Abstract P452: Impact of Socioeconomic Status in Intracerebral Hemorrhage

Background: Socioeconomic status (SES) has been associated with intracerebral hemorrhage (ICH) incidence, but its impact on ICH-related features and outcomes is unclear. Methods: We performed a single-center cohort study on consecutive ICH patients admitted over 2 years. Demographics, ICH characteristics, and outcomes were prospectively collected, while SES-related data were retrospectively abstracted. We classified SES quartiles using census estimates of median household incomes corresponding to patients’ home ZIP codes, then categorized patients as “lower SES” if their ZIP code was in the lowest SES quartile, if they were uninsured, or had Medicaid as their source of insurance. We compared ICH characteristics between patients with lower vs. higher SES, then determined associations between lower SES and unfavorable 3-month outcome (modified Rankin Scale 4-6) using multivariable logistic regression. Results: Of 665 patients, 31% (n=207) were categorized as lower SES. Patients with lower SES were significantly younger (mean [SD] 64.7 [16.1] vs. 73.1 [14.2] years, p<0.001), more often non-white (38% vs. 8%, p<0.001), and had a higher prevalence of multiple vascular risk factors. There were no significant differences in ICH volume or prevalence of infratentorial or intraventricular hemorrhage. However, patients with lower SES had a shorter time-to-presentation (median [IQR] 4.5 [1.3-15.2] vs. 7.4 [1.4-21.7]), hours from last known well, p=0.01), and had fewer ICH due to cerebral amyloid angiopathy (13% vs. 30%, p<0.001). Despite these differences, patients with lower SES did not have a significantly higher likelihood of unfavorable 3-month outcomes (OR 1.2 [95% CI 0.7-1.8]). Conclusions: Differences in ICH features may be driven by pre-morbid healthcare disparities in lower SES patients. Although their younger age and shorter time to presentation may have mitigated the deleterious effects of comorbidities on long-term outcomes, these factors may also belie a greater loss of quality-adjusted life years from ICH-related disability.

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Evaluation of long-term outcomes of very old patients admitted to intensive care: Survival, functional status, quality of life, and quality-adjusted life-years

Journal of Critical Care ◽

10.1016/j.jcrc.2015.05.005 ◽

2015 ◽

Vol 30 (5) ◽

pp. 1150.e7-1150.e11 ◽

Cited By ~ 4

Author(s):

Cláudia Ferrão ◽

Cláudio Quintaneiro ◽

Cláudia Camila ◽

Irene Aragão ◽

Teresa Cardoso

Keyword(s):

Quality Of Life ◽

Intensive Care ◽

Quality Adjusted Life Years ◽

Long Term Outcomes ◽

Old Patients ◽

Life Years ◽

Very Old Patients ◽

Quality Adjusted Life

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Long-term outcome and quality-adjusted life years after severe sepsis*

Critical Care Medicine ◽

10.1097/ccm.0b013e31819c13ac ◽

2009 ◽

Vol 37 (4) ◽

pp. 1268-1274 ◽

Cited By ~ 107

Author(s):

Sari Karlsson ◽

Esko Ruokonen ◽

Tero Varpula ◽

Tero I. Ala-Kokko ◽

Ville Pettilä

Keyword(s):

Severe Sepsis ◽

Quality Adjusted Life Years ◽

Term Outcome ◽

Long Term Outcome ◽

Life Years ◽

Quality Adjusted Life

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Abstract WP302: Transferring Patients with Primary Intracerebral Hemorrhage to Comprehensive Stroke Centers

Stroke ◽

10.1161/str.48.suppl_1.wp302 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Farhaan Vahidy ◽

Liang Zhu ◽

Nancy J Edwards

Keyword(s):

