scholarly journals Clustering and Healthcare Costs With Multiple Chronic Conditions in a US Cross-Sectional Study

2020 ◽  
Author(s):  
cother hajat ◽  
yakir siegal ◽  
amalia adler-waxman
Keyword(s):  
Mental Health ◽  
Chronic Conditions ◽  
Healthcare Costs ◽  
Multiple Chronic Conditions ◽  
Cross Sectional ◽  
The Us ◽  
Health Related ◽  
Insured Patients ◽  
The Impact ◽  
Hiv Aids

Objective To investigate healthcare costs and contributors to costs for multiple chronic conditions (MCCs), common clusters of conditions and their impact on cost and utilisation. Methods This was a cross-sectional analysis of US financial claims data representative of the US population, including Medicare, Medicaid and Commercial insurance claims in 2015. Outcome measures included healthcare costs and contributors; ranking of clusters of conditions according to frequency, strength of association and unsupervised (k-means) analysis; the impact of clustering on costs and contributors to costs. Results Of 1,878,951 patients, 931,045(49.6%) had MCCs, 56.5% weighted to the US population. Mean age was 53.0 years(SD16.7); 393,121(42.20%) were male. Mean annual healthcare spending was $12,601, ranging from $4,385 (2 conditions) to $33,874 (11 conditions), with spending increasing by 22-fold for inpatient services, 6-fold for outpatient services, 4.5-fold for generic drugs and 4.2-fold for branded drugs. Cluster ranking using the 3 methodologies yielded similar results: highest ranked clusters included metabolic syndrome(12.2% of US insured patients), age related diseases(7.7%), renal failure(5.6%), respiratory disorders(4.5%), cardiovascular disease(CVD)(4.3%), cancers(4.1-4.3%), mental health-related clusters(1.0-1.5%) and HIV/AIDS(0.2%). Highest spending was in HIV/AIDS clusters ($48,293), mental health-related clusters ($38,952-$40,637), renal disease ($38,551) and CVD ($37,155); with 89.9% of spending on outpatient and inpatient care combined, and 10.1% on medication. Conclusion and Relevance Over 57% of insured patients in the US may have MCCs. MCC Clustering is frequent and is associated with healthcare utilisation. The findings favour health system redesign towards a multiple condition approach for clusters of chronic conditions, alongside other cost-containment measures for MCCs.

scholarly journals Clustering and Healthcare Costs With Multiple Chronic Conditions in a US Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Cother Hajat ◽  
Yakir Siegal ◽  
Amalia Adler-Waxman
Keyword(s):  
Mental Health ◽  
Chronic Conditions ◽  
Healthcare Costs ◽  
Generic Drugs ◽  
Multiple Chronic Conditions ◽  
The Us ◽  
Health Related ◽  
Insured Patients ◽  
The Impact ◽  
Hiv Aids

Objective: To investigate healthcare costs and contributors to costs for multiple chronic conditions (MCCs), common clusters of conditions and their impact on cost and utilization.Methods: This was a cross-sectional analysis of US financial claims data representative of the US population, including Medicare, Medicaid, and Commercial insurance claims in 2015. Outcome measures included healthcare costs and contributors; ranking of clusters of conditions according to frequency, strength of association and unsupervised (k-means) analysis; the impact of clustering on costs and contributors to costs.Results: Of 1,878,951 patients, 931,045(49.6%) had MCCs, 56.5% weighted to the US population. Mean age was 53.0 years (SD16.7); 393,121(42.20%) were male. Mean annual healthcare spending was $12,601, ranging from $4,385 (2 conditions) to $33,874 (11 conditions), with spending increasing by 22-fold for inpatient services, 6-fold for outpatient services, 4.5-fold for generic drugs, and 4.2-fold for branded drugs. Cluster ranking using the 3 methodologies yielded similar results: highest ranked clusters included metabolic syndrome (12.2% of US insured patients), age related diseases (7.7%), renal failure (5.6%), respiratory disorders (4.5%), cardiovascular disease(CVD) (4.3%), cancers (4.1–4.3%), mental health-related clusters (1.0–1.5%), and HIV/AIDS (0.2%). Highest spending was in HIV/AIDS clusters ($48,293), mental health-related clusters ($38,952–$40,637), renal disease ($38,551), and CVD ($37,155); with 89.9% of spending on outpatient and inpatient care combined, and 10.1% on medication.Conclusion and Relevance: Over 57% of insured patients in the US may have MCCs. MCC Clustering is frequent and is associated with healthcare utilization. The findings favor health system redesign toward a multiple condition approach for clusters of chronic conditions, alongside other cost-containment measures for MCCs.

