Economic Burden of Comorbid Chronic Conditions Among Survivors of Stroke in China: 10-Year Longitudinal Study

Abstract Background: The coexistence of chronic diseases among people with stroke is common. However, little is known about the extent of incremental healthcare expenditures associated with having physically and psychologically chronic conditions among stroke survivors.Methods: We used the nationally representative data from the China Health and Nutrition Survey, including 36,076 participants enrolled as our analytic cohort of ten years of follow-up visits (2006, 2009, 2011, 2015). Chronic conditions include hypertension, diabetes, obesity, and impaired cognitive function. Two-part models were used to estimate the effect of comorbid chronic conditions on total annual healthcare expenditure, out-of-pocket (OOP) healthcare expenditure, and incidence of catastrophic healthcare expenditure (CHE).Results: Among survivors of stroke during 2006 to 2015, the prevalence rates of hypertension, diabetes, obesity and impaired cognitive function were 75.5%, 9,8%, 12.7% and 65.1%, significantly higher than those among adults without stroke history (27.9%, 2.7%, 10.0% and 41.2%). Having hypertension ($794.5, p=0.004), diabetes ($3978.5, p<0.001) were associated with the largest incremental total healthcare expenditures. Stroke survivors with diagnosed hypertension and diabetes had additional 5.7 (p<0.001) and 10.4 (p<0.001) percentage point of CHE rate, respectively. Total healthcare expenditures were $2413.0 (P<0.001) and $5151.7 (P<0.001) higher among patients with 2, and ≥3 chronic conditions, respectively, than those individuals with no chronic conditions.Conclusions: Excess expenditures associated with chronic diseases were substantial among stroke survivors. These results highlight the needs for both prevention and better management of multimorbidity among stroke survivors, which in turn may lower the financial burden of treating these concurrent comorbidities.

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Economic burden of comorbid chronic conditions among survivors of stroke in China: 10-year longitudinal study

BMC Health Services Research ◽

10.1186/s12913-021-07010-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ji Zhang ◽

Suhang Song ◽

Yang Zhao ◽

Gaoting Ma ◽

Yinzi Jin ◽

...

Keyword(s):

Cognitive Function ◽

Chronic Diseases ◽

Chronic Conditions ◽

Healthcare Expenditure ◽

Financial Burden ◽

Stroke Survivors ◽

Nutrition Survey ◽

Healthcare Expenditures ◽

Impaired Cognitive Function ◽

Nationally Representative

Abstract Background The coexistence of chronic diseases among people with stroke is common. However, little is known about the extent of incremental healthcare expenditures associated with having physically and psychologically chronic conditions among stroke survivors. Methods We used the nationally representative data from the China Health and Nutrition Survey, including 36,076 participants enrolled as our analytic cohort of ten years of follow-up visits (2006, 2009, 2011, 2015). Chronic conditions include hypertension, diabetes, obesity, and impaired cognitive function. Two-part models were used to estimate the effect of comorbid chronic conditions on total annual healthcare expenditure, out-of-pocket (OOP) healthcare expenditure, and incidence of catastrophic healthcare expenditure (CHE). Results Among survivors of stroke during 2006 to 2015, the prevalence rates of hypertension, diabetes, obesity and impaired cognitive function were 75.5, 9.8, 12.7 and 65.1%, significantly higher than those among adults without stroke history (27.9, 2.7, 10.0 and 41.2%). Having hypertension ($794.5, p = 0.004), diabetes ($3978.5, p < 0.001) were associated with the largest incremental total healthcare expenditures. Stroke survivors with diagnosed hypertension and diabetes had additional 5.7 (p < 0.001) and 10.4 (p < 0.001) percentage point of CHE rate, respectively. Total healthcare expenditures were $2413.0 (P < 0.001) and $5151.7 (P < 0.001) higher among patients with 2, and ≥ 3 chronic conditions, respectively, than those individuals with no chronic conditions. Conclusions Excess expenditures associated with chronic diseases were substantial among stroke survivors. These results highlight the needs for both prevention and better management of multimorbidity among stroke survivors, which in turn may lower the financial burden of treating these concurrent comorbidities.

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The prevalence of impaired cognitive function and depression in patients with type 2 diabetes mellitus and severe insulin resistance

Endocrine Abstracts ◽

10.1530/endoabs.63.p961 ◽

2019 ◽

Author(s):

Diana Šimonienę ◽

Džilda Veličkienę

Keyword(s):

Diabetes Mellitus ◽

Insulin Resistance ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cognitive Function ◽

Severe Insulin Resistance ◽

Impaired Cognitive Function

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Determinants of COVID-19 preventive behaviours among adults with chronic diseases in the USA: an analysis of the nationally representative COVID-19 impact survey

BMJ Open ◽

10.1136/bmjopen-2020-044600 ◽

2021 ◽

Vol 11 (2) ◽

pp. e044600

Author(s):

Jessica Y. Islam ◽

Denise C. Vidot ◽

Marlene Camacho-Rivera

Keyword(s):