Intracerebral Hemorrhage ◽

Patient Characteristics ◽

Hospital Treatment ◽

Stroke Severity ◽

Long Term Outcomes ◽

Similar Treatment ◽

Euroqol 5D ◽

Transferred Patients

Introduction: The American Heart Association’s updated guidelines for management of patients with primary intracerebral hemorrhage (ICH) recommend monitoring and early care at centers with advanced nursing and neuro-critical care expertise. This entails frequent transfer of ICH patients to certified Comprehensive Stroke Centers (CSC) for higher level of care. We hypothesized that transferred patients (TP) to a CSC will differ from directly admitted patients (DAP) in terms of patient characteristics, treatment factors, and functional and quality of life (QOL) outcomes. Methods: We analyzed data from a prospectively collected ICH registry at our CSC. Patients with traumatic or secondary causes of ICH were excluded. We collected data on demographics, comorbidities, presentation lab values, clinical characteristics, radiological parameters, in-hospital treatment variables, and discharge and long term outcomes. Functional outcomes were captured as modified Rankin Scale (mRS) and EuroQol 5D (EQ-5D) was used to assess QOL indices. Results: Out of a total 192 primary ICH patients, 114 (59.4%) were transferred-in. TP were significantly older, had lower diastolic blood pressure, lower arrival National Institutes of Health Stroke Scale (NIHSS) score, and smaller hematoma volumes as compared to DAP. A higher proportion of TP had a good discharge functional outcome (mRS score 0 - 3) as compared to DAP (29.8% vs. 15.4%, p = 0.02), this trend was also observed for Day-90 mRS (34.2% vs. 24.4%, p = 0.09). TP also reported significantly better QOL indices at Day-90; EQ-5D total median (Q1, Q3) score [10 (6,16) vs. 15 (9.5,18), p = 0.02] and self-reported median (Q1,Q3) score [75 (50,88) vs. 62.5(40,70)], p < 0.01]. Day-90 data are complete for approximately 50% patients. After adjusting for initial stroke severity, the discharge mRS was however not significantly different between TP and DAP. Conclusions: A larger proportion of ICH patients were transferred-in. Our data suggest that TP have lower disease severity, and better discharge and long term outcomes. However, they had similar treatment intensity as DAP at the CSC. We continue to capture day-90, 6 and 12-month functional and QOL data, which will be presented.

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Economic Analysis of Rivaroxaban for the Treatment and Long-Term Prevention of Venous Thromboembolism in Portugal

Acta Médica Portuguesa ◽

10.20344/amp.5257 ◽

2014 ◽

Vol 27 (5) ◽

pp. 615 ◽

Cited By ~ 4

Author(s):

Isabel Fonseca Santos ◽

Sónia Pereira ◽

Euan McLeod ◽

Anne-Laure Guillermin ◽

Ismini Chatzitheofilou

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Standard Of Care ◽

Quality Adjusted Life Years ◽

Vein Thrombosis ◽

Scenario Analyses ◽

Life Years ◽

Deep Vein ◽

Quality Adjusted Life

Introduction: Venous thromboembolism is a burden on healthcare systems. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (enoxaparin/warfarin) in Portugal for the treatment and secondary prevention of venous thromboembolism. Material and Methods: A Markov model was developed using event rates extracted from the EINSTEIN trials supplemented with literature-based estimates of longer-term outcomes. Core outcomes included per patient costs and quality-adjusted life years reported separately per treatment arm and incrementally, as well as cost per quality-adjusted life years gained. The deep vein thrombosis and pulmonary embolism indications were analysed separately. The analyses were conducted from the Portuguese societal perspective and over a 5-year time horizon. Costs and outcomes were discounted at a 5% annual rate. Several scenario analyses were undertaken to explore the impact on results of varying key modeling assumptions. Results: Rivaroxaban treatment was associated with cost-savings for the treatment of deep vein thrombosis and was both cost-saving and more effective for the treatment of pulmonary embolism, compared with enoxaparin/warfarin. Discussion: The results of the sensitivity and scenario analyses further supported that rivaroxaban is a cost-effective alternative to standard of care treatment. The use of an expert panel to derive some input values and the lack of Portuguese specific utilities were the main limitations. Conclusion: Rivaroxaban represents an efficient alternative to using enoxaparin/warfarin in Portugal, as it’s associated with lower costs (for both indications) and greater quality adjusted life years (for the pulmonary embolism indication). Keywords: Venous Thrombosis; Pulmonary Embolism; Rivaroxaban; Venous Thromboembolism.

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Transsphenoidal surgery for prolactinomas: results and prognosis

Medicina ◽

10.3390/medicina43090089 ◽

2007 ◽

Vol 43 (9) ◽

pp. 691 ◽

Cited By ~ 2

Author(s):

Kęstutis Šinkūnas ◽

Daiva Rastenytė ◽

Vytenis Deltuva ◽

Robertas Knispelis ◽

Arimantas Tamašauskas

Keyword(s):