scholarly journals Declining mental health among disadvantaged Americans

2018 ◽  
Vol 115 (28) ◽  
pp. 7290-7295 ◽  
Author(s):  
Noreen Goldman ◽  
Dana A. Glei ◽  
Maxine Weinstein
Keyword(s):  
Mental Health ◽  
Psychological Health ◽  
Positive Emotions ◽  
Well Being ◽  
The United States ◽  
Opioid Epidemic ◽  
Cross Sectional ◽  
Modest Improvement ◽  
The Us ◽  
The Impact

Although there is little dispute about the impact of the US opioid epidemic on recent mortality, there is less consensus about whether trends reflect increasing despair among American adults. The issue is complicated by the absence of established scales or definitions of despair as well as a paucity of studies examining changes in psychological health, especially well-being, since the 1990s. We contribute evidence using two cross-sectional waves of the Midlife in the United States (MIDUS) study to assess changes in measures of psychological distress and well-being. These measures capture negative emotions such as sadness, hopelessness, and worthlessness, and positive emotions such as happiness, fulfillment, and life satisfaction. Most of the measures reveal increasing distress and decreasing well-being across the age span for those of low relative socioeconomic position, in contrast to little decline or modest improvement for persons of high relative position.

scholarly journals Does the cancer patient's disease stage matter? A comparative study of caregivers' mental health and health related quality of life

2012 ◽  
Vol 10 (3) ◽  
pp. 189-196 ◽  
Author(s):  
Ellen Karine Grov ◽  
Berit Taraldsen Valeberg
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Cancer Patients ◽  
Cross Sectional Study ◽  
Disease Stage ◽  
Cross Sectional ◽  
Health Related Qol ◽  
Health Related ◽  
The Impact

AbstractObjective:Cancer affects both patients and their caregivers. Caregiver burden may change during different stages of the patients' cancer trajectory. Limited research has focused on the impact of being a caregiver, assessed by the caregiver's mental health and quality of life (QOL) during the curative and the palliative phases of the patient's disease. The aim of this study is to compare caregivers of cancer patients during the curative and a palliative phases with respect to their mental health and health-related QOL.Method:This descriptive, cross-sectional study combines data from two studies. The first group consists of caregivers of patients with cancer in the late palliative phase and the second group consists of caregivers of outpatients with cancer who suffer from pain and/or use analgesics. Data were collected by means of standardized measures and analyzed with descriptive statistics.Results:Based on this material, no significant differences in mental health and health- related QOL were revealed for caregivers of cancer patients in the palliative and the curative phases, respectively. Neither education level in the caregivers, nor the patients' functional status influenced caregivers' mental health or QOL. Younger caregivers seem to have better physical QOL.Significance of results:Being caregivers of cancer patients seems to have a similar pattern of impact on caregivers' mental health and quality of life regardless of the patient's disease stage. We share some reflections about the way in which the cancer stage is divided and the appropriateness of such selection for measuring caregivers' mental health and QOL. Additionally, we discuss the use of generic instruments for measuring specific contexts and particular samples.

scholarly journals Sociodemographic and Health-Related Characteristics of a Safety-Net Patient Population

2019 ◽  
Author(s):  
Afiba Manza-Azele Agovi ◽  
Ifedioranma Anikpo ◽  
Matthew J. Cvitanovich ◽  
Lu Yan ◽  
Tzu-Chun Chu ◽  
...  
Keyword(s):  
Mental Health ◽  
General Population ◽  
Chronic Conditions ◽  
Patient Characteristics ◽  
Safety Net ◽  
Cross Sectional ◽  
Tarrant County ◽  
Healthcare Needs ◽  
Urban Safety ◽  
Health Related

