needed.
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Affiliation(s)
- Miaomiao Zhao
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
- Department of Health Management, School of Public Health, Nantong University, 9 Seyuan Road, Chongchuan District, Nantong, 226019, Jiangsu, China
| | - Baohua Liu
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Linghan Shan
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Cui Li
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Qunhong Wu
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
| | - Yanhua Hao
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
| | - Zhuo Chen
- Department of Health Policy and Management College of Public Health, University of Georgia, Athens, GA, 30602, USA
- School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo, 199 Taikang East Road, Ningbo, Zhejiang, 315100, China
| | - Lan Lan
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Zheng Kang
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Libo Liang
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Ning Ning
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Mingli Jiao
- Department of Social Medicine, School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
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Saha UR, Chattapadhayay A, Richardus JH. Trends, prevalence and determinants of childhood chronic undernutrition in regional divisions of Bangladesh: Evidence from demographic health surveys, 2011 and 2014. PLoS One 2019; 14:e0220062. [PMID: 31398208 PMCID: PMC6688800 DOI: 10.1371/journal.pone.0220062] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 02/08/2019] [Accepted: 07/07/2019] [Indexed: 11/18/2022] Open
Abstract
Background Undernutrition, an important indicator for monitoring progress of development goals, is a matter of concern in many developing countries, including Bangladesh. Despite regional differences in chronic undernutrition in Bangladesh, regional determinants among children under the age of five were not extensively explored. Data and methods Using combined repeated cross-sectional nationwide Bangladesh Demographic and Health Surveys (BDHS 2011 and 2014) and employing bivariate and logistic regression analyses, we estimated prevalence, changes and variations in regional determinants of stunting among children aged 6–59 months over two time periods 2011 and 2014. Results Our benchmark results suggested that the children from Rajshahi, Khulna, Rangpur, Chittagong and Dhaka tend to be significantly less stunted by 51% (p = 0.000; CI = [0.38, 0.63]), 44% (p = 0.000; CI = [0.44, 0.71]), 26% (p = 0.012; CI = [0.58, 0.93]), 23% (p = 0.012; CI = [0.62, 0.95]) and 22% (p = 0.033; [0.63, 0.97]) respectively, against Sylhet in 2011. With the exception of Dhaka, no region showed significant differences in the odds of stunting over two time periods 2011 and 2014, i.e. only Dhaka revealed significant difference by 30% reductions in the odds of stunting in 2014. Also, rural children were less likely to be stunted (by 19%) of the urban counterparts. Regional covariates of stunting differ. However, children’s age, household wealth, mother’s height, and parental education were important determinants of stunting in Bangladesh. Conclusion Dhaka made an impressive improvement in child nutrition, thus contributed largely to the reduction of stunting levels in Bangladesh for 2014 over 2011. Sylhet and Barisal require strong push to improve nutritional status of children. Further decline is possible through region-specific multipronged interventions that can address area-specific covariates to break the cycle of undernutrition like strengthening economic and educational status, emphasizing the role of father to augment their knowledge in varying aspects like family planning, reduction of fertility and by improving mother’s health.
