Major depressive disorder, suicidal behaviour, bipolar disorder, and generalised anxiety disorder among emerging adults with and without chronic health conditions

Background.Despite the considerable physical, emotional and social change that occurs during emerging adulthood, there is little research that examines the association between having a chronic health condition and mental disorder during this developmental period. The aims of this study were to examine the sex-specific prevalence of lifetime mental disorder in an epidemiological sample of emerging adults aged 15–30 years with and without chronic health conditions; quantify the association between chronic health conditions and mental disorder, adjusting for sociodemographic and health factors; and, examine potential moderating and mediating effects of sex, level of disability and pain.Method.Data come from the Canadian Community Health Survey-Mental Health. Respondents were 15–30 years of age (n = 5947) and self-reported whether they had a chronic health condition. Chronic health conditions were classified as: respiratory, musculoskeletal/connective tissue, cardiovascular, neurological and endocrine/digestive. The World Health Organization Composite International Diagnostic Interview 3.0 was used to assess the presence of mental disorder (major depressive disorder, suicidal behaviour, bipolar disorder and generalised anxiety disorder).Results.Lifetime prevalence of mental disorder was significantly higher for individuals with chronic health conditions compared with healthy controls. Substantial heterogeneity in the prevalence of mental disorder was found in males, but not in females. Logistic regression models adjusting for several sociodemographic and health factors showed that the individuals with chronic health conditions were at elevated risk for mental disorder. There was no evidence that the level of disability or pain moderated the associations between chronic health conditions and mental disorder. Sex was found to moderate the association between musculoskeletal/connective tissue conditions and bipolar disorder (β = 1.71, p = 0.002). Exploratory analyses suggest that the levels of disability and pain mediate the association between chronic health conditions and mental disorder.Conclusions.Physical and mental comorbidity is prevalent among emerging adults and this relationship is not augmented, but may be mediated, by the level of disability or pain. Findings point to the integration and coordination of public sectors – health, education and social services – to facilitate the prevention and reduction of mental disorder among emerging adults with chronic health conditions.

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Shared Vision: Concordance Among Fathers, Mothers, and Pediatricians About Unmet Needs of Children With Chronic Health Conditions

PEDIATRICS ◽

10.1542/peds.105.s2.277 ◽

2000 ◽

Vol 105 (Supplement_2) ◽

pp. 277-285

Author(s):

Ellen C. Perrin ◽

Corinne Lewkowicz ◽

Martin H. Young

Keyword(s):

Primary Care Physicians ◽

Unmet Needs ◽

Chronic Health Condition ◽

Health Condition ◽

Shared Vision ◽

Chronic Health Conditions ◽

Health Conditions ◽

Pediatric Practice ◽

Chronic Health ◽

The Face

Objective. These analyses were undertaken to investigate the number and types of services and assistance believed to be useful to children with a chronic health condition and their families. The perspective of mothers, fathers, and primary care physicians were sought separately and compared. Methods. Families that include at least 1 child with a chronic health condition were selected from pediatric practices in Central Massachusetts. All 3 respondents completed a questionnaire describing their own perspective of current needs and of the severity of the child's condition. The 3 perspectives are compared statistically and areas of agreement/disagreement are described. Results. Mothers, fathers, and physicians described children's and families' needs with a surprising degree of concordance. On the other hand, pediatricians identified fewer needs, despite rating the severity of children's illnesses as greater than did parents. Mothers and fathers agreed substantially about the level of severity of their child's condition and about their unmet needs. Conclusions. It is important that pediatric practice systems include effective mechanisms to assess parents' opinions regarding the unmet needs of their child/family in the face of a child with a chronic health condition. Without input from families, pediatricians are aware of only some of the needs that parents identify. Pediatrics 2000;105:277–285;children, chronic health condition.

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Burden of Morbidity in 10+ Year Survivors of Hematopoietic Cell Transplantation (HCT): A Report From the Bone Marrow Transplant Survivor Study (BMTSS)

Blood ◽

10.1182/blood.v118.21.841.841 ◽

2011 ◽

Vol 118 (21) ◽

pp. 841-841

Author(s):

Can-Lan Sun ◽

John H. Kersey ◽

Liton Francisco ◽

K. Scott Baker ◽

Saro H. Armenian ◽

...

