scholarly journals Patterns of Multimorbidity

2021 ◽  
Author(s):  
Kien Wei Siah ◽  
Chi Heem Wong ◽  
Jerry Gupta ◽  
Andrew W. Lo
Keyword(s):  
Cross Sectional ◽  
Demographic Groups ◽  
The Past ◽  
The United Kingdom ◽  
Nationally Representative ◽  
Multimorbid Patients ◽  
Shared Risk ◽  
The Impact ◽  
Multiple Chronic Diseases ◽  
Perform Survival Analysis

Background: With multimorbidity becoming the norm rather than the exception, the management of multiple chronic diseases is a major challenge facing healthcare systems worldwide. Methods: Using a large, nationally representative database of electronic medical records from the United Kingdom spanning the years 2005 to 2016 and consisting over 4.5 million patients, we apply statistical methods and network analysis to identify comorbid pairs and triads of diseases and identify clusters of chronic conditions across different demographic groups. Unlike many previous studies, which generally adopt cross-sectional designs, we examine temporal changes in the patterns of multimorbidity. In addition, we perform survival analysis to examine the impact of multimorbidity on mortality. Results: The proportion of the population with multimorbidity has increased by approximately 2.5 percentage points over the last decade, with more than 17% having at least two chronic morbidities. We find that the prevalence and the severity of multimorbidity increase progressively with age. Stratifying by socioeconomic status, we find that people living in more deprived areas are more likely to be multimorbid compared to those living in more affluent areas at all ages. The same trend holds consistently for all years in our data. In addition to a number of strongly associated comorbid pairs (e.g., cardiac-vascular and cardiac-metabolic disorders), we identify three principal clusters: a respiratory cluster, a cardiovascular cluster, and a mixed cardiovascular-renal-metabolic cluster. These are supported by established pathophysiological mechanisms and shared risk factors, and are largely consistent with existing studies in the medical literature. Conclusions: In this paper, we use data-driven methods to characterize multimorbidity patterns in different demographic groups and their evolution over the past decade. Our findings contribute to the better understanding of the epidemiology of multimorbidity that is needed to develop more effective primary care for multimorbid patients.

scholarly journals Recent cannabis use and nightly sleep duration in adults: a population analysis of the NHANES from 2005 to 2018

2021 ◽  
pp. rapm-2021-103161
Author(s):  
Calvin Diep ◽  
Chenchen Tian ◽  
Kathak Vachhani ◽  
Christine Won ◽  
Duminda N Wijeysundera ◽  
...  
Keyword(s):  
Sleep Duration ◽  
Multinomial Logistic Regression ◽  
Population Analysis ◽  
Cannabis Use ◽  
Cross Sectional ◽  
The Past ◽  
Health Related ◽  
The Usa ◽  
Nationally Representative ◽  
The Impact

BackgroundWhile popularly consumed for its perceived benefits as a sleeping aid, the impact of cannabis on sleep-wake regulation in clinical studies is inconclusive. The purpose of this study was to determine the relationship between cannabis use and nightly sleep duration in a nationally representative dataset.MethodsA cross-sectional analysis of adults was undertaken using the National Health and Nutrition Examination Survey data from 2005 to 2018. Respondents were dichotomized as recent users or non-users if they had used or not used cannabis in the past 30 days, respectively. The primary outcome was nightly sleep duration, categorized as short (<6 hours), optimal (6–9 hours), and long (>9 hours). Multinomial logistic regression was used to adjust for sociodemographic and health-related covariates, and survey sample weights were used in modeling.ResultsFrom a sample representing approximately 146 million adults in the USA, 14.5% reported recent cannabis use. In an adjusted analysis, recent users were more likely than non-users to report both short sleep (OR 1.34, 95% CI 1.12 to 1.59, p<0.001) and long sleep (OR 1.56, 95% CI 1.25 to 1.96, p<0.001). Heavy users (≥20 of the past 30 days) were even more likely to be at the extremes of nightly sleep duration.DiscussionRecent cannabis use was associated with the extremes of nightly sleep duration in a nationally representative sample of adults, with suggestions of a dose–response relationship. Our findings highlight the need to further characterize the sleep health of regular cannabis users in the population.

scholarly journals Ten-year trends of hypertension treatment and control rate in Korea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kwang-il Kim ◽  
Eunjeong Ji ◽  
Jung-yeon Choi ◽  
Sun-wook Kim ◽  
Soyeon Ahn ◽  
...  
Keyword(s):  
Age Groups ◽  
Favorable Effect ◽  
Age Group ◽  
Hypertension Treatment ◽  
Treatment Rate ◽  
Cross Sectional ◽  
The Past ◽  
Nationally Representative ◽  
Multistage Sampling ◽  
And Control