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Affiliation(s)
- Unnati Rani Saha
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | | | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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15
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Dunbar P, Hall M, Gay JC, Hoover C, Markham JL, Bettenhausen JL, Perrin JM, Kuhlthau KA, Crossman M, Garrity B, Berry JG. Hospital Readmission of Adolescents and Young Adults With Complex Chronic Disease. JAMA Netw Open 2019; 2:e197613. [PMID: 31339547 PMCID: PMC6659144 DOI: 10.1001/jamanetworkopen.2019.7613] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 01/19/2023] Open
Abstract
IMPORTANCE Adolescents and young adults (AYA) who have complex chronic disease (CCD) are a growing population that requires hospitalization to treat severe, acute health problems. These patients may have increased risk of readmission as demands on their self-management increase and as they transfer care from pediatric to adult health care practitioners. OBJECTIVE To assess variation across CCDs in the likelihood of readmission for AYA with increasing age. DESIGN, SETTING, AND PARTICIPANTS Retrospective 1-year cross-sectional study of the 2014 Agency for Healthcare Research and Quality Nationwide Readmissions Database for all US hospitals. Participants were 215 580 hospitalized individuals aged 15 to 30 years with cystic fibrosis (n = 15 213), type 1 diabetes (n = 86 853), inflammatory bowel disease (n = 48 073), spina bifida (n = 7819), and sickle cell anemia (n = 57 622) from January 1, 2014, to December 1, 2014. EXPOSURES Increasing age at index admission. MAIN OUTCOMES AND MEASURES Unplanned 30-day hospital readmission. Readmission odds were compared by patients' ages in 2-year epochs (with age 15-16 years as the reference) using logistic regression, accounting for confounding patient characteristics and data clustering by hospital. RESULTS Of 215 580 participants, 115 982 (53.8%) were female; the median (interquartile range) age was 24 (20-27) years. Across CCDs, multimorbidity was common; the percentages of index hospitalizations with 4 or more coexisting conditions ranged from to 33.4% for inflammatory bowel disease to 74.2% for spina bifida. Thirty-day hospital readmission rates varied significantly across CCDs: 20.2% (cystic fibrosis), 19.8% (inflammatory bowel disease), 20.4% (spina bifida), 22.5% (type 1 diabetes), and 34.6% (sickle cell anemia). As age increased from 15 to 30 years, unadjusted, 30-day, unplanned hospital readmission rates increased significantly for all 5 CCD cohorts. In multivariable analysis, age trends in the adjusted odds of readmission varied across CCDs. For example, for AYA who had cystic fibrosis, the adjusted odds of readmission increased to 1.9 (95% CI, 1.5-2.3) by age 21 years and remained elevated through age 30 years. For AYA who had type 1 diabetes, the adjusted odds of readmission peaked at ages 23 to 24 years (odds ratio, 2.3; 95% CI, 2.1-2.6) and then declined through age 30 years. CONCLUSIONS AND RELEVANCE These findings suggest that hospitalized AYA who have CCDs have high rates of multimorbidity and 30-day readmission. The adjusted odds of readmission for AYA varied significantly across CCDs with increasing age. Further attention is needed to hospital discharge care, self-management, and prevention of readmission in AYA with CCD.
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Affiliation(s)
- Peter Dunbar
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matt Hall
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, University of Missouri–Kansas City School of Medicine, Kansas City
- Children’s Hospital Association, Lenexa, Kansas
| | - James C. Gay
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Jessica L. Markham
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, University of Missouri–Kansas City School of Medicine, Kansas City
| | - Jessica L. Bettenhausen
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, University of Missouri–Kansas City School of Medicine, Kansas City
| | - James M. Perrin
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Karen A. Kuhlthau
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Morgan Crossman
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Brigid Garrity
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jay G. Berry
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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16
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Lai FTT, Wong SYS, Yip BHK, Guthrie B, Mercer SW, Chung RY, Chung GKK, Chau PYK, Wong ELY, Woo J, Yeoh EK. Multimorbidity in middle age predicts more subsequent hospital admissions than in older age: A nine-year retrospective cohort study of 121,188 discharged in-patients. Eur J Intern Med 2019; 61:103-111. [PMID: 30581041 DOI: 10.1016/j.ejim.2018.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/24/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous research has suggested a differential short-term effect of multimorbidity on hospitalization by age, with younger groups affected more. This study compares the nine-year hospitalization pattern by age and multimorbidity status in a retrospective cohort of discharged in-patients, who represent a high-need portion of the population. METHODS We examined routine clinical records of all patients aged 45+ years with chronic conditions discharged from public general hospitals in 2005 in Hong Kong. Patterns of annual frequencies of hospital admissions and number of hospitalized days over nine years (2005-2014) were compared by multimorbidity status (1, 2, 3+ conditions) and age group (45-64, 65-74, 75+). RESULTS Among 121,188 included patients, 33.9% had 2+ conditions and 12.3% had 3+. Hospitalization patterns varied by age and multimorbidity status. For those having only 1 condition, annual number of admissions was similar by age, but older patients had more hospitalized days (4.40 days per person-year for the 45-64 group versus 10.29 for the 75+ group in the 5th year). For those with 3+ conditions, younger patients had more admissions (4.39 admissions per person-year for the 45-64 group versus 1.87 for the 75+ group in the 5th year) but similar number of hospitalized days with older patients. Interaction analysis showed effect of multimorbidity on hospitalization was stronger in younger groups (P < 0.05). CONCLUSION Middle-aged discharged in-patients with multimorbidity are admitted more often than their older counterparts and have similar total hospitalized days per year. Further research is needed to investigate chronic care needs of younger people with multimorbidity.