Keyword(s):

Cumulative Incidence ◽

Chronic Health Condition ◽

Health Condition ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

Somatic Distress ◽

Healthcare Needs ◽

Life Threatening

Abstract Abstract 841FN2 Background: High-intensity therapeutic exposures and prolonged immunosuppression increase the risk of long-term complications after HCT, with an attendant increase in the healthcare needs of these long-term survivors. We have previously demonstrated that morbidity increases with increasing time after HCT (Sun CL, Blood, 2010;116:3129–39). However, the burden of morbidity in patients who survive extended lengths of time after HCT and the consequent healthcare needs of these survivors are unknown. Methods: Utilizing resources offered by the BMTSS, we evaluated the risk of chronic health conditions and psychological health of 366 10+ year HCT survivors and their siblings (n=309). A severity score (grade 1 [mild]; grade 2 [moderate], grade 3[severe], grade 4 [life-threatening], and grade 5 [death due to chronic health condition]) was assigned to each health condition using the CTCAE, v3.0. Cumulative incidence of chronic health conditions was evaluated, using competing risks method. Brief Symptom Inventory (BSI) was used to describe adverse psychological health. Multivariate regression analysis allowed identification of vulnerable subgroups. The current status of healthcare utilization by the HCT survivors was also evaluated. Results: The mean age at HCT was 22 years (range: 0.4–59.8) and at study participation was 37 years (range: 11–72); mean length of follow-up was 15 years (range: 10–28). Primary diagnoses included AML (28%), ALL (17%), CML (17%), NHL (11%), aplastic anemia (11%), HL (7%), and other diagnoses (9%). Stem cell graft was autologous (27%); allogeneic related (65%) and unrelated donor (8%); 72% of the patients received TBI-based conditioning. At least one chronic health condition was reported by 74% of the HCT survivors, compared with 29% of siblings (p<0.001); 25% of the survivors reported severe/life-threatening conditions compared to only 8% of the siblings (p<0.001). Commonly reported severe/life-threatening chronic health conditions included myocardial infarction, stroke, blindness, diabetes, musculoskeletal problems, and subsequent malignancies. As shown in Figure 1A, the 15-year cumulative incidence of any chronic health condition (grades 1–5) was 71% (95% CI, 67–75%), and of severe-life-threatening conditions or death was 40% (95% CI, 33–47%). HCT survivors were 5.6 times as likely to develop a severe/life-threatening condition (95% CI, 3.7–8.6), compared with age- and sex-matched siblings. The cumulative incidence of severe/life-threatening conditions did not differ by type of HCT (p=0.79, Figure 1B). Using BSI, we evaluated somatic distress, anxiety, and depression among HCT survivors and their siblings. While the prevalence of anxiety and depression were comparable between survivors and siblings, HCT survivors were 2.7 times more likely to report somatic distress (p<0.001). Among survivors, female gender (OR=3.6, 95% CI, 1.4–9.0), low household income (<$20,000 OR=4.4, 95% CI, 1.1–17.2), and poor self-rated health status (OR=10.6, 95% CI, 4.0–27.9) were associated with increased risk for somatic distress. Fortunately, 90% of HCT survivors carried health insurance coverage, because a high proportion needed ongoing specialized medical care; 69% of the HCT survivors reported cancer/HCT-related visits at an average of 15 years after HCT. Conclusions: The burden of long-term physical and emotional morbidity borne by 10+ year HCT survivors is substantial, resulting in a high utilization of specialized healthcare. Patients, families and healthcare providers need to be made aware of the high burden, such that they can plan for post-HCT care, even many years after HCT. Disclosures: No relevant conflicts of interest to declare.

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Long-Term Health-Related Outcomes In Survivors Of Childhood Hematopoietic Cell Transplantation (HCT): A Report From The Bone Marrow Transplant Survivor Study (BMTSS)

Blood ◽

10.1182/blood.v122.21.553.553 ◽

2013 ◽

Vol 122 (21) ◽

pp. 553-553

Author(s):

Saro Armenian ◽

Can-Lan Sun ◽

Mukta Arora ◽

K. Scott Baker ◽

Liton Francisco ◽

...

