scholarly journals Special Health Care Utilization Pattern with Elevated Costs and High Risk of Premature Death Among Adults Living in Segregated Roma Settlements

2018 ◽  
Author(s):  
János Sándor ◽  
Anita Pálinkás ◽  
Ferenc Vincze ◽  
Nóra Kovács ◽  
Sipos Valéria ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Personal Data ◽  
Health Indicators ◽  
Premature Mortality ◽  
Premature Death ◽  
Care Utilization ◽  
Insurance Fund ◽  
Utilization Pattern ◽  
Special Health Care ◽  
Increased Risk

Roma is the largest ethnic minority of Europe with poor health status, which is poorly explored due to legal constrains of ethnicity assessment. We aimed to elaborate health-indicators for adults living in segregated Roma settlements (SRS) representing the most vulnerable Roma subpopulation. SRSs were mapped in a study area populated by 54682 adults. Records of all adults living in the study area were processed in the National Institute of Health Insurance Fund Management. Aggregated, age-sex standardized SRS-specific and non-SRS-specific indicators on healthcare utilization and premature death along with the ratio of them (RR) were computed with 95% confidence intervals. The rate of GP appointments was significantly higher among SRS inhabitants (RR=1.152, 95%CI: 1.136–1.167). The proportion of subjects hospitalized (RR=1.286, 1.177–1.405), and the reimbursement for inpatient care (RR=1.060, 1.057–1.064) were elevated for SRS. Premature mortality was significantly higher in SRSs (RR=1.711, 1.085-2.696). Our study demonstrated that it is possible to compute the SRS-specific version of the routine healthcare indicators without violating the protection of personal data by converting a sensitive ethical issue to a non-sensitive small area geographical analysis; there is an SRS-specific healthcare utilization pattern, which is associated with elevated costs and increased risk of premature death.

scholarly journals Healthcare Utilization and All-Cause Premature Mortality in Hungarian Segregated Roma Settlements: Evaluation of Specific Indicators in a Cross-Sectional Study

2018 ◽  
Vol 15 (9) ◽  
pp. 1835 ◽  
Author(s):  
János Sándor ◽  
Anita Pálinkás ◽  
Ferenc Vincze ◽  
Nóra Kovács ◽  
Valéria Sipos ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Personal Data ◽  
Health Indicators ◽  
Premature Mortality ◽  
Premature Death ◽  
Cross Sectional Study ◽  
Insurance Fund ◽  
Sectional Study ◽  
Cross Sectional ◽  
Increased Risk

Roma is the largest ethnic minority of Europe with deprived health status, which is poorly explored due to legal constrains of ethnicity assessment. We aimed to elaborate health indicators for adults living in segregated Roma settlements (SRS), representing the most vulnerable Roma subpopulation. SRSs were mapped in a study area populated by 54,682 adults. Records of all adults living in the study area were processed in the National Institute of Health Insurance Fund Management. Aggregated, age-sex standardized SRS-specific and non-SRS-specific indicators on healthcare utilization and all-cause premature death along with the ratio of them (RR) were computed with 95% confidence intervals. The rate of GP appointments was significantly higher among SRS inhabitants (RR = 1.152, 95% CI: 1.136–1.167). The proportion of subjects hospitalized (RR = 1.286, 95% CI: 1.177–1.405) and the reimbursement for inpatient care (RR = 1.060, 95% CI: 1.057–1.064) were elevated for SRS. All-cause premature mortality was significantly higher in SRSs (RR = 1.711, 1.085–2.696). Our study demonstrated that it is possible to compute the SRS-specific version of routine healthcare indicators without violating the protection of personal data by converting a sensitive ethical issue into a non-sensitive small-area geographical analysis; there is an SRS-specific healthcare utilization pattern, which is associated with elevated costs and increased risk of all-cause premature death.