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Affiliation(s)
- Francisco T T Lai
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Samuel Y S Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Benjamin H K Yip
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Bruce Guthrie
- The Centre for Population Health Sciences, The Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom.
| | - Stewart W Mercer
- The Centre for Population Health Sciences, The Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom.
| | - Roger Y Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Gary K K Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Patsy Y K Chau
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Eliza L Y Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
| | - Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong.
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Barrenho E, Miraldo M, Smith PC. Does global drug innovation correspond to burden of disease? The neglected diseases in developed and developing countries. Health Econ 2019; 28:123-143. [PMID: 30417950 DOI: 10.1002/hec.3833] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 07/05/2018] [Accepted: 08/23/2018] [Indexed: 06/09/2023]
Abstract
Although it is commonly argued that there is a mismatch between drug innovation and disease burden, there is little evidence on the magnitude and direction of such disparities. In this paper, we measure inequality in innovation, by comparing research and development activity with population health and gross domestic product data across 493 therapeutic indications to globally measure: (a) drug innovation, (b) disease burden, and (c) market size. We use concentration curves and indices to assess inequality at two levels: (a) broad disease groups and (b) disease subcategories for both 1990 and 2010. For some top burden disease subcategories (i.e., cardiovascular and circulatory diseases, neoplasms, and musculoskeletal disorders), innovation is disproportionately concentrated in diseases with high disease burden and large market size, whereas for others (i.e., mental and behavioral disorders, neonatal disorders, and neglected tropical diseases) innovation is disproportionately concentrated in low burden diseases. These inequalities persisted over time, suggesting inertia in pharmaceutical research and development in tackling the global health challenges. Our results confirm quantitatively assertions about the mismatch between disease burden and pharmaceutical innovation in both developed and developing countries and highlight the disease areas for which morbidity and mortality remain unaddressed.
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Affiliation(s)
- Eliana Barrenho
- Imperial College Business School Department of Management, Imperial College London, London, UK
- Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, UK
- Hospinnomics, Paris School of Economics, France
| | - Marisa Miraldo
- Imperial College Business School Department of Management, Imperial College London, London, UK
- Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, UK
- Hospinnomics, Paris School of Economics, France
| | - Peter C Smith
- Imperial College Business School Department of Management, Imperial College London, London, UK
- Hospinnomics, Paris School of Economics, France
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18
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Humphries C, Jaganathan S, Panniyammakal J, Singh S, Goenka S, Dorairaj P, Gill P, Greenfield S, Lilford R, Manaseki-Holland S. Investigating clinical handover and healthcare communication for outpatients with chronic disease in India: A mixed-methods study. PLoS One 2018; 13:e0207511. [PMID: 30517130 PMCID: PMC6281223 DOI: 10.1371/journal.pone.0207511] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 11/01/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Research concentrating on continuity of care for chronic, non-communicable disease (NCD) patients in resource-constrained settings is currently limited and focusses on inpatients. Outpatient care requires attention as this is where NCD patients often seek treatment and optimal handover of information is essential. We investigated handover, healthcare communication and barriers to continuity of care for chronic NCD outpatients in India. We also explored potential interventions for improving storage and exchange of healthcare information. METHODS A mixed-methods design was used across five healthcare facilities in Kerala and Himachal Pradesh states. Questionnaires from 513 outpatients with cardiovascular disease, chronic respiratory disease, or diabetes covered the form and comprehensiveness of information exchange between healthcare professionals (HCPs) and between HCPs and patients. Semi-structured interviews with outpatients and HCPs explored handover, healthcare communication and intervention ideas. Barriers to continuity of care were identified through triangulation of all data sources. RESULTS Almost half (46%) of patients self-referred to hospital outpatient clinics (OPCs). Patient-held healthcare information was often poorly recorded on unstructured sheets of paper; 24% of OPC documents contained the following: diagnosis, medication, long-term care and follow-up information. Just 55% of patients recalled receiving verbal follow-up and medication instructions during OPC appointments. Qualitative themes included patient preference for hospital visits, system factors, inconsistent doctor-patient communication and attitudes towards medical documents. Barriers were hospital time constraints, inconsistent referral practices and absences of OPC medical record-keeping, structured patient-held medical documents and clinical handover training. Patients and HCPs were in favour of the introduction of patient-held booklets for storing and transporting medical documents. CONCLUSIONS Deficiencies in communicative practices are compromising the continuity of chronic NCD outpatient care. Targeted systems-based interventions are urgently required to improve information provision and exchange. Our findings indicate that well-designed patient-held booklets are likely to be an acceptable, affordable and effective part of the solution.