Keyword(s):

Premature Death ◽

Chronic Health Condition ◽

Health Condition ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

Allogeneic Hct ◽

Increased Risk ◽

Life Threatening ◽

Grade 3

Abstract Introduction HCT is frequently offered as a curative option for children with benign and malignant conditions. Improvement in HCT strategies have increased survival by approximately 10% per decade. Adult HCT survivors are at increased risk for chronic health conditions (Sun, Blood 2010), and premature death (Bhatia, Blood 2007; 2005). The magnitude of risk of these chronic health conditions and of premature death in childhood HCT survivors is not known. Methods Participants were drawn from the BMTSS, and included patients undergoing HCT between 1976 and 1998 at City of Hope or University of Minnesota. Participants were ≤21 years of age at HCT and were ≥2 yrs from myeloablative HCT. Participants completed a questionnaire addressing the diagnosis of physical health conditions (endocrinopathies, central nervous system compromise, cardiopulmonary dysfunction, gastrointestinal sequelae, musculoskeletal abnormalities, and subsequent malignancies), chronic GvHD (cGVHD), and sociodemographics. Chronic physical health conditions were graded using CTCAE v 3.0 (grade 1-5, ranging from mild to death due to chronic health condition). Relative risk (RR) regression was used to identify risk of health conditions and 95% confidence interval (CI). Information on vital status and cause of death was obtained from medical records, National Death Index, and Social Security Death Index, and compared with age-, sex-and calendar-specific mortality of the US general population (standardized mortality ratio [SMR]). Results The current study included 317 BMTSS participants. Median age at HCT was 7.9 yrs, and at study participation was 19.9 yrs; time from HCT was 10.3 yrs; 42% were female, 86.7% were non-Hispanic white, and 79% underwent allogeneic HCT. The most frequent indications for HCT included AML (27%), ALL (21%), SAA (13%), lymphoma (6%), and CML (5%). Total body irradiation (TBI) was used in 61% of 2 year survivors, and cGvHD was reported in 26%. Health Conditions: The cumulative incidence of a chronic health condition (grade 1-5) was 56% (95% CI: 51%-60%) at 15 years after HCT, with a cumulative incidence of 25% (95% CI: 20%-30%) for severe/life-threatening or fatal condition (grade 3-5, Figure). The highest incidence of grade 3-5 conditions was in allogeneic HCT recipients with cGvHD (32% at 15 years, 95% CI: 20%-44%; Figure). Risk Factors: After adjustment for age at HCT, follow-up, ethnicity/race, diagnosis, relapse risk at HCT, and treatment era, female participants were 1.2 (1.0-1.4, p=0.02) times more likely to report a chronic health condition, and 1.6 (1.1-2.4, p=0.01) times more likely to report a severe/life-threatening/fatal condition. Exposure to TBI was associated with a 1.3-fold (1.0-1.5, p=0.02) risk of a chronic health condition, and a 2.6-fold (1.4-4.91, p=0.003) risk of a severe/life-threatening/fatal condition compared to chemotherapy-only conditioning. Among allogeneic HCT recipients, cGvHD was associated with a 2.0-fold (1.2-3.2, p<0.01) risk of severe/life-threatening/fatal conditions when compared to survivors without cGvHD. Healthcare utilization: 92% of the survivors carried health insurance and 68% had been seen at their transplant center within the past 2 yrs. Late mortality: Overall survival in 2 year survivors was 80% at 10 years (68% autologous, 83% allogeneic, p<0.01). The primary cause of death included primary disease (61%), secondary cancer (8%), cGvHD (6%), cardiopulmonary compromise (5%), and other causes (21%). The cohort was at a 22-fold (SMR 22.0, 18.9-25.5, p<0.01) increased risk of premature death compared to age-and sex-matched general population. Female participants, those treated with TBI, and autologous HCT survivors had the highest risk of premature death (Table). Conclusions Childhood HCT survivors carry a substantial burden of morbidity, years following completion of therapy, providing clear evidence for their close monitoring in a specialized setting targeting these high risk complications. Disclosures: No relevant conflicts of interest to declare.

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53 Health Outcomes of Siblings of Children with Chronic Health Conditions: A Systematic Review and Meta-Analysis

Paediatrics & Child Health ◽

10.1093/pch/pxab061.042 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e38-e39

Author(s):

Benjamin Martinez ◽

Petros Pechlivanoglou ◽

Dorisa Meng ◽

Benjamin Traubici ◽

Quenby Mahood ◽

...