scholarly journals Epilepsy and Mortality

2020 ◽  
Vol 38 (1) ◽  
pp. 1-8
Author(s):  
Hye-Jin Moon ◽  
Keun Tae Kim ◽  
Kyung Wook Kang ◽  
Soo Yeon Kim ◽  
Yong Seo Koo ◽  
...  
Keyword(s):  
Public Health ◽  
Epilepsy Surgery ◽  
Associated Factors ◽  
Causes Of Death ◽  
Premature Mortality ◽  
Premature Death ◽  
Increased Risk ◽  
Significant Burden

Epilepsy is associated with an increased risk of premature death. Epilepsy-related premature mortality imposes a significant burden on public health. This review aims to update the previous assessments of mortality among people with epilepsy and to identify associated factors, causes of death, and preventable causes of death in epilepsy patients. We also reviewed the mortality of epilepsy patients who had undergone epilepsy surgery. Finally, we suggest a further direction of studies about the mortality of people with epilepsy.

scholarly journals A decade lost: does educational success mitigate the increased risks of premature death among children with experience of out-of-home care?

2018 ◽  
Vol 72 (11) ◽  
pp. 997-1002 ◽  
Author(s):  
Ylva B Almquist ◽  
Josephine Jackisch ◽  
Hilma Forsman ◽  
Karl Gauffin ◽  
Bo Vinnerljung ◽  
...  
Keyword(s):  
Home Care ◽  
Regression Models ◽  
Cox Regression ◽  
Premature Mortality ◽  
Premature Death ◽  
High Risk Group ◽  
Educational Success ◽  
Out Of Home Care ◽  
Increased Risk ◽  
Majority Population

BackgroundPast research has consistently identified children with out-of-home care (OHC) experience as a high-risk group for premature mortality. While many have argued that educational success is a key factor in reducing these individuals’ excessive death risks, empirical evidence has hitherto been limited. The aim of the current study was therefore to examine the potentially mitigating role of educational success in the association between OHC experience and premature mortality.MethodsDrawing on a Stockholm cohort born in 1953 (n=15 117), we analysed the associations among placement in OHC (ages 0–12), school performance (ages 13, 16 and 19) and premature all-cause mortality (ages 20–56) by means of Cox and Laplace regression analyses.ResultsThe Cox regression models confirmed the increased risk of premature mortality among individuals with OHC experience. Unadjusted Laplace regression models showed that, based on median survival time, these children died more than a decade before their majority population peers. However, among individuals who performed well at school, that is, those who scored above-average marks at the age of 16 (grade 9) and at the age of 19 (grade 12), the risks of premature mortality did not significantly differ between the two groups.ConclusionEducational success seems to mitigate the increased risks of premature death among children with OHC experience.

scholarly journals Development and validation of a Bayesian survival model for inclusion body myositis

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Gorana Capkun ◽  
Jens Schmidt ◽  
Shubhro Ghosh ◽  
Harsh Sharma ◽  
Thomas Obadia ◽  
...  
Keyword(s):  
General Population ◽  
Inclusion Body Myositis ◽  
Premature Mortality ◽  
Premature Death ◽  
Survival Model ◽  
Age And Gender ◽  
Disease Characteristics ◽  
Increased Risk ◽  
And Gender ◽  
Bayesian Survival Model

