Cross-classification between self-rated health and health status: longitudinal analyses of all-cause mortality and leading causes of death in the UK

Risk stratification is an important public health priority that is central to clinical decision making and resource allocation. The aim of this study was to examine how different combinations of self-rated and objective health status predict all-cause mortality and leading causes of death in the UK. The UK Biobank study recruited > 500,000 participants between 2006 and 2010. Self-rated health was assessed using a single-item question and health status was derived from medical history, including data on 81 cancer and 443 non-cancer illnesses. Analyses included > 370,000 middle-aged and older adults with a median follow-up of 11.75 (IQR = 1.4) years, yielding 4,320,270 person-years of follow-up. Compared to individuals with excellent self-rated health and favourable health status, individuals with other combinations of self-rated and objective health status had a greater mortality risk, with hazard ratios ranging from HR = 1.22 (95% CI 1.15–1.29, PBonf. < 0.001) for individuals with good self-rated health and favourable health status to HR = 7.14 (95% CI 6.70–7.60, PBonf. < 0.001) for individuals with poor self-rated health and unfavourable health status. Our findings highlight that self-rated health captures additional health-related information and should be more widely assessed. The cross-classification between self-rated health and health status represents a straightforward metric for risk stratification, with applications to population health, clinical decision making and resource allocation.

Subjective Social Status and Objective Health Among Older People in England. A Longitudinal Approach With Biomarkers

Subjective social status has a known association with health, whereby better health outcomes are observed for those with higher perceived status. However, in this article we offer new evidence on the status–health relationship using a rigorous methodological approach that considers both observed and unobserved confounders. We use 14 years of data from the English Longitudinal Study of Aging and derive a measure of allostatic load with biomarkers as an objective measure of health. We apply ‘within–between’ panel regression models which reveal the expected association between subjective status and health when comparing participants (the ‘between’ estimate), but no association when examining temporal variation within participants (the ‘within’ estimate). When controlling for personality traits, optimism, and parental education the ‘between’ association between subjective status and allostatic also load disappears. These results suggest that perceived status is not a pathway to health, in and of itself, among older people.

Consumer Medicine’s Origins and Harms

Consumer medicine consists of medical interventions pursued for non–health-related goals with the locus of the goals residing solely with the patient. Currently, contraceptives, abortion, cosmetic procedures, and physician-assisted suicide (PAS)/euthanasia fall in this category. Consumer medicine originates from the fusion of expressive individualism with its sole focus on the subjective psychological well-being intersecting with an expansion of health now including well-being combined with an exaltation of autonomy. Expressive individualism is inward-focused and entirely subjective reducing the human to a psychologic self while instrumentalizing the biological and social dimensions and neglecting the spiritual dimension. Expressive individualism is currently manifested through economic activity (career and consumption) and particularly sexual expression. This contrasts with the holistic biopsychosocial-spiritual model of health with its deep inter-relationships and prioritization of the spiritual. Consumer medicine has damaged the profession of medicine. Physicians now have conflicting roles of healer versus body engineer, and conflicting obligations to do no harm while performing medical harms unrelated to objective health. There is now division within medicine and increasing external state regulations both seriously harming its professional status. The traditional teleologically driven ethical framework that is objectively disease-focused is now confused with a subjective list of non–health-related values as goals for medical interventions leading to an incoherent ethical framework. Biologic solutions best address biological problems and do not effectively address psychological, social, or even spiritual problems but rather make them worse. Medicine now reinforces and is complicit with expressive individualism and its attendant shallow and narrow understanding of what it means to be human with the current valuation of sexual expression and economic activity. Medical harms and social costs have resulted while challenging the value of those who are disabled, elderly, or marginalized. This shallow view has likely fueled the current existential crisis contributing to the marked increase in PAS/euthanasia in the West. Summary: Consumer medicine currently includes contraceptives, abortion, cosmetic procedures, and physician-assisted suicide (PAS)/euthanasia. These medical interventions are pursued for subjective non–health-related goals as opposed to the traditional goal of treating sick patients for their objective health. Consumer medicine’s origins lie in the intersection of expressive individualism, the exaltation of patient autonomy combined with health’s redefinition as subjective well-being. This has resulted in harms to the profession of medicine, ethical incoherence, and medical injury. Consumer medicine promotes a truncated understanding of the human at odds with the biopsychosocial-spiritual model and human flourishing. This has likely contributed to the rise of PAS/euthanasia.

Healthcare Resource Utilization and Healthcare Costs of COVID-19 Patients in A Tertiary Care Public Hospital: A Retrospective Cohort Study in Thailand

Objective: Health care costs (HCCs) are a significant concern in developing countries. The authors investigated the healthcare resource utilization (HCRU) and HCCs for patients with COVID-19 based on disease severity and infection site. Materials and Methods: The authors reviewed data from the electronic medical records of COVID-19 patients admitted to the present study hospital between January 2020 and April 2020. The authors used comorbidities and patient characteristics as covariates. Analyses were conducted using simple linear regression and generalized linear regression models with a log-link and gamma distribution. Results: Two hundred two patients had confirmed SARS-CoV-2 infection. Total costs per patient were 6,626 USD (756 to 45,586). Personal protection equipment costs were the most significant cost for COVID-19 patients with a mean of 3,778 USD. The mean treatment cost per patient was 326 USD. Patients with severe symptoms and lower respiratory tract infection (LRI) had a higher cost and resource utilization value before and after adjusting for covariates. Conclusion: COVID-19 patients with severe symptoms and LRI had higher HCRU. Length of stay, severity of symptoms, and LRI were associated with higher cost of treatment. Keywords: SARS-CoV-2; COVID-19; Healthcare resource utilization; Healthcare costs; Thailand