AbstractWe analyzed the Korean National Health and Nutrition Examination Survey (KNHANES) database to determine the trends of hypertension treatment and control rate in Korea over the past 10 years. In addition, we tried to investigate the effect of chronic medical conditions on hypertension management. We investigated the hypertension prevalence, awareness, treatment, and control rate from 2008 to 2017. KNHANES, which uses a stratified multistage sampling design, is a cross-sectional, nationally representative survey conducted by the Korean government. A total of 59,282 adults (≥ 20 years) were included, which was representative of the total population of around 40 million Koreans per year. The mean age was 50.7 ± 16.4 years and 42.6% were male. The prevalence of hypertension, hypercholesterolemia, diabetes mellitus, and obesity significantly increased over the 10 years. During this period, the hypertension treatment and control rate significantly improved. Hypertension treatment rate was significantly lower in the younger age group compared to the older age group, but the control rate among the treated patients was not significantly different between age groups. The treatment and control rates of hypertension were higher in patients with multimorbidity, which implies that it has a favorable effect on the treatment and control of hypertension. Hypertension treatment and control rate have improved over the past 10 years. The higher treatment and control rate in patients with multimorbidity suggest that the more aggressive surveillance might be associated with the improvement of hypertension treatment and control rate in Korea.

scholarly journals Characteristics of those most vulnerable to employment changes during the COVID-19 pandemic: a nationally representative cross-sectional study in Wales

2021 ◽  
pp. jech-2020-216030
Author(s):  
Benjamin J Gray ◽  
Richard G Kyle ◽  
Jiao Song ◽  
Alisha R Davies
Keyword(s):  
Multinomial Logistic Regression ◽  
Household Survey ◽  
Well Being ◽  
Employment Outcomes ◽  
Cross Sectional Study ◽  
Public Health Response ◽  
Cross Sectional ◽  
Exact Test ◽  
Nationally Representative ◽  
The Impact

BackgroundThe public health response to the SARS-CoV-2 (COVID-19) pandemic has had a detrimental impact on employment and there are concerns the impact may be greatest among the most vulnerable. We examined the characteristics of those who experienced changes in employment status during the early months of the pandemic.MethodsData were collected from a cross-sectional, nationally representative household survey of the working age population (18–64 years) in Wales in May/June 2020 (n=1379). We looked at changes in employment and being placed on furlough since February 2020 across demographics, contract type, job skill level, health status and household factors. χ2 or Fisher’s exact test and multinomial logistic regression models examined associations between demographics, subgroups and employment outcomes.ResultsOf our respondents, 91.0% remained in the same job in May/June 2020 as they were in February 2020, 5.7% were now in a new job and 3.3% experienced unemployment. In addition, 24% of our respondents reported being placed on furlough. Non-permanent contract types, individuals who reported low mental well-being and household financial difficulties were all significant factors in experiencing unemployment. Being placed on ‘furlough’ was more likely in younger (18–29 years) and older (60–64 years) workers, those in lower skilled jobs and from households with less financial security.ConclusionA number of vulnerable population groups were observed to experience detrimental employment outcomes during the initial stage of the COVID-19 pandemic. Targeted support is needed to mitigate against both the direct impacts on employment, and indirect impacts on financial insecurity and health.

Measuring Value Change in Western Industrialized Societies: The Impact of Unemployment

1991 ◽  
Vol 85 (3) ◽  
pp. 905-920 ◽  
Author(s):  
Harold D. Clarke ◽  
Nitish Dutt
Keyword(s):  
Time Series ◽  
Economic Conditions ◽  
Aggregate Level ◽  
Value Change ◽  
Short Term ◽  
Cross Sectional ◽  
The Past ◽  
Value Priorities ◽  
Time Series Analyses ◽  
The Impact

During the past two decades a four-item battery administered in biannual Euro-Barometer surveys has been used to measure changing value priorities in Western European countries. We provide evidence that the measure is seriously flawed. Pooled cross-sectional time series analyses for the 1976–86 period reveal that the Euro-Barometer postmaterialist-materialist value index and two of its components are very sensitive to short-term changes in economic conditions, and that the failure to include a statement about unemployment in the four-item values battery accounts for much of the apparent growth of postmaterialist values in several countries after 1980. The aggregate-level findings are buttressed by analyses of panel data from three countries.

scholarly journals Parental self-medication with antibiotics for children promotes antibiotic over-prescribing in clinical settings in China