Abstract Background Safety-net health systems are an important source of healthcare for underserved or vulnerable individuals, but definitions of safety-net institutions are largely based on patient characteristics. Some definitions may not accurately identify such institutions. Therefore, we aimed to describe the characteristics of urban safety-net patients in Texas and compare the distribution of morbidities between safety-net and general population patients. Methods We used hospital claims data from the Dallas-Fort Worth Hospital Council Foundation to create a cross-sectional cohort. Eligible patients were aged ≥18 years and Tarrant County residents in 2018. Patients were divided into two groups for comparison. The first group represented patients with hospital claims from JPS Health Network (i.e. safety-net population). The second group represented all patients with hospital claims in Tarrant County (i.e. general population). We estimated frequencies of patient characteristics. In addition, we estimated overall and payor-stratified standardized morbidity ratios (SMRs) adjusted for age, gender, and race/ethnicity to compare the prevalence of common chronic diseases between safety-net patients and patients in the general population. Results Our study population comprised 459,827 patients, of whom 74,323 (16%) were safety-net patients. Patients aged ≥65 years comprised 23% of the general population and 11% of the safety-net population. Non-Hispanic Whites comprised 52% of the general population and 29% of safety-net patients. A larger proportion of safety-net patients were uninsured compared with general population patients (safety-net: 54%; general population: 25%), but Medicaid distribution was less discrepant (safety-net: 9%; general population: 7%). Medicare was the primary payor for 24% of general population patients and 14% of safety-net patients. Safety-net patients had relative excesses of mental health and chronic conditions ranging between 5% and 230% for all selected conditions except dementia/Alzheimer’s. The patterns for payor-stratified SMRs were consistent with the overall results. Conclusions We observed considerable sociodemographic diversity and a high burden of mental health and chronic conditions among safety-net patients, which may support understanding the healthcare needs of safety-net populations. Our findings raise questions about definitions of safety-net institutions based on Medicaid distribution alone and the transportability of findings from studies in which safety-net populations are unrepresented.

scholarly journals Ethno-cultural disparities in mental health during the COVID-19 pandemic: a cross-sectional study on the impact of exposure to the virus and COVID-19-related discrimination and stigma on mental health across ethno-cultural groups in Quebec (Canada)

BJPsych Open ◽  
2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Diana Miconi ◽  
Zhi Yin Li ◽  
Rochelle L. Frounfelker ◽  
Tara Santavicca ◽  
Jude Mary Cénat ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Online Survey ◽  
Cross Sectional Study ◽  
Cultural Group ◽  
Cultural Groups ◽  
Cross Sectional ◽  
Public Health Authorities ◽  
Health Related ◽  
The Impact

Background Although social and structural inequalities associated with COVID-19 have been documented since the start of the pandemic, few studies have explored the association between pandemic-specific risk factors and the mental health of minority populations. Aims We investigated the association of exposure to the virus, COVID-19-related discrimination and stigma with mental health during the COVID-19 pandemic, in a culturally diverse sample of adults in Quebec (Canada). Method A total of 3273 residents of the province of Quebec (49% aged 18–39 years, 57% women, 51% belonging to a minority ethno-cultural group) completed an online survey. We used linear and ordinal logistic regression to identify the relationship between COVID-19 experiences and mental health, and the moderating role of ethno-cultural identity. Results Mental health varied significantly based on socioeconomic status and ethno-cultural group, with those with lower incomes and Arab participants reporting higher psychological distress. Exposure to the virus, COVID-19-related discrimination, and stigma were associated with poorer mental health. Associations with mental health varied across ethno-cultural groups, with exposed and discriminated Black participants reporting higher mental distress. Conclusions Findings indicate sociocultural inequalities in mental health related to COVID-19 in the Canadian context. COVID-19-related risk factors, including exposure, discrimination and stigma, jeopardise mental health. This burden is most noteworthy for the Black community. There is an urgent need for public health authorities and health professionals to advocate against the discrimination of racialised minorities, and ensure that mental health services are accessible and culturally sensitive during and in the aftermath of the pandemic.

Multimorbidity is associated with higher out-of-pocket spending: a study of older Australians with multiple chronic conditions

2013 ◽  
Vol 19 (2) ◽  
pp. 144 ◽  
Author(s):  
Ian McRae ◽  
Laurann Yen ◽  
Yun-Hee Jeon ◽  
Pushpani M. Herath ◽  
Beverley Essue
Keyword(s):  
Chronic Disease ◽  
Chronic Conditions ◽  
Financial Burden ◽  
Chronic Health Condition ◽  
Health Condition ◽  
Economic Consequences ◽  
Multiple Chronic Conditions ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Health Related

Most older Australians have at least one chronic health condition. The management of chronic disease is associated with potentially severe economic consequences for patients and their households, partially due to the financial burden associated with out-of-pocket costs for medical and health-related care. A questionnaire was mailed to a cross-sectional sample of older Australians in mid-2009, with 4574 responding. Multivariate logistic regression models were developed to investigate the relationships between multimorbidity and out-of-pocket spending on medical and health-related expenses, including the factors associated with severe financial stress among older Australians. We found a positive relationship between number of chronic conditions and out-of-pocket spending on health and that people with multiple chronic conditions tend to be on lower incomes. People with five or more chronic conditions spent on average five times as much on their health as those with no diagnosed chronic conditions and each additional chronic disease added 46% to the likelihood of a person facing a severe financial burden due to health costs. While health policy may minimise out-of-pocket spending for individual conditions, costs compound rapidly for patients with multiple conditions and this burden falls most heavily on those with the lowest incomes.