Keyword(s):

Health Outcomes ◽

Rating Scale ◽

Well Being ◽

Chronic Health Condition ◽

Health Condition ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

Increased Risk ◽

Scale Scores

Abstract Primary Subject area Mental Health Background Chronic childhood health conditions are known to have an impact on the well-being of family members. Parental caregivers face well-defined adverse health outcomes, though less is known about the health impacts on siblings. Objectives To assess clinical health outcomes in siblings of children with chronic health condition(s) compared to siblings of healthy children or normative data. Design/Methods We searched Ovid MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, PsycInfo, and CINAHL through June 4, 2020. We included English-language studies that: (1) reported clinically diagnosable mental or physical health outcomes of siblings of children (0-18 years old) diagnosed with any childhood chronic health condition; (2) included a comparison group; and (3) used an experimental or observational study design. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results We included 28 studies of the 9053 screened, comprising 10 cohort studies and 18 cross-sectional studies. Studies from 11 different countries reported most commonly on siblings of children with disabilities (12 studies), cancer (8 studies), or psychiatric disorders (4 studies). Siblings of children with chronic conditions had greater depression rating scale scores than their comparison groups (standardized mean difference 0.49; 95% CI 0.33-0.65; P < .001 [5 studies]) (Fig. 1), whereas anxiety scores did not differ significantly (standardized mean difference 0.24; 95% CI -0.03-0.52; P = .08 [6 studies]) (Fig. 2). Studies that reported on prevalence of psychiatric diagnoses, rather than rating scale scores, had mixed results, either indicating increased risk (3 studies) or no increased risk (4 studies) among exposed siblings. We did not meta-analyze effects for mortality (3 studies) or physical health outcomes (dental caries [1 study], traumatic brain injury [1 study], sexually transmitted infection [1 study], overweightness/obesity [1 study]) given the limited number of studies and between-study heterogeneity. Included studies were rated as high quality (12 studies) or of moderate quality (16 studies). Conclusion Siblings of children with chronic health conditions may be at an increased risk of depression. Our findings suggest the need for targeted interventions to support the psychological well-being of siblings of children with chronic health conditions.

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Online psychological interventions to reduce symptoms of depression, anxiety, and general distress in those with chronic health conditions: a systematic review and meta-analysis of randomized controlled trials

Psychological Medicine ◽

10.1017/s0033291720002251 ◽

2020 ◽

pp. 1-26

Author(s):

V. White ◽

J. Linardon ◽

J. E. Stone ◽

E. Holmes-Truscott ◽

L. Olive ◽

...

Keyword(s):

Chronic Health Condition ◽

Health Condition ◽

Chronic Health Conditions ◽

Health Conditions ◽

Psychological Interventions ◽

Web Based ◽

Chronic Health ◽

Symptoms Of Depression ◽

Randomized Controlled ◽

Anxiety Depression

Abstract Background Over the past 15 years, there has been substantial growth in web-based psychological interventions. We summarize evidence regarding the efficacy of web-based self-directed psychological interventions on depressive, anxiety and distress symptoms in people living with a chronic health condition. Method We searched Medline, PsycINFO, CINAHL, EMBASE databases and Cochrane Database from 1990 to 1 May 2019. English language papers of randomized controlled trials (usual care or waitlist control) of web-based psychological interventions with a primary or secondary aim to reduce anxiety, depression or distress in adults with a chronic health condition were eligible. Results were assessed using narrative synthases and random-effects meta-analyses. Results In total 70 eligible studies across 17 health conditions [most commonly: cancer (k = 20), chronic pain (k = 9), arthritis (k = 6) and multiple sclerosis (k = 5), diabetes (k = 4), fibromyalgia (k = 4)] were identified. Interventions were based on CBT principles in 46 (66%) studies and 42 (60%) included a facilitator. When combining all chronic health conditions, web-based interventions were more efficacious than control conditions in reducing symptoms of depression g = 0.30 (95% CI 0.22–0.39), anxiety g = 0.19 (95% CI 0.12–0.27), and distress g = 0.36 (95% CI 0.23–0.49). Conclusion Evidence regarding effectiveness for specific chronic health conditions was inconsistent. While self-guided online psychological interventions may help to reduce symptoms of anxiety, depression and distress in people with chronic health conditions in general, it is unclear if these interventions are effective for specific health conditions. More high-quality evidence is needed before definite conclusions can be made.

