scholarly journals Association Between Patient‐Clinician Relationships and Adherence to Antihypertensive Medications Among Black Adults: An Observational Study Design

2021 ◽  
Author(s):  
Teng‐Jen Chang ◽  
John F. P. Bridges ◽  
Mary Bynum ◽  
John W. Jackson ◽  
Joshua J. Joseph ◽  
...  
Keyword(s):  
Study Design ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Antihypertensive Medications ◽  
Black Adults ◽  
Logistic Regression Models ◽  
Medication Refill ◽  
Refill Adherence ◽  
Clinician Communication ◽  
Patient Responses

Background We assessed the associations between patient‐clinician relationships (communication and involvement in shared decision‐making [SDM]) and adherence to antihypertensive medications. Methods and Results The 2010 to 2017 Medical Expenditure Panel Survey (MEPS) data were analyzed. A retrospective cohort study design was used to create a cohort of prevalent and new users of antihypertensive medications. We defined constructs of patient‐clinician communication and involvement in SDM from patient responses to the standard questionnaires about satisfaction and access to care during the first year of surveys. Verified self‐reported medication refill information collected during the second year of surveys was used to calculate medication refill adherence; adherence was defined as medication refill adherence ≥80%. Survey‐weighted multivariable‐adjusted logistic regression models were used to measure the odds ratio (OR) and 95% CI for the association between both patient‐clinician constructs and adherence. Our analysis involved 2571 Black adult patients with hypertension (mean age of 58 years; SD, 14 years) who were either persistent (n=1788) or new users (n=783) of antihypertensive medications. Forty‐five percent (n=1145) and 43% (n=1016) of the sample reported having high levels of communication and involvement in SDM, respectively. High, versus low, patient‐clinician communication (OR, 1.38; 95% CI, 1.14–1.67) and involvement in SDM (OR, 1.32; 95% CI, 1.08–1.61) were both associated with adherence to antihypertensives after adjusting for multiple covariates. These associations persisted among a subgroup of new users of antihypertensive medications. Conclusions Patient‐clinician communication and involvement in SDM are important predictors of optimal adherence to antihypertensive medication and should be targeted for improving adherence among Black adults with hypertension.

Association of Self-Reported Frequent Exercise Among a Nationally Representative Sample of Older People in the United States With Self-Reported Pain

2020 ◽  
pp. 1-8
Author(s):  
David R. Axon ◽  
Niloufar Emami
Keyword(s):  
Physical Health ◽  
Chronic Conditions ◽  
Medical Expenditure Panel Survey ◽  
The United States ◽  
Medical Expenditure ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Poor Physical Health ◽  
Nationally Representative ◽  
Fair Poor

This retrospective, cross-sectional database study aimed to identify characteristics associated with self-reported frequent exercise (defined as moderate- to vigorous-intensity exercise for ≥30 min five times a week) in older U.S. (≥50 years) adults with pain in the past 4 weeks, using 2017 Medical Expenditure Panel Survey data and hierarchical logistic regression models. The variables significantly associated with frequent exercise included being male (adjusted odds ratio [AOR] = 1.507, 95% confidence interval [CI] [1.318, 1.724]); non-Hispanic (AOR = 1.282, 95% CI [1.021, 1.608]); employed (AOR = 1.274, 95% CI [1.040, 1.560]); having no chronic conditions versus ≥5 conditions (AOR = 1.576, 95% CI [1.094, 2.268]); having two chronic conditions versus ≥5 conditions (AOR = 1.547, 95% CI [1.226, 1.952]); having no limitation versus having a limitation (AOR = 1.209, 95% CI [1.015, 1.441]); having little/moderate versus quite/extreme pain (AOR = 1.358, 95% CI [1.137, 1.621]); having excellent/very good versus fair/poor physical health (AOR = 2.408, 95% CI [1.875, 3.093]); and having good versus fair/poor physical health (AOR = 1.337, 95% CI [1.087, 1.646]). These characteristics may be useful to create personalized pain management protocols that include exercise for older adults with pain.

scholarly journals Direct Medical Expenditures Associated with Eye Complications among Adults with Diabetes in the United States

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Abdulkarim M. Meraya ◽  
Monira Alwhaibi ◽  
Moteb A. Khobrani ◽  
Hafiz A. Makeen ◽  
Saad S. Alqahtani ◽  
...  
Keyword(s):  
Study Design ◽  
Prescription Drugs ◽  
Medical Expenditure Panel Survey ◽  
Smoking Status ◽  
The United States ◽  
Medical Expenditures ◽  
Medical Expenditure ◽  
Physical And Mental Health ◽  
Poverty Level ◽  
Healthcare Expenditures