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Jiayao Xu ◽  
Xiaomin Wang ◽  
Kai Sing Sun ◽  
Leesa Lin ◽  
Xudong Zhou
Keyword(s):  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Clinical Settings ◽  
Cross Sectional Survey ◽  
Self Medication ◽  
Cross Sectional ◽  
Prescribing Behavior ◽  
The Past ◽  
Outpatient Settings ◽  
The Impact

Abstract Background Self-medication with antibiotics (SMA) is one of the most dangerous inappropriate antibiotic use behaviors. This study aims to investigate the impact of parental SMA for children before a consultation on their doctor’s subsequent antibiotic prescribing behavior, including intravenous (IV) antibiotic use in the clinical setting of China. Methods A cross-sectional survey was conducted between June 2017 and April 2018 in three provinces of China. A total of 9526 parents with children aged 0–13 years were investigated. Data from 1275 parents who had self-medicated their children and then visited a doctor in the past month were extracted and analyzed. Results One-third (410) of the studied children had parental SMA before the consultation and 83.9% of them were subsequently prescribed antibiotics by doctors. Children with parental SMA were more likely to be prescribed antibiotics (aOR = 7.79, 95% CI [5.74–10.58]), including IV antibiotics (aOR = 3.05, 95% CI [2.27–4.11]), and both oral and IV antibiotics (aOR = 3.42, 95% CI [2.42–4.84]), than children without parental SMA. Parents with SMA behaviors were more likely to request antibiotics (aOR = 4.05, 95% CI [2.59–6.31]) including IV antibiotics (aOR = 2.58, 95% CI [1.40–4.76]), and be fulfilled by doctors (aOR = 3.22, 95% CI [1.20–8.63]). Conclusions Tailored health education for parents is required in both community and clinical settings to discourage parental SMA for children. The doctors should not prescribe unnecessary antibiotics to reinforce parents’ SMA behaviors. We recommend expanding the current IV antibiotics ban in outpatient settings of China to cover outpatient pediatrics.

scholarly journals Functional Hearing Loss and Social Engagement Among Medicare Beneficiaries

2019 ◽  
Vol 76 (1) ◽  
pp. 195-200 ◽  
Author(s):  
Aishwarya Shukla ◽  
Thomas K M Cudjoe ◽  
Frank R Lin ◽  
Nicholas S Reed
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Social Engagement ◽  
Social Activity ◽  
Medicare Beneficiaries ◽  
Cross Sectional ◽  
The Past ◽  
Hearing Ability ◽  
Nationally Representative ◽  
Using Data

Abstract Objectives Hearing loss is common in older adults and limits communication. We investigated the independent association between functional hearing loss and social engagement in a nationally representative sample of older adults. Methods Using data from the 2015 Medicare Current Beneficiaries Survey, we modeled the cross-sectional association between self-reported hearing ability and limitation in social activity over the past month using multivariable logistic regression. Results The majority of the study population was female (54.8%) and non-Hispanic white (74.3%). Participants (40.4%) reported “a little trouble” hearing and 7.4% reported “a lot of trouble” hearing. Those who reported any trouble hearing had higher odds of limited social engagement in the past month. After adjustment for demographic, clinical, and functional covariates, those who reported “a lot of trouble” hearing had 37% higher odds of limited social activity in the past month compared to those with normal hearing. Discussion These results suggest that hearing loss may be an important risk factor for limited social engagement and downstream negative health consequences, independent of other disability and health conditions.

E-Cigarette Advice to Patients From Physicians and Dentists in the United States

2017 ◽  
Vol 32 (5) ◽  
pp. 1228-1233 ◽  
Author(s):  
Olivier Drouin ◽  
Robert C. McMillen ◽  
Jonathan D. Klein ◽  
Jonathan P. Winickoff
Keyword(s):  
United States ◽  
The United States ◽  
Fisher Exact Test ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Exact Test ◽  
The Past ◽  
Random Digit Dialing ◽  
Potential Benefits ◽  
Nationally Representative