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Determinants for the implementation of person-centered tools for workers with chronic health conditions: a mixed-method study using the Tailored Implementation for Chronic Diseases checklist

BMC Public Health ◽

10.1186/s12889-021-11047-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

N. Zipfel ◽

B. Horreh ◽

C. T. J. Hulshof ◽

A. Suman ◽

A. G. E. M. de Boer ◽

...

Keyword(s):

Focus Group ◽

Chronic Health Condition ◽

Health Condition ◽

Chronic Health Conditions ◽

Health Conditions ◽

Structured Interviews ◽

Chronic Health ◽

Occupational Physicians ◽

Tailored Implementation ◽

Insurance Physicians

Abstract Background The aim was to identify the most important determinants of practice for the implementation of person-centered tools which enhance work participation for patients with chronic health conditions. Methods A mixed-method study was conducted consisting of semi-structured interviews, a focus group and a survey. Various stakeholders were involved including (representatives of) workers with chronic health conditions, insurance physicians, occupational physicians, other healthcare professionals, researchers, employers, and policymakers. The semi-structured interviews were performed to identify implementation determinants, followed by a focus group to validate resulting determinants. To conclude, a survey was conducted to select the most important implementation determinants through prioritization by ranking the order of importance. The Tailored Implementation of Chronic Diseases checklist (TICD) was used as concept-driven coding frame for the qualitative analysis of the interviews and focus group. The self-developed survey was based on the domains of the TICD. The survey was analyzed by frequency count of first ranking of determinants per and between domains of the TICD. Results Various stakeholders participated (N = 27) in the interviews and focus group. The qualitative data retrieved yielded a list of determinants with additional in-depth themes according to the TICD. For the selection of the most important determinants, a survey with 101 respondents was conducted, consisting of occupational physicians, insurance physicians and workers with a chronic health condition. From the seven domains of the TICD, respondents emphasized the importance of taking into account the needs and factors associated with workers with a chronic health condition as this determinant ranked highest. Taking into account the individual needs and wishes of workers was mentioned to enable successful implementation, whereas stress of the workers was indicated to impede implementation. Other important determinants included ‘being able to work with the tools’ in terms of time and usability or ‘cognitions, beliefs and attitudes of occupational and insurance physicians’ to be able to use the tools. Conclusion This study identified the most important determinants from the perspective of various stakeholders involved in the implementation of client-centered tools in occupational health for workers with chronic health conditions. Furthermore, by prioritizing the most important determinants, targeted implementation strategies can be developed.

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Adding a fatigue item to the EQ-5D-5L improves its psychometric performance in the general population

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-021-00406-x ◽

2022 ◽

Vol 6 (1) ◽

Author(s):

Inge Spronk ◽

Suzanne Polinder ◽

Gouke J. Bonsel ◽

M. F. Janssen ◽

Juanita A. Haagsma

Keyword(s):

General Population ◽

Convergent Validity ◽

Explanatory Power ◽

Population Sample ◽

Chronic Health Condition ◽

Health Condition ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

Psychometric Performance

Abstract Background Fatigue is a common and often disturbing sequela of serious chronic health conditions. In the widely applied HRQL instrument, the EQ-5D, this aspect is not included directly, for its assumed lack of additional information. We investigated the validity of this assumption by determining the gain—if any—of an additional fatigue item to the EQ-5D-5L in a general population sample. Methods A Dutch general population sample (including diseased people) completed a web-based survey including the EQ-5D-5L and the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). The RPQ fatigue item was used to create the EQ-5D-5L + Fatigue. We head-to-head compared the psychometric performance contrasting the EQ-5D-5L and EQ-5D-5L + Fatigue: distribution (e.g. ceiling), informativity cf. Shannon's indices, convergent validity, domain dependency, and explanatory power. Results were compared between subgroups with and without ≥ 1 chronic health condition. Results The study population consisted of 3027 persons of whom 52% had a chronic health condition. The mean EQ-5D-5L utility score was 0.83 and 48% experienced some degree of fatigue. Adding the fatigue item to the EQ-5D-5L decreased the ceiling effect, increased absolute informativity (Hʹ = 6.44 vs. Hʹ = 4.90) and relative informativity (Jʹ = 0.46 vs. Jʹ = 0.42). The extra fatigue item slightly increased convergent validity (Spearman’s rank correlation coefficient = − 0.61 vs. − 0.62). Domain dependency analysis showed that all EQ-5D-5L domains are dominant over the fatigue item. Explanatory power of the EQ-5D-5L + Fatigue was higher compared to the EQ-5D-5L (R2 = 0.42 vs. 0.39). The gain is substantially larger in the subgroup with chronic health conditions. Conclusions Adding a fatigue item to the EQ-5D-5L improved all psychometric performance criteria of the enriched instrument in the general population. Effects are substantially larger in the subgroup with chronic health conditions, indicating that adding a fatigue item to the EQ-5D-5L is especially relevant in evaluating the HRQL of diseased people.