Objectives. National estimates of healthcare expenditures by types of services for adults with comorbid diabetes and eye complications (ECs) are scarce. Therefore, the first objective of this study is to estimate total healthcare expenditures and expenditures by types of services (inpatient, outpatient, prescription, and emergency) for adults with ECs. The second objective is to estimate the out-of-pocket spending burden among adults with ECs. Study Design. A cross-sectional study design using data from multiple panels (2009-2015) of the Medical Expenditure Panel Survey was employed. The sample included adults aged 21 years or older with diabetes (n=8,420). Principal Findings. Of adults with diabetes, 18.9% had ECs. Adults ECs had significantly higher incremental total medical expenditures of $3,125. The highest incremental expenditures were associated with outpatient and prescription drugs. After controlling for sex, age, race, poverty level, insurance coverage, prescription coverage, perceived physical and mental health, the number of chronic physical and mental conditions, marital status, education, the region of residence, smoking status, exercise, and chronic kidney disease (CKD), there was no difference in the out-of-pocket spending burden between adults with and those without ECs. However, adults with comorbid diabetes and CKD were more likely to have the out-of-pocket spending burden than those without CKD. Conclusions. The study showed that ECs in individuals with diabetes are associated with high incremental direct medical and out-of-pocket expenditures. Therefore, it requires more health initiatives, interventions, strategies, and programs to address and minimize the risk involved in such affected individuals.

scholarly journals Association of Self-Reported Functional Limitations among a National Community-Based Sample of Older United States Adults with Pain: A Cross-Sectional Study

2021 ◽  
Vol 10 (9) ◽  
pp. 1836
Author(s):  
David R. Axon ◽  
Darlena Le
Keyword(s):  
United States ◽  
Medical Expenditure Panel Survey ◽  
Functional Limitations ◽  
Functional Limitation ◽  
Cross Sectional Study ◽  
Medical Expenditure ◽  
Outcome Variable ◽  
Sectional Study ◽  
Cross Sectional ◽  
Logistic Regression Models

The characteristics of self-reported functional limitations among older United States (US) adults with pain are currently unknown. This cross-sectional study aimed to determine the characteristics associated with functional limitations among non-institutionalized older (≥50 years) US adults with pain using 2017 Medical Expenditure Panel Survey (MEPS) data. Eligible subjects were alive for the calendar year, aged ≥50 years, and experienced pain within the past four weeks. Hierarchical logistic regression models were utilized to determine significant characteristics associated with functional limitations (outcome variable; yes, no). Functional limitations included difficulty with bending, stooping, climbing stairs, grasping objects, lifting, reaching overhead, standing for long periods of time, or walking. Extrapolation of national data values was possible by adjusting for the complex MEPS design. We found approximately 22 million of the 57 million older US adults (≥50 years) who reported pain had a functional limitation in 2017. Characteristics associated with functional limitations included: gender, race, ethnicity, employment status, marital status, pain intensity, physical health, number of chronic conditions, and frequent exercise status. Knowledge of characteristics associated with functional limitations may provide an opportunity to identify and resolve gaps in patient care among this population.

scholarly journals Predictors of Mental Health Status among Older United States Adults with Pain

2021 ◽  
Vol 11 (2) ◽  
pp. 23
Author(s):  
David R. Axon ◽  
Jonathan Chien
Keyword(s):  
Mental Health ◽  
United States ◽  
Health Status ◽  
Medical Expenditure Panel Survey ◽  
Poor Mental Health ◽  
Mental Health Status ◽  
Medical Expenditure ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Good Mental Health

Poor mental health is common among older adults with pain, resulting in high economic burden and impaired quality of life. This retrospective, cross-sectional database study aimed to identify characteristics associated with good mental health status among United States (US) adults aged ≥50 years with self-reported pain in the last four weeks using a weighted sample of 2017 Medical Expenditure Panel Survey data. Hierarchical multivariable logistic regression models were used to identify statistically significant predictors of good (versus poor) perceived mental health status. From a weighted population of 57,074,842 individuals, 85.5% (95% confidence interval (CI) = 84.4%, 86.7%) had good perceived mental health. Good mental health was associated most strongly with physical health status (adjusted odds ratio (AOR) = 9.216, 95% CI = 7.044, 12.058). Employed individuals were 1.7 times more likely to report good mental health versus unemployed (AOR = 1.715, 95% CI = 1.199, 2.452). Individuals who had completed less than high school education (AOR = 0.750, 95% CI = 0.569, 0.987) or who reported having a limitation (AOR = 0.513, 95% CI = 0.384, 0.684) were less likely to report good mental health. These key characteristics can be utilized to predict mental health status, which may be investigated to better manage concurrent pain and poor mental health.

Abstract 254: Persistent SES Disparities in Cardiovascular Risk Factors and Health in the United States: MEPS 2002-2013

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Javier Valero-Elizondo ◽  
Erica S Spatz ◽  
Joseph A Salami ◽  
Chukwuemeka U Osondu ◽  
Nihar R Desai ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Medical Expenditure Panel Survey ◽  
The United States ◽  
Pooled Analysis ◽  
High Income ◽  
Self Report ◽  
Medical Expenditure ◽  
Poverty Level ◽  
Logistic Regression Models