Risk and Health Policy Preferences: Evidence from the UK COVID-19 Crisis

The onset of the COVID-19 pandemic constituted a large shock to the risk of acquiring a disease that represents a meaningful threat to health. We investigate whether individuals subject to larger increases in objective health risk -- operationalised by occupation-based measures of proximity to other people -- became more supportive of increased government healthcare spending during the crisis. Using panel data which tracks UK individuals before and after the outbreak of the pandemic, we implement a fixed-effect design which was pre-registered before the key treatment variable was available to us. While individuals in high-risk occupations were more worried about their personal risk of infection, and had higher COVID death rates, there is no evidence that increased health risks during COVID-19 shifted attitudes on government spending on healthcare, nor broader attitudes relating to redistribution. Our findings are consistent with recent research demonstrating the limited effects of the pandemic on political attitudes.

Comparisons of factors associated with suicidal ideation of older individuals by health status

This study examined the factors associated with suicidal ideation among older individuals and compared those factors by their objective and subjective health status. Data were obtained from the 13th wave of the Korean Health Panel Survey in 2018. The sample of 6,283 older individuals, who are 55 years and older, was classified into four groups by their objective and subjective health status. Objective health status was measured by the number of chronic health conditions, and subjective health status was defined by an individual’s self-reported health status. To examine the factors associated with suicidal ideation among four groups of older individuals, logistic regression analyses were conducted after controlling for socio-demographic characteristics, physical health and mental health characteristics. The results show that depression and anxiety were found as common factors associated with suicidal ideation for all four groups. As for the group of older individuals who reported bad objective health and bad subjective health, younger age, being male, and low educational attainment were found to be associated suicidal ideation. For those with bad objective health regardless of their subjective health status, the level of stress was found to be related to suicidal ideation among older individuals. Based upon those results, the present study discussed practical and policy implications for suicide prevention among older individuals by reflecting their objective health and subjective health status.

Developing and evaluating non-invasive healthcare technologies for a group of female participants from a socioeconomically disadvantaged area

When compared to the general population, socioeconomically disadvantaged communities frequently experience compromised health. Monitoring the divide is challenging since standardized biomedical tests are linguistically and culturally inappropriate. The aim of this study was to develop and test a unique mobile biomedical testbed based on non-invasive analysis, as well as to explore the relationships between the objective health measures and subjective health outcomes, as evaluated with the World Health Organization Quality of Life survey. The testbed was evaluated in a socioeconomically disadvantaged neighborhood in Malmö, which has been listed as one of the twelve most vulnerable districts in Sweden. The study revealed that compared to conventional protocols the less intrusive biomedical approach was highly appreciated by the participants. Surprisingly, the collected biomedical data illustrated that the apparent health of the participants from the ethnically diverse low-income neighborhood was comparable to the general Swedish population. Statistically significant correlations between perceived health and biomedical data were disclosed, even though the dependences found were complex, and recognition of the manifest complexity needs to be included in further research. Our results validate the potential of non-invasive technologies in combination with advanced statistical analysis, especially when combined with linguistically and culturally appropriate healthcare methodologies, allowing participants to appreciate the significance of the different parameters to evaluate and monitor aspects of health.

Frailty and Processing Speed Performance at the Cusp of Midlife in CATSLife

Frailty is an important multi-domain measure of health status and aging. Processing speed (PS) performance may be predictive of later frailty among older adults, but the interrelation between frailty and PS at the cusp of mid-adulthood is unclear. Using data from the ongoing Colorado Adoption/Twin Study of Lifespan Behavioral Development and Cognitive Aging (CATSLife; N = 1213; Mean age = 33.22 years; SD = 5.0), we constructed a 24-item frailty sum score across anthropomorphic, objective health, and perceived health and engagement measures based on the Accumulation of Deficits model. PS was measured using the Colorado Perceptual Speed (CPS) and WAIS-III Digit Symbol (DS) tests. All mixed-effects regression models accounted for clustering among siblings, and covariates included sex, age, race, ethnicity, and educational attainment. Intraclass correlations (ICCs) [95% CI] for frailty among siblings, adjusted for sex and age, ranged from near zero for siblings in adoptive families, .13 [.08-.30] for nonadoptive siblings/fraternal (DZ) twins, and .44 [.40-.48] for identical (MZ) twins, suggesting possible heritable influences. Poorer PS performance was associated with higher frailty, but was significant for DS only (B: DS = -0.43, p =.005). Furthermore, the DS-frailty association was magnified by age (B: DSxAge = -0.06, p =.025), suggesting that the associations between processing speed and frailty may increase with age. These findings help elucidate the interrelationship between indicators of frailty and cognitive performance for adults approaching midlife, a salient and understudied period within lifespan development.

Characteristics of Our Patient Population

To date, 106 patients have completed behavioral health assessments across three sites: a rural primary care clinic (n = 32), urban federally qualified health center (n = 33), and state-certified residential rehabilitation facility (n = 41). Patients ranged from 18 to 65 years of age (M = 38.6, SD = 11.4). Approximately 51% were female and 75% were non-Hispanic White (followed by 22% African American). Over 60% had a high school degree or less and found it at least somewhat difficult to pay for basic needs. Most patients endorsed substantial (44%) or severe (39%) drug use, with 40% endorsing opioid use. There were no significant differences in substance use by age group. Moderate to severe symptoms of depression (43%) and anxiety (49%) were common. Approximately 70% endorsed adverse childhood experiences, and 44% reported clinically significant post-traumatic stress symptoms. Measures of cognitive functioning and objective health literacy are currently being collected.