scholarly journals Social conditions and mental health during COVID-19 lockdown among people who do not identify with the man/woman binomial in Spain

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256261
Author(s):  
Constanza Jacques-Aviñó ◽  
Tomàs López-Jiménez ◽  
Laura Medina-Perucha ◽  
Jeroen de Bont ◽  
Anna Berenguera
Keyword(s):  
Mental Health ◽  
Online Survey ◽  
Health Anxiety ◽  
Gender Diversity ◽  
Logistic Models ◽  
Anxiety And Depression ◽  
Related Factors ◽  
Cross Sectional ◽  
Health Related ◽  
The Impact

Evidence suggests that non-binary people have poorer mental and physical health outcomes, compared with people who identify within the gender binomial (man/woman). Research on the impact of the COVID-19 pandemic on mental health has been conducted worldwide in the last few months. It has however overlooked gender diversity. The aim of our study was to explore social and health-related factors associated with mental health (anxiety and depression) among people who do not identify with the man/woman binomial during COVID-19 lockdown in Spain. A cross-sectional study with online survey, aimed at the population residing in Spain during lockdown, was conducted. Data were collected between the 8th of April until the 28th of May 2020, the time period when lockdown was implemented in Spain. Mental health was measured using the Generalised Anxiety Disorder 7-item (GAD-7) scale for anxiety, and the Patient Health Questionnaire (PHQ-9) for depression. The survey included the question: Which sex do you identify with? The options “Man”, “Woman”, “Non-binary” and “I do not identify” were given. People who answered one of the last two options were selected for this study. Multivariate regression logistic models were constructed to evaluate the associations between sociodemographic, social and health-related factors, anxiety and depression. Out of the 7125 people who participated in the survey, 72 (1%) identified as non-binary or to not identify with another category. People who do not identify with the man/woman binomial (non-binary/I do not identify) presented high proportions of anxiety (41.7%) and depression (30.6%). Poorer mental health was associated with social-employment variables (e.g., not working before the pandemic) and health-related variables (e.g., poor or regular self-rated health). These findings suggest that social inequities, already experienced by non-binary communities before the pandemic, may deepen due to the COVID-19 pandemic.

The positive association between employment and self-reported mental health in the USA: a robust application of marginalized zero-inflated negative binomial regression (MZINB)

2020 ◽  
Vol 42 (2) ◽  
pp. 340-352
Author(s):  
Chinaeke Eric ◽  
Gwynn Melanie ◽  
Hong Yuan ◽  
Zhang Jiajia ◽  
Olatosi Bankole
Keyword(s):  
Mental Health ◽  
Chronic Conditions ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Chronically Ill ◽  
Interactive Effects ◽  
Behavioral Risk ◽  
Cross Sectional ◽  
Binomial Regression ◽  
The Impact

Abstract Background Few studies have assessed the impact of employment on mental health among chronically ill patients. This study investigated the association between employment and self-reported mental unhealthy days among US adults. Methods For this cross-sectional cohort study, we pooled 2011–2017 Behavioral Risk Factor Surveillance System (BRFSS) survey data. We examined the association between employment and mental health in nine self-reported chronic conditions using marginalized zero-inflated negative binomial regression (MZINB). All analyses were conducted using SAS statistical software 9.4. Results Respondents (weighted n = 245 319 917) were mostly white (77.16%), aged 18–64 (78.31%) and employed (57.08%). Approximately 10% of respondents reported one chronic condition. Expected relative risk of mental unhealthy days was highest for employed respondents living with arthritis (RR = 1.70, 95% CI = [1.66, 1.74]), COPD (RR = 1.45, 95% CI = [1.41, 1.49]) and stroke (RR = 1.31, 95% CI = [1.25, 1.36]) compared to unemployed respondents. Employed males had 25% lower risk of self-reported mental unhealthy days compared to females. Conclusions Results show the interactive effects of employment on self-reported mental health. Employment may significantly impact on self-reported mental health among patients suffering from chronic conditions than those without chronic conditions.

scholarly journals Sociodemographic and Health-Related Characteristics of a Safety-Net Patient Population

2019 ◽  
Author(s):  
Afiba Manza-Azele Agovi ◽  
Ifedioranma Anikpo ◽  
Matthew J. Cvitanovich ◽  
Lu Yan ◽  
Tzu-Chun Chu ◽  
...  
Keyword(s):  
Mental Health ◽  
General Population ◽  
Chronic Conditions ◽  
Patient Characteristics ◽  
Safety Net ◽  
Cross Sectional ◽  
Tarrant County ◽  
Healthcare Needs ◽  
Urban Safety ◽  
Health Related