Abstract Background Associations between disease characteristics and payer-relevant outcomes can be difficult to establish for rare and progressive chronic diseases with sparse available data. We developed an exploratory bridging model to predict premature mortality from disease characteristics, and using inclusion body myositis (IBM) as a representative case study. Methods Candidate variables that may be potentially associated with premature mortality were identified by disease experts and from the IBM literature. Interdependency between candidate variables in IBM patients were assessed using existing patient-level data. A Bayesian survival model for the IBM population was developed with identified variables as predictors for premature mortality in the model. For model selection and external validation, model predictions were compared to published mortality data in IBM patient cohorts. After validation, the final model was used to simulate the increased risk of premature death in IBM patients. Baseline survival was based on age- and gender-specific survival curves for the general population in Western countries as reported by the World Health Organisation. Results Presence of dysphagia, aspiration pneumonia, falls, being wheelchair-bound and 6-min walking distance (6MWD in meters) were identified as candidate variables to be used as predictors for premature mortality based on inputs received from disease experts and literature. There was limited correlation between these functional performance measures, which were therefore treated as independent variables in the model. Based on the Bayesian survival model, among all candidate variables, presence of dysphagia and decrease in 6MWD [m] were associated with poorer survival with contributing hazard ratios (HR) 1.61 (95% credible interval [CrI]: 0.84–3.50) and 2.48 (95% CrI: 1.27–5.00) respectively. Excess mortality simulated in an IBM cohort vs. an age- and gender matched general-population cohort was 4.03 (95% prediction interval 1.37–10.61). Conclusions For IBM patients, results suggest an increased risk of premature death compared with the general population of the same age and gender. In the absence of hard data, bridging modelling generated survival predictions by combining relevant information. The methodological principle would be applicable to the analysis of associations between disease characteristics and payer-relevant outcomes in progressive chronic and rare diseases. Studies with lifetime follow-up would be needed to confirm the modelling results.

Prevalence of metabolic syndrome in never treated mood disordered patientss

2007 ◽  
Vol 30 (4) ◽  
pp. 95
Author(s):  
Valerie Taylor ◽  
Glenda M. MacQueen
Keyword(s):  
Metabolic Syndrome ◽  
Mood Disorders ◽  
Population Attributable Risk ◽  
Disease Process ◽  
Visceral Obesity ◽  
Premature Mortality ◽  
Overweight And Obesity ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Bipolar Patients

Bipolar disorder and major depression are life-shortening illnesses. Unnatural causes such as suicide and accidents account for only a portion of this premature mortality1 Research is beginning to identify that mood disordered patients have a higher incidence of metabolic syndrome, an illness characterized by dyslipidemia, impaired glucose tolerance, hypertension and obesity.2 Metabolic syndrome is associated with an increased risk for a variety of physical illnesses. Hypothesis: Never treated patients with mood disorders have preexisting elevations in the prevalence of the component variables of metabolic syndrome. Central obesity will be especially elevated, predicting increased premature mortality. Methods: We assessed never treated patients with mood disorders for metabolic syndrome and its component variables. Patients were assessed at baseline and followed up at 6-month intervals. All psychiatric pharmacotherapy was documented. Body mass index (BMI) was also obtained and the percentage of deaths attributable to overweight and obesity was calculated using the population attributable risk (PAR). [PAR= ∑[P (RR-1)/RR] Results: Prior to the initiation of treatment, patients did not differ from population norms with respect to metabolic syndrome or BMI. At 2-year follow-up, BMI had increased for unipolar patients 2.02 points and 1.92 points for bipolar patients. (p < .001) This increase in BMI predicted an increase in mortality of 19.4%. Conclusion: An increase in visceral obesity is often the first component of metabolic syndrome to appear and may indicate the initiation of this disease process prematurely in this group. The increase in BMI places patients with mood disorders at risk for premature mortality and indicates a need for early intervention. References 1.Osby U, Brandt L, Correia N, Ekbom A & Sparen P. Excess mortability in bipolar and Unipolar disorder rin Sweden. Archives of General Psychiatry, 2001;58: 844-850 2.Toalson P, Saeeduddin A, Hardy T & Kabinoff G. The metabolic syndrome in patients with severe mental illness. Journal of Clinical Psychiatry, 2004; 6(4): 152-158

Epidemiology of Hypertension and Diabetes Mellitus in Latin America

2020 ◽  
Vol 16 ◽  
Author(s):  
Patricio Lopez-Jaramillo ◽  
Jose Lopez-Lopez ◽  
Daniel Cohen ◽  
Natalia Alarcon-Ariza ◽  
Margarita Mogollon-Zehr
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Latin America ◽  
Cardiovascular Diseases ◽  
Latin American ◽  
Premature Mortality ◽  
Increased Risk ◽  
And Control