Chronic Diseases ◽

Rural Areas ◽

Prevalence Ratio ◽

Face Mask ◽

Chronic Obstructive ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

High School Degree ◽

The Usa ◽

Nationally Representative

BackgroundPreventive behaviours have been recommended to control the spread of SARS-CoV-2. Adults with chronic diseases (CDs) are at higher risk of COVID-19-related mortality compared to the general population. Our objective was to evaluate adherence to COVID-19 preventive behaviours among adults without CDs compared with those with CDs and identify determinants of non-adherence to COVID-19 preventive behaviours.Study designCross-sectional.Setting and participantsWe used data from the nationally representative COVID-19 Impact Survey (n=10 760) conducted in the USA.Primary measuresAdults with CDs were categorised based on a self-reported diagnosis of diabetes, high blood pressure, heart disease/heart attack/stroke, asthma, chronic obstructive pulmonary disease (COPD), bronchitis or emphysema, cystic fibrosis, liver disease, compromised immune system, or cancer (54%).ResultsCompared with adults without CDs, adults with CDs were more likely to adhere to preventive behaviours including wearing a face mask (χ2-p<0.001), social distancing (χ2-p<0.001), washing or sanitising hands (χ2-p<0.001), and avoiding some or all restaurants (χ2-p=0.002) and public or crowded places (χ2-p=0.001). Adults with a high school degree or below [Adjusted prevalence ratio (aPR):1.82, 95% Confidence interval (CI)1.04 to 3.17], household income <US$50 000 (aPR:2.03, 95% CI 1.34 to 2.72), uninsured (aPR:1.65, 95% CI1.09 to 2.52), employed (aPR:1.48, 95% CI 1.02 to 2.17), residing in rural areas (aPR:1.70, 95% CI 1.01 to 2.85) and without any CD (aPR:1.78, 95% CI 1.24 to 2.55) were more likely to not adhere to COVID-19 preventive behaviours.ConclusionAdults with CDs are more likely to adhere to recommended COVID-19 preventive behaviours. Public health messaging targeting specific demographic groups and geographic areas, such as adults without CD or adults living in rural areas, should be prioritised.

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Diagnosing dementia in the Arctic: translating tools and developing and validating an algorithm for assessment of impaired cognitive function in Greenland Inuit

International Journal of Circumpolar Health ◽

10.1080/22423982.2021.1948247 ◽

2021 ◽

Vol 80 (1) ◽

pp. 1948247

Author(s):

Inaluk Kleist ◽

Paneeraq Noahsen ◽

Ole Gredal ◽

Johannes Riis ◽

Stig Andersen

Keyword(s):

Cognitive Function ◽

The Arctic ◽

Impaired Cognitive Function

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The Effect of Proximal Cleaning Devices on Periodontal Status in Korean Adults between 2016 and 2018

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18042116 ◽

2021 ◽

Vol 18 (4) ◽

pp. 2116

Author(s):

Eun-Jeong Kim ◽

Su-Jin Han

Keyword(s):

Periodontal Disease ◽

Multivariable Logistic Regression Analysis ◽

Nutrition Survey ◽

Periodontal Health ◽

Dental Floss ◽

Explanatory Variables ◽

Dental Biofilm ◽

Korean Adults ◽

Nationally Representative ◽

Interdental Brush

Removal of the biofilm from the proximal space is essential for preventing periodontal disease. This study aimed to prove the association between the use of proximal cleaning devices, such as dental floss and interdental brushes, and periodontal health among nationally representative Korean adults. Data collected from the 7th National Health Nutrition Survey (KNHANES VII: 2016–2018) were used for this purpose. A total of 11,359 participants aged 19 years or older who participated in KNHANES were reviewed. The response variable was the prevalence of high CPI (CPI of 3–4), and the explanatory variables were dental floss and interdental brush. A multivariable logistic regression analysis was performed to adjust for potential confounding factors and to analyze the association between periodontal disease and proximal cleaning devices. It was found that 63.1% of the participants did not use proximal cleaning devices at all, 17.5% used dental floss alone, 11.9% used an interdental brush, and 7.5% used both. Subjects who used both dental floss and interdental brush had a high CPI rate nearly half that of all the models for those who did not. In particular, for those using dental floss, the aOR of high CPI was 0.681 in Model 1, 0.714 in Model 2, and 0.737 in Model 3. Dental hygiene products for cleaning the proximal space, such as dental floss, are essential for removing the dental biofilm as a basic tool along with toothbrushes. Teaching and explaining the need to use these devices well are important for oral health care and maintenance.

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Dementia Caregiving, Care Recipient Health, and Financial Burdens

Innovation in Aging ◽

10.1093/geroni/igaa057.183 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 56-56

Author(s):

Rashmita Basu

Keyword(s):

Physical Health ◽

Healthcare Costs ◽

Financial Burden ◽

Care Recipient ◽

Positive Feeling ◽

Nationally Representative ◽

Financial Burdens ◽

Health Deterioration ◽

Retirement Study

Abstract Objective: While about 75% of people with ADRD receive care informally by their family members, relatively little is known about the effect of the quality of caregiving on maintaining carerecipient’s health and financial burden of out-of-pocket (OOP) healthcare costs. The goal of this study is to examine the quality of caregiving on the out-of-pocket healthcare costs among ADRD patients and if caregiving prevents deterioration of physical health of carerecipients. Data and Sample: We used a nationally representative sample of people diagnosed with ADRD from the Aging Demographic and Memory Study, subsample of the Health and Retirement Study. The study sample includes carerecipients whose caregivers participated in the survey (N=261). Outcome measures: Primary outcomes were deterioration of carerecipients’ health (1=yes, 0=no) and annual OOP healthcare costs. The quality of caregiving is captured by if caregiving made them feel good, feel useful and fee closer to carerecipients. More than 70% caregivers reported that caregiving make them feel good or useful. About 60% of carerecipients’ physical health was maintained, and average out-of-pocket costs was $3,701/year ($0-$31,051). Multivariable logit for binary health outcome and OLS regression for OOP cost were estimated. Results: The likelihood of health deterioration was significantly lower for carerecipients whose caregivers reported that caregiving made them feel useful (AOR=5.1, 95% CI: 1.9- 14.5) and lower OOP remained significantly associated with presence of usefulness of caregiving (cost decrease, $3000 [95% CI: $6309-$918). Positive feeling of caregiving is independently associated with lower OOP cost and deterioration of physical health among ADRD patients.

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