Abstract Background Safety-net health systems are an important source of healthcare for underserved or vulnerable individuals, but definitions of safety-net institutions are largely based on patient characteristics. Some definitions may not accurately identify such institutions. Therefore, we aimed to describe the characteristics of urban safety-net patients in Texas and compare the distribution of morbidities between safety-net and general population patients. Methods We used hospital claims data from the Dallas-Fort Worth Hospital Council Foundation to create a cross-sectional cohort. Eligible patients were aged ≥18 years and Tarrant County residents in 2018. Patients were divided into two groups for comparison. The first group represented patients with hospital claims from JPS Health Network (i.e. safety-net population). The second group represented all patients with hospital claims in Tarrant County (i.e. general population). We estimated frequencies of patient characteristics. In addition, we estimated overall and payor-stratified standardized morbidity ratios (SMRs) adjusted for age, gender, and race/ethnicity to compare the prevalence of common chronic diseases between safety-net patients and patients in the general population.Results Our study population comprised 459,827 patients, of whom 74,323 (16%) were safety-net patients. Patients aged ≥65 years comprised 23% of the general population and 11% of the safety-net population. Non-Hispanic Whites comprised 52% of the general population and 29% of safety-net patients. A larger proportion of safety-net patients were uninsured compared with general population patients (safety-net: 54%; general population: 25%), but Medicaid distribution was less discrepant (safety-net: 9%; general population: 7%). Medicare was the primary payor for 24% of general population patients and 14% of safety-net patients. Safety-net patients had relative excesses of mental health and chronic conditions ranging between 5% and 230% for all selected conditions except dementia/Alzheimer’s. The patterns for payor-stratified SMRs were consistent with the overall results.Conclusions We observed considerable sociodemographic diversity and a high burden of mental health and chronic conditions among safety-net patients, which may support understanding the healthcare needs of safety-net populations. Our findings raise questions about definitions of safety-net institutions based on Medicaid distribution alone and the transportability of findings from studies in which safety-net populations are unrepresented.

scholarly journals Sociodemographic and Health-Related Characteristics of a Safety-Net Patient Population

2019 ◽  
Author(s):  
Afiba Manza-Azele Agovi ◽  
Ifedioranma Anikpo ◽  
Matthew J. Cvitanovich ◽  
Lu Yan ◽  
Tzu-Chun Chu ◽  
...  
Keyword(s):  
Mental Health ◽  
General Population ◽  
Chronic Conditions ◽  
Patient Characteristics ◽  
Safety Net ◽  
Cross Sectional ◽  
Tarrant County ◽  
Healthcare Needs ◽  
Urban Safety ◽  
Health Related

Abstract ABSTRACT Background Safety-net health systems are an important source of healthcare for underserved or vulnerable individuals, but definitions of safety-net institutions are largely based on patient characteristics. Some definitions may not accurately identify such institutions. Therefore, we aimed to describe the characteristics of urban safety-net patients in Texas and compare the distribution of morbidities between safety-net and general population patients. Methods We used hospital claims data from the Dallas-Fort Worth Hospital Council Foundation to create a cross-sectional cohort. Eligible patients were aged ≥18 years and Tarrant County residents in 2018. Patients were divided into two groups for comparison. The first group represented patients with hospital claims from JPS Health Network (i.e. safety-net population). The second group represented all patients with hospital claims in Tarrant County (i.e. general population). We estimated frequencies of patient characteristics. In addition, we estimated overall and payor-stratified standardized morbidity ratios (SMRs) adjusted for age, gender, and race/ethnicity to compare the prevalence of common chronic diseases between safety-net patients and patients in the general population. Results Our study population comprised 459,827 patients, of whom 74,323 (16%) were safety-net patients. Patients aged ≥65 years comprised 23% of the general population and 11% of the safety-net population. Non-Hispanic Whites comprised 52% of the general population and 29% of safety-net patients. A larger proportion of safety-net patients were uninsured compared with general population patients (safety-net: 54%; general population: 25%), but Medicaid distribution was less discrepant (safety-net: 9%; general population: 7%). Medicare was the primary payor for 24% of general population patients and 14% of safety-net patients. Safety-net patients had relative excesses of mental health and chronic conditions ranging between 5% and 230% for all selected conditions except dementia/Alzheimer’s. The patterns for payor-stratified SMRs were consistent with the overall results. Conclusions We observed considerable sociodemographic diversity and a high burden of mental health and chronic conditions among safety-net patients, which may support understanding the healthcare needs of safety-net populations. Our findings raise questions about definitions of safety-net institutions based on Medicaid distribution alone and the transportability of findings from studies in which safety-net populations are unrepresented.

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