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Affiliation(s)
- Claire Humphries
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Suganthi Jaganathan
- Public Health Foundation of India, New Delhi, Delhi, India
- Centre for Chronic Disease Control, New Delhi, Delhi, India
| | - Jeemon Panniyammakal
- Public Health Foundation of India, New Delhi, Delhi, India
- Centre for Chronic Disease Control, New Delhi, Delhi, India
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sanjeev Singh
- Hospital Administration, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Shifalika Goenka
- Public Health Foundation of India, New Delhi, Delhi, India
- Centre for Chronic Disease Control, New Delhi, Delhi, India
| | - Prabhakaran Dorairaj
- Public Health Foundation of India, New Delhi, Delhi, India
- Centre for Chronic Disease Control, New Delhi, Delhi, India
| | - Paramjit Gill
- Academic Unit of Primary Care, University of Warwick, Coventry, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Richard Lilford
- Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Semira Manaseki-Holland
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, United Kingdom
- * E-mail:
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Wang A, Pollack T, Kadziel LA, Ross SM, McHugh M, Jordan N, Kho AN. Impact of Practice Facilitation in Primary Care on Chronic Disease Care Processes and Outcomes: a Systematic Review. J Gen Intern Med 2018; 33:1968-1977. [PMID: 30066117 PMCID: PMC6206351 DOI: 10.1007/s11606-018-4581-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/08/2018] [Accepted: 07/06/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND More than 100 million individuals in the USA have been diagnosed with a chronic disease, yet chronic disease care has remained fragmented and of inconsistent quality. Improving chronic disease management has been challenging for primary care and internal medicine practitioners. Practice facilitation provides a comprehensive approach to chronic disease care. The objective is to evaluate the impact of practice facilitation on chronic disease outcomes in the primary care setting. METHODS This systematic review examined North American studies from PubMed, EMBASE, and Web of Science (database inception to August 2017). Investigators independently extracted and assessed the quality of the data on chronic disease process and clinical outcome measures. Studies implemented practice facilitation and reported quantifiable care processes and patient outcomes for chronic disease. Each study and their evidence were assessed for risk of bias and quality according to the Cochrane Collaboration and the Grade Collaboration tool. RESULTS This systematic review included 25 studies: 12 randomized control trials and 13 prospective cohort studies. Across all studies, practices and their clinicians were aware of the implementation of practice facilitation. Improvements were observed in most studies for chronic diseases including asthma, cancer (breast, cervical, and colorectal), cardiovascular disease (cerebrovascular disease, coronary artery disease, dyslipidemia, hypertension, myocardial infarction, and peripheral vascular disease), and type 2 diabetes. Mixed results were observed for chronic kidney disease and chronic illness care. DISCUSSION Overall, the results suggest that practice facilitation may improve chronic disease care measures. Across all studies, practices were aware of practice facilitation. These findings lend support for the potential expansion of practice facilitation in primary care. Future work will need to investigate potential opportunities for practice facilitation to improve chronic disease outcomes in other health care settings (e.g., specialty and multi-specialty practices) with standardized measures.