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Nativity, Chronic Health Conditions, and Health Behaviors in Filipino Americans

Journal of Transcultural Nursing ◽

10.1177/1043659617703164 ◽

2017 ◽

Vol 29 (3) ◽

pp. 249-257 ◽

Cited By ~ 3

Author(s):

Maria L. G. Bayog ◽

Catherine M. Waters

Keyword(s):

United States ◽

Health Behaviors ◽

Asian American ◽

The United States ◽

Chronic Health Condition ◽

Health Condition ◽

Chronic Health Conditions ◽

Health Conditions ◽

California Health Interview Survey ◽

Chronic Health

Introduction: Nearly half of Americans have a chronic health condition related to unhealthful behavior. One in four Americans is an immigrant; yet immigrants’ health has been studied little, particularly among Asian American subpopulations. Methodology: Years lived in United States, hypertension, diabetes, smoking, walking, adiposity, and fruit/vegetable variables in the 2011-2012 California Health Interview Survey were analyzed to examine the influence of nativity on chronic health conditions and health behaviors in 555 adult Filipinos, the second largest Asian American immigrant subpopulation. Results: Recent and long-term immigrant Filipinos had higher odds of having hypertension and diabetes, but lower odds of smoking and overweight/obesity compared with second-generation Filipinos. Discussion: Being born in the United States may be protective against chronic health conditions, but not for healthful behaviors among Filipinos. Chronic disease prevention and health promotion strategies should consider nativity/length of residence, which may be a more consequential health determinant than other immigration and acculturation characteristics.

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Differential Morbidity by Ethnicity in Long-Term Survivors of Hematopoietic Cell Transplantation (HCT): A Report from the Bone Marrow Transplant Survivor Study (BMTSS)

Blood ◽

10.1182/blood.v112.11.454.454 ◽

2008 ◽

Vol 112 (11) ◽

pp. 454-454

Author(s):

Saro Armenian ◽

Can-Lan Sun ◽

Liton Francisco ◽

K. Scott Baker ◽

Stephen J. Forman ◽

...

Keyword(s):