Purpose: To report on adults’ recall of discussion by physicians and dentists about e-cigarettes. Design: A nationally representative cross-sectional survey (Internet and random digit dialing) in the United States. Participants: Adults who ever used e-cigarettes. Measures: Participant-reported discussion about the potential benefits and harms of e-cigarettes with their doctor, dentist, or child’s doctor in the past 12 months. Analysis: Fisher exact test for the analysis between benefits and harms for each type of provider and for rates of advice between provider types. Results: Among the 3030 adults who completed the survey, 523 (17.2%) had ever used e-cigarettes. Of those who had seen their doctor, dentist, or child’s doctor in the last year, 7.3%, 1.7%, and 10.1%, respectively, reported discussing potential harms of e-cigarettes. Conversely, 5.8%, 1.7%, and 9.3% of patients who had seen their doctor, dentist, or child’s doctor in the last year reported that the clinician discussed the potential benefits of e-cigarettes. Each clinician type was as likely to discuss harms as benefits. Rates of advice were similar between doctors and child’s doctors but lower for dentists. Rates were comparable when the analysis was limited to current e-cigarette users, participants with children, or those who reported using both e-cigarettes and combusted tobacco. Conclusions: Few physicians and dentists discuss either the harms or benefits of e-cigarettes with their patients. These data suggest an opportunity to educate, train, and provide resources for physicians and dentists about e-cigarettes and their use.

scholarly journals Impact of Pregnancy-Related Venous Thromboembolism on Quality of Patients’ Lives

2021 ◽  
Vol 27 ◽  
pp. 107602962110408
Author(s):  
Naser Al-Husban ◽  
Leena N. Alnsour ◽  
Zaid El-adwan ◽  
Nada A. Saleh ◽  
Mazen El-Zibdeh
Keyword(s):  
Drug Level ◽  
Cross Sectional Study ◽  
Negative Effects ◽  
Cross Sectional ◽  
The Past ◽  
Hospital Visits ◽  
Future Pregnancy ◽  
Anxiety Depression ◽  
The Impact

Background: During pregnancy, the risk of venous thrombo-embolism (VTE) is increased at least five times compared with non-pregnant women of the same age, while the relative risk in the postpartum period can be as high as sixty times. The aim of the study was to explore the impact of pregnancy-related VTE on patients' mental, professional, social and personal life. Methods and Materials: Cross-sectional study at Jordan University Hospital's Obstetrics Department. Results: There were 112 women. Forty-six (41.1%) had a postpartum VTE. Twenty-eight of the patients (25%) had comorbidity. Eleven (9.9%) had a previous episode of VTE. Thirty-nine (35%) of the women reported three or more hospital visits over the past six months. Twenty-one (19.6%) of the women answered that their leg or chest pain has impeded their social activities. Anxiety/Depression was reported by 96.43% while Pain/Discomfort by 73.21%. A significant reduction of time spent on their work (correlation = 0.663, significant at <0.01) and accomplishing less work (correlation = 0.787, this was significant at <0.01) was found; 57.14% of patients indicated that VTE affecting their future pregnancies; 58.9% of patients were receiving anticoagulants with the most commonly used drug was aspirin. Twenty-four (36.4%) of the women were on multiple anticoagulant therapies. Twenty-five of the patients receiving medications do not monitor their medications and 20 patients said that monitoring the drug level was a bother to them. Conclusions: Pregnancy-related VTE had a significant adverse impact on physical, mental and professional life of women. It also had negative effects on future pregnancy plans.

scholarly journals Household level health and socio-economic vulnerabilities and the COVID-19 crisis: An analysis from the UK

2020 ◽  
Author(s):  
Julia Mikolai ◽  
Katherine Keenan ◽  
Hill Kulu
Keyword(s):  
United Kingdom ◽  
Economic Consequences ◽  
Retirement Age ◽  
Cross Sectional ◽  
Household Level ◽  
Representative Study ◽  
The United Kingdom ◽  
Working Age ◽  
Nationally Representative ◽  
The Uk

Objectives. To investigate how COVID-19-related health and socio-economic vulnerabilities occur at the household level, and how they are distributed across household types and geographical areas in the United Kingdom. Design. Cross-sectional, nationally representative study. Setting. The United Kingdom. Participants. ~19,500 households. Main outcome measures. Using multiple household-level indicators and principal components analysis, we derive summary measures representing different dimensions of household vulnerabilities critical during the COVID-19 epidemic: health, employment, housing, financial and digital. Results. Our analysis highlights three key findings. First, although COVID-19 health risks are concentrated in retirement-age households, a substantial proportion of working age households also face these risks. Second, different types of households exhibit different vulnerabilities, with working-age households more likely to face financial, housing and employment precarities, and retirement-age households health and digital vulnerabilities. Third, there are area-level differences in the distribution of vulnerabilities across England and the constituent countries of the United Kingdom. Conclusions. The findings imply that the short- and long-term consequences of the COVID-19 crisis are likely to vary by household type. Policy measures that aim to mitigate the health and socio-economic consequences of the COVID-19 pandemic should consider how vulnerabilities cluster together across different household types, and how these may exacerbate already existing inequalities.

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