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Affiliation(s)
- Andrew Wang
- Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Teresa Pollack
- Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lauren A Kadziel
- Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Samuel M Ross
- Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Megan McHugh
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neil Jordan
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Departments of Psychiatry & Behavioral Sciences and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
| | - Abel N Kho
- Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Jeuring HW, Comijs HC, Deeg DJH, Stek ML, Huisman M, Beekman ATF. Secular trends in the prevalence of major and subthreshold depression among 55-64-year olds over 20 years. Psychol Med 2018; 48:1824-1834. [PMID: 29198199 DOI: 10.1017/s0033291717003324] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Studying secular trends in the exposure to risk and protective factors of depression and whether these trends are associated with secular trends in the prevalence of depression is important to estimate future healthcare demands and to identify targets for prevention. METHODS Three birth cohorts of 55-64-year olds from the population-based Longitudinal Aging Study Amsterdam were examined using identical methods in 1992 (n = 944), 2002 (n = 964) and 2012 (n = 957). A two-stage screening design was used to identify subthreshold depression (SUBD) and major depressive disorder (MDD). Multinomial logistic regression analyses were used to identify secular trends in depression prevalence and to identify factors from the biopsychosocial domains of functioning that were associated with these trends. RESULTS Compared with 1992, MDD became more prevalent in 2002 (OR 1.90, 95% CI 1.10-3.28, p = 0.022) and 2012 (OR 1.80, 95% CI 1.03-3.14, p = 0.039). This was largely attributable to an increase in the prevalence of chronic diseases and functional limitations. Socioeconomic and psychosocial improvements, including an increase in labor market participation, social support and mastery, hampered MDD rates to rise more and were also associated with a 32% decline of SUBD-rates in 2012 as compared with 2002 (OR 0.68, 95% CI 0.48-0.96, p = 0.03). CONCLUSIONS Among late middle-aged adults, there is a substantial net increase of MDD, which is associated with deteriorating physical health. If morbidity and disability continue to increase, a further expansion of MDD rates may be expected. Improving socioeconomic and psychosocial conditions may benefit public health, as these factors were protective against a higher prevalence of both MDD and SUBD.
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Affiliation(s)
- Hans W Jeuring
- Department of Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Hannie C Comijs
- Department of Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Max L Stek
- Department of Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
- Department of Sociology, VU University, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
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Abstract
PURPOSE OF REVIEW The purpose of this study was to review public and private sector obesity policies in Canada and to make recommendations for future evidence-based obesity prevention and management strategies. RECENT FINDINGS Synthesis of obesity prevention and management policies and research studies are presented in three primary themes: (1) Increased awareness about the impact of weight bias and obesity stigma in Canada; (2) Inadequate government obesity prevention and management policies and strategies; and (3) Lack of comprehensive private sector obesity prevention and management policies. Findings suggest that in Canada, obesity continues to be treated as a self-inflicted risk factor, which affects the type of interventions and approaches that are implemented by governments or covered by private health plans. The lack of recognition of obesity as a chronic disease by Canadian public and private payers, health systems, employers, and the public, has a trickle-down effect on access to evidence-based prevention and treatment. Although there is increasing recognition and awareness about the impact of weight bias and obesity stigma on the health and social well-being of Canadians, interventions are urgently needed in education, healthcare, and public policy sectors. We conclude by making recommendations for the advancement of evidence-based obesity prevention and management policies that can improve the lives of Canadians affected by obesity.
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Affiliation(s)
- Arya M Sharma
- University of Alberta, Li Ka Shing Building, Rm 1-116, 87th Avenue and 112th Street, Edmonton, AB, T6G 2E1, Canada
| | - Ximena Ramos Salas
- Canadian Obesity Network, University of Alberta, Li Ka Shing Building, Rm 2-126, 87th Avenue and 112th Street, Edmonton, AB, T6G 2E1, Canada.