Chronic Health Condition ◽

Health Condition ◽

Chronic Health Conditions ◽

Health Conditions ◽

Malignant Neoplasms ◽

Chronic Health ◽

Allogeneic Hct ◽

Healthcare Needs ◽

Life Threatening

Abstract Improvement in transplantation strategies have contributed to incremental change in post-HCT survival rates of 10% per decade; but this improvement is not enjoyed equally by all. Data from the CIBMTR (J Clin Oncol2005;23:7032–42) found Hispanics to be at a higher risk of treatment failure (relapse or death: hazard ratio [HR]=1.3, 95% confidence interval [CI], 1.1–1.5), when compared to non-Hispanic whites. According to the 2005 census, Hispanics form the largest ethnic minority group in the U.S., constituting 14.4% of the entire population. Compared to non-Hispanic whites, Hispanics are considered to be a vulnerable population for adverse health outcomes, due to reasons that include socioeconomic, cultural, and language barriers as well as barriers within the healthcare system. The purpose of this study was to determine the prevalence of and risk factors for chronic health conditions in a large population of Hispanic and non-Hispanic white HCT survivors. The BMTSS (a collaborative effort between City of Hope National Medical Center and University of Minnesota) examined self-reported chronic health conditions in individuals who underwent HCT between 1976 and 1998, and survived two or more years. A severity score (grade 1 through 4, ranging from mild to life-threatening or disabling) was assigned to each health condition according to the Common Terminology Criteria for Adverse Events (version 3). Some of the conditions graded as severe (grade 3) or life-threatening (grade 4) in this study included congestive heart failure, second malignant neoplasms, cerebrovascular accident, renal failure, and active chronic graft vs. host disease (GvHD). Adverse psychosocial outcomes were not included. Cox proportional-hazard models were used to estimate HR and 95% CI. The current study included 984 HCT survivors (443 [45.0%] allogeneic HCT and 541 [55.0%] autologous HCT recipients; 825 [83.8%] non-Hispanic whites and 159 [16.2%] Hispanics). Median age at study participation was 44.5 years (range, 18.2–73.0) for whites and 41.5 years (range 20.0–67.4) for Hispanics, and median follow-up was 7.3 years (range 2.0–27.8) and 8.0 years (range 2.5–25.2), respectively. There were no differences with respect to gender, BMI, presence of active chronic GvHD, relapse risk, and cancer surveillance practices, between the two ethnic groups. Hispanics were significantly less likely to have completed high school (55.1% vs. 96.6%, p<0.001) and to be currently insured (75.9% vs. 93.7%, p<0.001). Hispanics were significantly more likely to have undergone allogeneic HCT (67.9% vs. 52.5%; P<0.01), and received the majority of their continued medical care at a cancer center (90.1% vs. 77.8%; p<0.01). Hispanics were significantly less likely to report a chronic health condition of any severity (60.4% vs. 72.0%; p<0.01). In fact, the cumulative incidence of a self-reported severe/life threatening chronic health condition was significantly higher for whites, when compared with Hispanics (54% vs. 41% at 10 years after HCT, p=0.02). After adjustment for age at HCT, gender, health insurance, primary diagnosis, type of HCT, exposure to TBI, length of follow-up after HCT, exposure to alcohol and tobacco, non-Hispanic whites were 1.34 (95% CI, 1.1–1.6) times as likely as Hispanics to report a chronic health condition; 1.38 (1.0–1.8) times as likely to report a mild/moderate condition; and 1.39 (1.1–1.8) times more likely to report a severe/life threatening condition. However, adjustment for education resulted in a mitigation of the ethnic differences, and the residual differences in chronic health conditions between whites and Hispanics were statistically non-significant (HR=1.18 [0.95–1.5, p=0.1], 1.13 [0.9–1.5, p=0.40, and 1.16 [0.9–1.5], respectively). This study demonstrates that the ability to self-report the presence of chronic health conditions may be a function of the educational status, and underscores the critical need for culturally adapted awareness of healthcare needs and issues among the educationally disadvantaged survivors, in order to improve their ability to seek and obtain adequate healthcare and reduce the associated morbidity and mortality.

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Multimorbidity among people with HIV in regional New South Wales, Australia

Sexual Health ◽

10.1071/sh14070 ◽

2015 ◽

Vol 12 (5) ◽

pp. 425 ◽

Cited By ~ 8

Author(s):

Natalie Edmiston ◽

Erin Passmore ◽

David J. Smith ◽

Kathy Petoumenos

Keyword(s):

Rating Scale ◽

Transcriptase Inhibitor ◽

Chronic Health Condition ◽

Health Condition ◽

Chronic Health Conditions ◽

Health Conditions ◽

Hiv Positive ◽

Chronic Health ◽

Factors Associated ◽

Care Models

Background Multimorbidity is the co-occurrence of more than one chronic health condition in addition to HIV. Higher multimorbidity increases mortality, complexity of care and healthcare costs while decreasing quality of life. The prevalence of and factors associated with multimorbidity among HIV positive patients attending a regional sexual health service are described. Methods: A record review of all HIV positive patients attending the service between 1 July 2011 and 30 June 2012 was conducted. Two medical officers reviewed records for chronic health conditions and to rate multimorbidity using the Cumulative Illness Rating Scale (CIRS). Univariate and multivariate linear regression analyses were used to determine factors associated with a higher CIRS score. Results: One hundred and eighty-nine individuals were included in the study; the mean age was 51.8 years and 92.6% were men. One-quarter (25.4%) had ever been diagnosed with AIDS. Multimorbidity was extremely common, with 54.5% of individuals having two or more chronic health conditions in addition to HIV; the most common being a mental health diagnosis, followed by vascular disease. In multivariate analysis, older age, having ever been diagnosed with AIDS and being on an antiretroviral regimen other than two nucleosides and a non-nucleoside reverse transcriptase inhibitor or protease inhibitor were associated with a higher CIRS score. Conclusion: To the best of our knowledge, this is the first study looking at associations with multimorbidity in the Australian setting. Care models for HIV positive patients should include assessing and managing multimorbidity, particularly in older people and those that have ever been diagnosed with AIDS.

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