: Hypertension and type 2 diabetes mellitus are two important risk factors that contribute to cardiovascular diseases worldwide. In Latin America hypertension prevalence varies from 30 to 50%. Moreover, the proportion of awareness, treatment and control of hypertension is very low. The prevalence of type 2 diabetes mellitus varies from 8 to 13% and near to 40% are unaware of their condition. In addition, the prevalence of prediabetes varies from 6 to 14% and this condition has been also associated with increased risk of cardiovascular diseases. The principal factors linked to a higher risk of hypertension in Latin America are increased adiposity, low muscle strength, unhealthy diet, low physical activity and low education. Besides being chronic conditions, leading causes of cardiovascular mortality, both hypertension and type 2 diabetes mellitus represent a substantial cost for the weak health systems of Latin American countries. Therefore, is necessary to implement and reinforce public health programs to improve awareness, treatment and control of hypertension and type 2 diabetes mellitus, in order to reach the mandate of the Unit Nations of decrease the premature mortality for CVD.

scholarly journals Nutritional Status Measurement Instruments for Diabetes: A Systematic Psychometric Review

2020 ◽  
Vol 17 (16) ◽  
pp. 5719
Author(s):  
Pedro Montagut-Martínez ◽  
David Pérez-Cruzado ◽  
José Joaquín García-Arenas
Keyword(s):  
Nutritional Status ◽  
Dietary Intake ◽  
Psychometric Properties ◽  
Premature Death ◽  
Diabetes Mellitus Type 1 ◽  
Measurement Properties ◽  
Cochrane Library ◽  
Individual Treatment ◽  
Measurement Instruments ◽  
Increased Risk

Background: Diabetes is a serious chronic disease associated with a large number of complications and an increased risk of premature death. A dietary evaluation is of utmost importance for health promotion, disease prevention and individual treatment plans in patients with diabetes. Methods: An exhaustive search was carried out in various databases—Medline, Web of Science, Open Gray Cochrane Library and Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN)—for systematic review of the measurement properties of instruments that evaluate the dietary intake of people with diabetes mellitus type 1 and/or 2 according to COSMIN standards. Results: Seven instruments were identified. There was no instrument measuring nutritional status for which all the psychometric properties were evaluated. The methodological quality for each of the psychometric properties evaluated was ‘inadequate’ or ‘doubtful’ for all instruments. The Food Frequency Questionnaire (FFQ) evaluated the most psychometric characteristics and with a better score in terms of quality of the evidence. Conclusions: Several instruments have been developed for the evaluation of dietary intake in people with diabetes. Evaluation of this construct is very useful, both in clinical practice and in research, requiring new knowledge in this area. The FFQ is the best instrument available to assess dietary intake in people with diabetes.

Association Between Potentially Inappropriate Medications and 30-Day Post–Hospital Discharge Outcomes in US Veterans

2021 ◽  
pp. 106002802110320
Author(s):  
Heather G. Allore ◽  
Danijela Gnjidic ◽  
Melissa Skanderson ◽  
Ling Han
Keyword(s):  
Hospital Discharge ◽  
Adverse Drug Events ◽  
Primary Care Clinic ◽  
Care Utilization ◽  
Potentially Inappropriate Medications ◽  
Care Hospital ◽  
Care Clinic ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Reduced Risk