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22
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Hou C, Ping Z, Yang K, Chen S, Liu X, Li H, Liu M, Ma Y, Van Halm-Lutterodt N, Tao L, Luo Y, Yang X, Wang W, Li X, Guo X. Trends of Activities of Daily Living Disability Situation and Association with Chronic Conditions among Elderly Aged 80 Years and Over in China. J Nutr Health Aging 2018; 22:439-445. [PMID: 29484359 DOI: 10.1007/s12603-017-0947-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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] [Indexed: 12/01/2022]
Abstract
OBJECTIVES In China, few studies reported the disability situation and the association between disabilities with chronic conditions in aged people. This study investigates the cross-sectional trends of prevalence and severity of activities of daily living disability (ADL) in Chinese oldest-old people from 1998 to 2008, and identified the potential risk factors of disability. DESIGN A combination of population-based longitudinal prospective study and probabilistically sampling cross-sectional studies. SETTING The Chinese Longitudinal Healthy Longevity Survey (CLHLS) was based on a random sampling of aged people from twenty-two provinces in China. PARTICIPANTS A total of 52,667 participants aged from 80 years old to 105 years old sampled in the year of 1998 (n=8,768), 2000 (n=10,940), 2002 (n=10,905), 2005 (n=10,396) and 2008 (n=11,658) were analyzed respectively. RESULTS The prevalence of ADL disability decreased from the year of 1998 (18%) to 2008 (12%). The disability prevalence significantly increased in 2002 and decreased in 2008 (P<0.001) in total participants than the year of 1998. The prevalence trends of low ADL disability level were almost identical with that of the total ADL disability. Stroke/cerebrovascular disease (CVD) and cognitive impairment were the strongest risk factors of disability. Vision impairment became less associated with ADL disability (P=0.045), while the association between multimorbidity and ADL disability became stronger (P=0.033). CONCLUSIONS The prevalence of ADL disability declined among the oldest-old population in China from the year of 1998 to 2008 without obeying a linear pattern. Temporal trends of ADL disability mainly attributed to the change of low disability level prevalence. Stroke/CVD and cognitive impairment were the most common risk factors of disability. Vision impairment caused disability has become less common, while risks of multimorbidity related disability increased.
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Affiliation(s)
- C Hou
- Xiuhua Guo, PhD, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, 100069, China. E-mail:
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23
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Abstract
Chronic disease is common, costly and the epidemic of the 21st century. Primary care providers seek new and innovative approaches to prevent chronic illness. Since the majority of chronic illness management occurs outside a physician's office, providers must use different techniques to support daily self-management of any chronic illness. Assisting the individual to develop life skills to support self-management is one way to improve patient outcomes. Technology, that is easily accessed, may provide an additional method to develop and individual's self-management skills to prevent diabetes.
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24
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Onizuka N, Gaichas A, Roesler J. Hospital-Treated Falls and Comorbidities Among Older Adults in Minnesota, 2010-2014. Minn Med 2017; 100:40-44. [PMID: 30428185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Falls are a serious concern for older adults as they frequently result in injury, disability and even death. In older adults in Minnesota, the number and rate of hospital-treated falls have been increasing, for both males and females. The purpose of this study was to estimate trends in falls among older adults in Minnesota, and to examine whether there is an association between severe outcomes of falls and predictors. We investigated hospital-treated (both emergency department treatment and hospitalizations) falls among adults 65 years and older in Minnesota between 2010 and 2014, using hospital discharge data from the Minnesota Hospital Association. In total, 199,364 cases were identified; this represents a rate of 5,281.4/100,000 during the five-year period. We found the number of hospital-treated falls increased each year by 1,820 cases on average, for an average rate increase of 108.3/100,000 per year. The rate for falls with no comorbidities decreased, while the rate for falls with one or more comorbidities increased: Also, comorbidities were more likely among hospitalized and/ or fatal cases than among nonhospitalized and/or nonfatal cases. The most frequent principal injury diagnoses associated with falls included fractures (31.7% of total hospital-treated falls), superficial wounds/contusions (14.7%), open wounds (10.9%) and traumatic brain injuries (TBIs) (3.9%). The most frequent type of fracture was hip fracture (29.1 %). Additional complications commonly occurring during hospital treatment of injury resulting from a fall included urinarytract infection (7.2%), pneumonia (2.2%), pressure ulcer (1.2%) and sepsis (0.9%). Among these, sepsis had the highest odds ratio of 9.9 for death. These data show the burden of falls is greatest among those who are 85 and older and/or who have one or more comorbidities.
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Abstract
This review article addresses the concept of the social determinants of health (SDH), selected theories, and its application in studies of chronic disease. Once ignored or regarded only as distant or secondary influences on health and disease, social determinants have been increasingly acknowledged as fundamental causes of health afflictions. For the purposes of this discussion, SDH refers to SDH variables directly relevant to chronic diseases and, in some circumstances, obesity, in the research agenda of the Mid-South Transdisciplinary Collaborative Center for Health Disparities Research. The health effects of SDH are initially discussed with respect to smoking and the social gradient in mortality. Next, four leading SDH theories-life course, fundamental cause, social capital, and health lifestyle theory-are reviewed with supporting studies. The article concludes with an examination of neighborhood disadvantage, social networks, and perceived discrimination in SDH research.
