scholarly journals Prevalence and associated factors of premature discontinuation of antiplatelet therapy after ischemic stroke: a nationwide population-based study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Seung Jae Kim ◽  
Oh Deog Kwon ◽  
Ho Chun Choi ◽  
Eung-Joon Lee ◽  
BeLong Cho ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Low Income ◽  
Multivariate Logistic Regression Analysis ◽  
National Sample ◽  
Population Based ◽  
Affecting Factors ◽  
Middle Income ◽  
Income Class ◽  
Strategic Approach ◽  
Rural Residency

Abstract Background We tried to evaluate the prevalence of premature discontinuation of antiplatelets and its affecting factors after ischemic stroke using large-sized representative national claims data. Methods Patients aged 20 years or older with newly confirmed ischemic stroke who started aspirin or clopidogrel for the first time were selected from 2003 to 2010 National Health Insurance Service-National Sample Cohort (NHIS-NSC) of South Korea (n = 4621), a randomly collected sample which accounts for 2.2% (n = 1,017,468) of total population (n = 46,605,433). The prevalence of discontinuation of antiplatelets was measured every 6 months until the 24 months since the first prescription. Then we classified the participants into 2 groups according to the discontinuation status at 12 months and assessed the factors influencing premature discontinuation of antiplatelets within 12 months. Results Among total participants, 35.5% (n = 1640) discontinued antiplatelets within 12 months and 58.5% (n = 2704) discontinued them within 24 months. The remaining 41.5% (n = 1917) continued them for 24 months or more. In the multivariate logistic regression analysis, initiating treatment with aspirin monotherapy [adjusted OR (aOR), 2.66, 95% CI 2.17–3.25] was the most prominent determinant of premature discontinuation within 12 months followed by CCI score ≥ 6 (aOR 1.50, 95% CI 1.31–1.98), and beginning treatment with clopidogrel monotherapy (aOR 1.41, 95% CI 1.15–1.72). Rural residency (aOR 1.36, 95% CI 1.14–1.62), < 4 total prescribed drugs (aOR 1.24, 95% CI 1.05–1.47), lower income (aOR 1.20, 95% CI 1.03–1.40 for middle income class and OR 1.21, 95% CI 1.02–1.45 for low income class), and ages ≥70 years (aOR 1.15, 95% CI 1.00–1.31) were also significantly associated with premature discontinuation of antiplatelets within 12 months. Conclusions The prevalence of premature discontinuation of antiplatelets after ischemic stroke was quite high. Thus, by understanding factors associated with premature discontinuation, a more strategic approach is required for the physicians to improve persistence with antiplatelets.

scholarly journals The burden of serious health-related suffering among cancer decedents: Global projections study to 2060

2020 ◽  
pp. 026921632095756
Author(s):  
Katherine E Sleeman ◽  
Barbara Gomes ◽  
Maja de Brito ◽  
Omar Shamieh ◽  
Richard Harding
Keyword(s):  
Palliative Care ◽  
Low Income ◽  
Population Based ◽  
World Health ◽  
Low Income Countries ◽  
Cancer Type ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Related ◽  
Health Organization

Background: Palliative care improves outcomes for people with cancer, but in many countries access remains poor. Understanding future needs is essential for effective health system planning in response to global policy. Aim: To project the burden of serious health-related suffering associated with death from cancer to 2060 by age, gender, cancer type and World Bank income region. Design: Population-based projections study. Global projections of palliative care need were derived by combining World Health Organization cancer mortality projections (2016–2060) with estimates of serious health-related suffering among cancer decedents. Results: By 2060, serious health-related suffering will be experienced by 16.3 million people dying with cancer each year (compared to 7.8 million in 2016). Serious health-related suffering among cancer decedents will increase more quickly in low income countries (407% increase 2016–2060) compared to lower-middle, upper-middle and high income countries (168%, 96% and 39% increase 2016-2060, respectively). By 2060, 67% of people who die with cancer and experience serious health-related suffering will be over 70 years old, compared to 47% in 2016. In high and upper-middle income countries, lung cancer will be the single greatest contributor to the burden of serious health-related suffering among cancer decedents. In low and lower-middle income countries, breast cancer will be the single greatest contributor. Conclusions: Many people with cancer will die with unnecessary suffering unless there is expansion of palliative care integration into cancer programmes. Failure to do this will be damaging for the individuals affected and the health systems within which they are treated.

scholarly journals Early Detection of CKD: Implications for Low-Income, Middle-Income, and High-Income Countries

2020 ◽  
Vol 31 (9) ◽  
pp. 1931-1940 ◽  
Author(s):  
Marcello Tonelli ◽  
James A. Dickinson
Keyword(s):  
Early Detection ◽  
Low Income ◽  
Population Based ◽  
Case Finding ◽  
High Income ◽  
Opportunity Costs ◽  
Middle Income ◽  
Middle Income Countries ◽  
Use Of Resources ◽  
Low And Middle Income