Background Potentially inappropriate medication (PIMs) use is common in older inpatients and it may lead to increased risk of adverse drug events. Objectives To examine prevalence of PIMs at hospital discharge and its contribution to health care utilization and mortality within 30-days of hospital discharge. Methods This was a prospective cohort of 117 570 veterans aged ≥65 years and hospitalized in 2013. PIMs at discharge were categorized into central nervous system acting (CNS) and non-CNS. Outcomes within 30-days of hospital discharge were: (1) time to first acute care hospital readmission, and all-cause mortality, (2) an emergency room visit, and (3) ≥3 primary care clinic visits. Results The cohort’s mean age was 74.3 years (SD 8.1), with 51.3% exposed to CNS and 62.8% to non-CNS PIMs. Use of CNS and non-CNS PIMs, respectively, was associated with a reduced risk of readmission, with an adjusted hazard ratio (aHR) of 0.93 (95% CI = 0.89-0.96) for ≥2 (vs 0) CNS PIMs and an aHR of 0.85 (95% CI = 0.82-0.88) for ≥2 (vs 0) non-CNS PIMs. Use of CNS PIMs (≥2 vs 0) was associated with increased risk of mortality (aHR = 1.37 [95% CI = 1.25-1.51]), whereas non-CNS PIMs use was associated with a reduced risk of mortality (aHR = 0.75 [95% CI = 0.69-0.82]). Conclusion and Relevance PIMs were highly common in this veteran cohort, and the association with outcomes differed by PIMs. Thus, it is important to consider whether PIMs are CNS acting to optimize short-term posthospitalization outcomes.

scholarly journals AB0393 PRE-EXISTING MORBIDITY AS A RISK FACTORS FOR MORTALITY IN IgA VASCULITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1224.3-1225
Author(s):  
J. Nossent ◽  
D. Preen ◽  
W. Raymond ◽  
H. Keen ◽  
C. Inderjeeth
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Mortality Rate ◽  
Data Collection ◽  
Premature Death ◽  
Iga Vasculitis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Serious Infections ◽  
Western Australian

Background:IgA vasculitis is generally considered to be a self-limiting condition, but this is at odds with the increased mortality observed in adult patients with IgA vasculitis (1).Objectives:With sparse data on prognostic factors in IgAV, we investigated whether pre-existing conditions are risk factors for mortality in adult IgAV patients.Methods:Observational population-based cohort study using state-wide linked longitudinal health data for adults with IgAV (n=267) and matched controls (n=1080) between 1980-2015. Charlson comorbidity index (CCI) and serious infections (SI) were recorded over an extensive lookback period prior to diagnosis. Date and causes of death were extracted from the WA Death Registry. Mortality rate (deaths/1000 person-years) ratios (MRR) and time dependent survival analysis assessed the risk of death. Age and gender specific mortality rate data were obtained from the Australian Bureau of Statistics.Results:During 9.9 (±9.8) years lookback IgAV patients accrued higher CCI scores (2.60 vs1.50 p<0.001) and had higher risk of SI (OR 8.4, p<0.001), not fully explained by CCI scores. During 19 years follow-up, the risk of death in IgAV patients (n=137) was higher than in controls (n=397) (MRR 2.06, CI 1.70-2.50, p<0.01) and the general population (SMRR 5.64, CI 4.25, 7.53, p<0.001). Survival in IgAV was reduced at five (72.7 vs. 89.7 %) and twenty years (45.2% vs. 65.6 %) (both p<0.05). CCI (HR1.88, CI:1.25 - 2.73, p=0.001), renal failure (HR 1.48, CI: 1.04 - 2.22, p=0.03) and prior SI (HR 1.48, CI:1.01 – 2.16, p=0.04) were independent risk factors. Death from infections (5.8 vs 1.8%, p=0.02) was significantly more frequent in IgAV patients.Conclusion:Premorbid accrual of comorbidity is increased and predicts premature death in IgAV patients. However, comorbidity does not fully explain the increased risk of serious infections prior to diagnosis or the increased mortality due to infections in IgAV.References:[1]Villatoro-Villar M, Crowson CS, Warrington KJ, Makol A, Ytterberg SR, Koster MJ. Clinical Characteristics of Biopsy-Proven IgA Vasculitis in Children and Adults: A Retrospective Cohort Study. Mayo Clin Proc. 2019;94(9):1769-80.Acknowledgements:The authors would like to acknowledge the support of the Arthritis Foundation of WA and acknowledge the Western Australian Data Linkage Branch, the Western Australian Department of Health, and the data custodians of, the Hospital and Morbidity Data Collection, the Emergency Department Data Collection the WA Cancer Register and the WA Death Register for their assistance with the study.Disclosure of Interests:None declared

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