Background: Given the health and cost burden of cardiovascular (CV) disease, we aimed to describe the trends in CV risk factors (CRF) in the US over the last twelve years, and quantify the disparities in healthcare by socioeconomic status (SES). Methods: The 2002-2013 Medical Expenditure Panel Survey (MEPS), a nationally representative sample was the basis for our study. CRFs (hypertension, diabetes mellitus, hypercholesterolemia, smoking, lack of physical activity and obesity) were identified by ICD9CM codes and/or self-report. Individuals were stratified by income level (per the federal poverty level), and proportions and logistic regression models were used to study trends and relationships for each CRF in two-year intervals. All analyses took into consideration the survey’s complex design. Inclusion criteria: age ≥ 18, BMI ≥ 18.5 and a positive sampling weight. Results: The study sample consisted of 250,371 MEPS participants (46 ± 14 years of age, 49% male), translating into 1.3 billion US adults. During the study period, the proportion of individuals with obesity increased overall, though moreso among people of low SES (Table). Trends in diabetes prevalence increased (from 9.6% to 12.8% in “Poor/Near Poor” and 5.6% to 8.3% in “High Income”, both p trend < 0.001) and hypertension (from 28.5% to 36.3% in “Poor/Near Poor” and 24.2% to 33.4% in “High Income”, both p trend < 0.001), though the greatest relative change was observed among the Middle/High Income SES group. Prevalence of inadequate physical activity increased in all SES categories, with the “Poor/Near Poor” group having the most drastic change (32.4% vs. 55.4%, p trend < 0.001), and a relative percent change of 71.1% increase in this category. Smoking declined across time in all SES categories, and hypercholesterolemia showed no significant changes. In pooled analysis, the odds of having a “Poor CRF Profile” (≥ 4 CRFs) for “Poor/Near Poor” SES were 36% higher when compared to “High Income” SES (OR 1.36, 95% CI [1.30, 1.44]) (Table). Conclusion: Disparities in the prevalence of CRFs have increased over the past 12 years, and have worsened for some conditions, including obesity, diabetes, hypertension and physical inactivity. There is a need for healthcare initiatives and policies to target the groups most in need.

scholarly journals Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors

2016 ◽  
Vol 34 (3) ◽  
pp. 259-267 ◽  
Author(s):  
K. Robin Yabroff ◽  
Emily C. Dowling ◽  
Gery P. Guy ◽  
Matthew P. Banegas ◽  
Amy Davidoff ◽  
...  
Keyword(s):  
United States ◽  
Cancer Survivors ◽  
Family Income ◽  
Medical Expenditure Panel Survey ◽  
The United States ◽  
Population Based ◽  
Financial Hardship ◽  
Medical Expenditure ◽  
Logistic Regression Models ◽  
Adult Cancer Survivors

Purpose To estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with financial hardship. Methods We identified 1,202 adult cancer survivors diagnosed or treated at ≥ 18 years of age from the 2011 Medical Expenditure Panel Survey Experiences With Cancer questionnaire. Material financial hardship was measured by ever (1) borrowing money or going into debt, (2) filing for bankruptcy, (3) being unable to cover one’s share of medical care costs, or (4) making other financial sacrifices because of cancer, its treatment, and lasting effects of treatment. Psychological financial hardship was measured as ever worrying about paying large medical bills. We examined factors associated with any material or psychological financial hardship using separate multivariable logistic regression models stratified by age group (18 to 64 and ≥ 65 years). Results Material financial hardship was more common in cancer survivors age 18 to 64 years than in those ≥ 65 years of age (28.4% v 13.8%; P < .001), as was psychological financial hardship (31.9% v 14.7%, P < .001). In adjusted analyses, cancer survivors age 18 to 64 years who were younger, female, nonwhite, and treated more recently and who had changed employment because of cancer were significantly more likely to report any material financial hardship. Cancer survivors who were uninsured, had lower family income, and were treated more recently were more likely to report psychological financial hardship. Among cancer survivors ≥ 65 years of age, those who were younger were more likely to report any financial hardship. Conclusion Cancer survivors, especially the working-age population, commonly experience material and psychological financial hardship.

scholarly journals Modeling the Conditional Dependence between Discrete and Continuous Random Variables with Applications in Insurance

Mathematics ◽  
2020 ◽  
Vol 9 (1) ◽  
pp. 45
Author(s):  
Emilio Gómez-Déniz ◽  
Enrique Calderín-Ojeda
Keyword(s):  
Structural Model ◽  
Medical Expenditure Panel Survey ◽  
Health Care Use ◽  
Medical Expenditure ◽  
Panel Survey ◽  
Conditional Distributions ◽  
Conditional Dependence ◽  
Outpatient Visits ◽  
Conditional Expectations ◽  
The U.S

We jointly model amount of expenditure for outpatient visits and number of outpatient visits by considering both dependence and simultaneity by proposing a bivariate structural model that describes both variables, specified in terms of their conditional distributions. For that reason, we assume that the conditional expectation of expenditure for outpatient visits with respect to the number of outpatient visits and also, the number of outpatient visits expectation with respect to the expenditure for outpatient visits is related by taking a linear relationship for these conditional expectations. Furthermore, one of the conditional distributions obtained in our study is used to derive Bayesian premiums which take into account both the number of claims and the size of the correspondent claims. Our proposal is illustrated with a numerical example based on data of health care use taken from Medical Expenditure Panel Survey (MEPS), conducted by the U.S. Agency of Health Research and Quality.

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