CKD is common, costly, and associated with adverse health outcomes. Because inexpensive treatments can slow the rate of kidney function loss, and because CKD is asymptomatic until its later stages, the idea of early detection of CKD to improve outcomes ignites enthusiasm, especially in low- and middle-income countries where renal replacement is often unavailable or unaffordable. Available data and prior experience suggest that the benefits of population-based screening for CKD are uncertain; that there is potential for harms; that screening is not a wise use of resources, even in high-income countries; and that screening has substantial opportunity costs in low- and middle-income countries that offset its hypothesized benefits. In contrast, some of the factors that diminish the value of population-based screening (such as markedly higher prevalence of CKD in people with diabetes, hypertension, and cardiovascular disease, as well as high preexisting use of kidney testing in such patients) substantially increase the appeal of searching for CKD in people with known kidney risk factors (case finding) in high-income countries as well as in low- and middle-income countries. For both screening and case finding, detection of new cases is the easiest component; the real challenge is ensuring appropriate management for a chronic disease, usually for years or even decades. This review compares and contrasts the benefits, harms, and opportunity costs associated with these two approaches to early detection of CKD. We also suggest criteria (discussed separately for high-income countries and for low- and middle-income countries) to use in assessing when countries should consider case finding versus when they should consider foregoing systematic attempts at early detection and focus on management of known cases.

Alcohol use among young adolescents in low-income and middle-income countries: a population-based study

2018 ◽  
Vol 2 (6) ◽  
pp. 415-429 ◽  
Author(s):  
Chuanwei Ma ◽  
Pascal Bovet ◽  
Lili Yang ◽  
Min Zhao ◽  
Yajun Liang ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Low Income ◽  
Population Based ◽  
Young Adolescents ◽  
Population Based Study ◽  
Middle Income ◽  
Middle Income Countries

scholarly journals Socioeconomic Disparities in Drugs and Substance Abuse: results from a Household Cross-sectional Survey in Murang’ a County, Kenya

2020 ◽  
Author(s):  
Vincent Omondi Were ◽  
Collins Omondi Okoyo ◽  
Sylvie Biyaki Araka ◽  
Henry Muriuki Kanyi ◽  
Elizabeth Echoka Echoka ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Prescription Drugs ◽  
Low Income ◽  
Economic Burden ◽  
Multivariate Logistic Regression Analysis ◽  
Cross Sectional ◽  
Middle Income ◽  
Household Level ◽  
Income Groups ◽  
Economic Inequalities

Abstract IntroductionDrugs and substance abuse has adverse health effects and substantial economic burden to the global economies and at the household level. There is, however, limited data on socio-economic inequalities disparities in drugs and substance abuse in low-to-middle income countries such as Kenya. This study aimed to assess the socio-economic inequalities in a selected county of central Kenya.MethodThe study design was cross-sectional, and data collection was conducted between November and December 2017. A total of 449 households with a least one person who uses any drugs or substance of abuse were randomly sampled from 4 purposively selected sub-locations of Murang’ a County, central Kenya. Structured questionnaires were used to collect data on types of drugs used, economic burden, and gender roles at the household level. Household socio-economic status (SES) was established ( low, middle, and high SES ) using principal component analysis f(PCA) from a set of household assets and characteristics. Multivariate logistic regression analysis was used to assess the association between SES, gender, and other factors on the uptake of drugs and substance of abuse.ResultsIndividuals in higher SES were more likely to use cigarettes ( OR = 2.13; 95%CI = 1.25–3.61, p = 0.005) or piped tobacco (OR = 11.37; 95% CI, 2.55–50.8; p-value = 0.001) than those in low SES. The wealthier individuals were less likely to use legal alcohol (OR = 0.39; 95%CI = 0.21–0.71, p = 0.002) than the poorest individuals. The use of prescription drugs did not vary with SES. A comparison of the median amount of money spent on acquiring drugs showed that richer individuals spent a significantly higher amount than the poorest individuals (Ksh 1500 vs. Ksh 1000, p = 0.0310). Deaths related to drugs and substance abuse were more likely to occur in middle SES than amongst the poorest households (OR = 2.96; 95%CI = 1.03–8.45).ConclusionSocioeconomic disparities exist in the use of drugs and substance abuse. The low-income individuals are at a higher risk of abuse and thus of economic burden due to catastrophic expenditure in acquiring the drugs. Cases of deaths were likely to occur in middle-income groups. Strategies to reduce drugs and substance abuse must address socio-economic inequalities through targeted approaches to individuals in low-income groups.

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