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Affiliation(s)
- William C Cockerham
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama;.
| | - Bryant W Hamby
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gabriela R Oates
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Cho Y, Cudhea F, Park JH, Lee JT, Mozaffarian D, Singh G, Shin MJ. Estimating change in cardiovascular disease and diabetes burdens due to dietary and metabolic factors in Korea 1998-2011: a comparative risk assessment analysis. BMJ Open 2016; 6:e013283. [PMID: 28003293 PMCID: PMC5223650 DOI: 10.1136/bmjopen-2016-013283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Over the past 10 years, the burden of chronic diseases in Korea has increased. However, there are currently no quantitative estimates of how changes in diet and metabolic factors have contributed to these shifting burdens. This study aims to evaluate the contributions of dietary and metabolic risk factors to death from cardiometabolic diseases (CMDs) such as cardiovascular conditions, strokes and diabetes in Korea, and to estimate how these contributions have changed over the past 10 years (1998-2011). DESIGN AND METHODS We used data on 6 dietary and 4 metabolic risk factors by sex, age and year from the Korea National Health and Nutrition Examination Survey. The relative risks for the effects of the risk factors on CMD mortality were obtained from meta-analyses. The population-attributable fraction attributable to the risk factors was calculated by using a comparative risk assessment approach across sex and age strata (males and females, age groups 25-34, 35-44, 45-54, 55-64, 65-74 and 75+ years) from 1998 to 2011. RESULTS The results showed that a suboptimal diet and high blood pressure were the main risk factors for CMD mortality in Korea. High blood pressure accounted for 127 096 (95% uncertainty interval (UI): 121 907 to 132 218) deaths from CMD. Among the individual dietary risk factors, a high intake of sodium (42 387 deaths; 95% UI: 42 387 to 65 094) and a low intake of fruit (50 244 deaths; 95% UI: 40 981 to 59 178) and whole grains (54 248 deaths; 95% UI: 47 020 to 61 343) were responsible for the highest number of CMD deaths in Korea. CONCLUSIONS Indicating the relative importance of risk factors in Korea, the results suggest that metabolic and dietary risk factors were major contributors to CMD mortality.
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Affiliation(s)
- Yoonsu Cho
- Department of Public Health Sciences, BK21PLUS Program in Embodiment: Health-Society Interaction, Graduate School, Korea University, Seoul, Republic of Korea
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Ju-Hyun Park
- Department of Statistics, Dongguk University, Seoul, Republic of Korea
| | - Jong-Tae Lee
- Department of Public Health Sciences, BK21PLUS Program in Embodiment: Health-Society Interaction, Graduate School, Korea University, Seoul, Republic of Korea
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Gitanjali Singh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Min-Jeong Shin
- Department of Public Health Sciences, BK21PLUS Program in Embodiment: Health-Society Interaction, Graduate School, Korea University, Seoul, Republic of Korea
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Abstract
This article explores the spatio-temporal logics at work in global health. Influenced by ideas of time-space compression, the global health literature argues that the world is characterised by a convergence of disease patterns and biomedical knowledge. While not denying the influence of these temporalities and spatialities of globalisation within the global health and chronic disease field, the article argues that they sit alongside other, often-conflicting notions of time and space. To do so, it explores the spatio-temporal logics that underpin a highly influential epidemiological model of the smoking epidemic. Unlike the temporalities and spatialities of sameness described in much of the global health literature, the article shows that this model is articulated around temporalities and spatialities of difference. This is not the difference celebrated by postmoderns, but the difference of modernisation theorists built around nations, sequential stages and progress. Indeed, the model, in stark contrast to the 'one world, one time, one health' globalisation mantra, divides the world into nation-states and orders them along epidemiological, geographical and development lines.
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Affiliation(s)
- David Reubi
- Department of Social Science, Health and Medicine, King's College London, London WC2R 2LS, United Kingdom.
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