Surgical Treatment ◽

Dopamine Agonist ◽

Remission Rate ◽

Visual Field Defects ◽

Plasma Prolactin ◽

Long Term Outcomes ◽

Agonist Therapy ◽

Dopamine Agonist Therapy ◽

Younger Age

Objective. The aim of this study was to explore the long-term outcomes of surgery for transsphenoidal prolactinomas and the factors that influence them. Material and methods. Transsphenoidal approach for pituitary adenomas has been applied to 329 patients in the Department of Neurosurgery of Kaunas University of Medicine Hospital in the period of 1995 to 2006. Of these, 85 patients were operated for prolactinomas. Results. Of the 85 patients operated on for prolactinomas, 68 (80%) were females and 17 (20%) were males. Thirty-two microprolactinomas and 36 macroprolactinomas were diagnosed in women and 16 and 1, respectively, in men. Twenty (23.5%) patients (16 women and 4 men) had visual field defects before the operation. Dopamine agonist therapy was administered in 50 patients (38 women and 12 men) before the operation. Of 10 women, in whom microadenoma was diagnosed and no dopamine agonist therapy was prescribed, remission was achieved in 9 (90%) patients after the operation, while of 22 women, who was treated with dopamine agonists before the operation, remission was achieved only in 10 (45.5%) (P=0.01). Each year of age decreased the chance of remission by 8%. Conclusions. Remission after the surgical treatment was achieved in 11.8% of men and 47.1% of women hyperprowith prolactinomas. Remission rate was very high (90%) among women with microprolactinoma not treated with dopamine agonist before the surgical treatment. The probability of a good outcome of surgery among women with prolactinoma was related to younger age of the patient, noninvasive tumor growth, plasma prolactin level less than 2309 mU/L, and no use of dopamine agonist before the surgical treatment.

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Prevention versus early detection for long-term control of melanoma and keratinocyte carcinomas: a cost-effectiveness modelling study

BMJ Open ◽

10.1136/bmjopen-2019-034388 ◽

2020 ◽

Vol 10 (2) ◽

pp. e034388 ◽

Cited By ~ 3

Author(s):

Louisa Gordon ◽

Catherine Olsen ◽

David C Whiteman ◽

Thomas M Elliott ◽

Monika Janda ◽

...

Keyword(s):

Cost Effectiveness ◽

Primary Prevention ◽

Early Detection ◽

Population Level ◽

Population Based ◽

Quality Adjusted Life Years ◽

Sunscreen Use ◽

Life Years ◽

Quality Adjusted Life

ObjectiveTo compare the long-term economic impact of melanoma prevention by sun protection, with the corresponding impact of early detection of melanoma to decrease melanoma deaths.DesignCost-effectiveness analysis using Markov cohort model. Data were primarily from two population-based randomised controlled trials, epidemiological and costing reports, and included flow-on effects for keratinocyte cancers (previously non-melanoma skin cancers) and actinic keratoses.SettingQueensland, Australia.ParticipantsMen and women with a mean age 50 years modelled for 30 years.InterventionsDaily sunscreen use (prevention) compared with annual clinical skin examinations (early detection) and comparing these in turn with the status quo.Primary and secondary outcomesCosts, counts of melanoma, melanoma deaths, keratinocyte cancers, life years and quality-adjusted life years.ResultsPer 100 000 individuals, for early detection, primary prevention and without intervention, there were 2446, 1364 and 2419 new melanomas, 556, 341 and 567 melanoma deaths, 64 452, 47 682 and 64 659 keratinocyte cancers and £493.5, £386.4 and £406.1 million in economic costs, respectively. There were small differences between prevention and early detection in life years saved (0.09%) and quality-adjusted life years gained (0.10%).ConclusionsCompared with early detection of melanoma, systematic sunscreen use at a population level will prevent substantial numbers of new skin tumours, melanoma deaths and save healthcare costs. Primary prevention through daily use of sunscreen is a priority for investment in the control of melanoma.

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FTY720 attenuates iron deposition and glial responses in improving delayed lesion and long-term outcomes of collagenase-induced intracerebral hemorrhage

Brain Research ◽

10.1016/j.brainres.2019.04.031 ◽

2019 ◽

Vol 1718 ◽

pp. 91-102 ◽

Cited By ~ 4

Author(s):

Zhiyong Yang ◽

Sisi Dong ◽

Qiuyue Zheng ◽

Lingling Zhang ◽

Xinmei Tan ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Iron Deposition ◽

Long Term Outcomes

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Women’s Romantic Relationships After Widowhood

Journal of Family Issues ◽

10.1177/0192513x06289096 ◽

2006 ◽

Vol 27 (9) ◽

pp. 1281-1304 ◽

Cited By ~ 32

Author(s):

Sara M. Moorman ◽

Alan Booth ◽

Karen L. Fingerman

Keyword(s):

Social Support ◽

Socioeconomic Status ◽

Romantic Relationships ◽

Physical Health ◽

Random Sample ◽

Trait Anxiety ◽

Younger Age ◽

Logistic Regressions ◽

Household Incomes ◽

Mental And Physical Health

This study examines decisions women make about their romantic lives after widowhood. Participants were women from the Americans’ Changing Lives survey, a nationwide random sample of 3,617 Americans older than age 25 years who, in 1986, were widowed ( n = 259) or had been widowed and were remarried ( n = 49). Widowed participants provided information about their male companions and their interest in remarriage, as well as information about their social support, mental and physical health, age, and socioeconomic status. Logistic regressions revealed that younger age and greater unhappiness predicted interest in remarriage. Higher trait anxiety predicted having male companionship. Widows who had remarried had higher household incomes and worried less about finances than did widows who did not remarry. Widows appear to make choices about partners based on their individual needs and desires as well as the attributes and availability of partners.

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