Risk of Newly-diagnosed Depression, Treatment and its Economic Outcomes among Elderly Medicare Beneficiaries with Incident Breast, Colorectal or Prostate Cancer

Depression is a highly prevalent chronic condition among the elderly cancer survivors. It is estimated that 5-25% of elderly cancer survivors suffer from depression. Depression co-existing with cancer is associated with many negative health consequences such as high mortality, poor health related quality of life and high healthcare utilization and expenditures. However, depression is treatable with pharmacotherapy, psychotherapy or combination of both. There are no studies that examine the variations in the risk of depression by cancer types and there are few studies that examined the rates of depression treatment among elderly with cancer. In addition, there is lack of evidence on the impact of depression treatment on the economic outcomes of cancer survivors. To fill the knowledge gap, the three related aims of this dissertation were to: (1) examine the variations in the risk of depression by cancer types among elderly with incident breast, colorectal, and prostate cancer; (2) identify the rates of depression treatment and the factors associated with depression treatment among elderly with newly-diagnosed depression and incident breast, colorectal and prostate cancer; (3) analyze the impact of depression treatment on the healthcare expenditures among elderly with newly-diagnosed depression and incident breast, colorectal and prostate cancer. The study used a retrospective cohort study design, using multiple years (2002--2011) of the cancer registry data from the Surveillance, Epidemiology and End Results (SEER) program linked with the Medicare claims data, the American community survey census-tract files and the Area Health Resource Files. In the first aim, among elderly with incident breast, colorectal and prostate cancer (N= 53,821), women with colorectal cancer had 28.0% higher risk of newly-diagnosed depression as compared to women with breast cancer; men with colorectal cancer had 104.0% higher risk of newly-diagnosed depression as compared to men with prostate cancer. Elderly diagnosed with cancer at an advanced stage had a 61.0% higher risk of newly-diagnosed depression as compared to those diagnosed with cancer at an early stage. Elderly with higher number of primary care providers visits had a higher newly-diagnosed depression as compared to those with lower number of primary care providers visits. In the second aim, among elderly with newly-diagnosed depression and incident breast, colorectal and prostate cancer (N= 1,673), 45.7% received antidepressants only; 8.8% received psychotherapy only; 18.4% received combined therapy; and 27.1% received no treatment for depression. Elderly cancer survivors who received ongoing cancer treatment were less likely to receive psychotherapy only, or combination therapy. Elderly living in counties with a higher percentage of psychologists were more likely to receive psychotherapy only, or combination therapy. In the third aim, among elderly with newly-diagnosed depression and incident breast, colorectal and prostate cancer (N= 1,502), the average 1-year total healthcare expenditures after depression diagnosis were higher among those who received depression treatment as compared to no depression treatment. The associations between depression treatment and the higher healthcare expenditures were observed across all types of healthcare expenditures (inpatient, outpatient, prescription drugs, and other expenditures). To summarize, this dissertation found that there are variations in the risk of newly-diagnosed depression by cancer type. Among cancer survivors with newly-diagnosed depression, one-quarter of cancer survivors did not receive any form of depression treatment; cancer-related factors were associated with depression treatment; and depression treatment was associated with increase in short-term healthcare expenditures

Type of Multimorbidity and Complementary and Alternative Medicine Use among Adults

Objective. To examine the association between type of multimorbidity and CAM use among adults with multimorbidity. Methods. The current study used a cross-sectional design with retrospective data from 2012 National Health Interview Survey. Multimorbidity was classified into two groups: (1) adults with coexisting physical and mental illnesses and (2) adults with two or more chronic physical illnesses only. CAM use was measured using a set of 18 variables. Logistic regression and multinomial logistic regressions were used to assess the association between the type of multimorbidity and ever used CAM, CAM use in the past 12 months, and type of CAM. Results. Overall, 31.2% of adults with coexisting physical and mental illnesses and 20.1% of adults with only physical illnesses used CAM in the past 12 months. Adults with coexisting physical and mental illnesses were more likely to ever use CAM (AOR = 1.68, 95% CI = 1.49, 1.90), use CAM in the past 12 months (AOR = 1.32, 95% CI = 1.15, 1.52), and use mind-body therapies in the past 12 months (AOR = 1.36, 95% CI = 1.16, 1.59) compared to adults with only physical illnesses. Conclusion. Multimorbidity of chronic physical and mental illnesses was associated with higher CAM use

The Use of Herbal Remedies among Mothers of Young Children Living in the Central Appalachian Region

ntroduction. Women often use herbal remedies as a complement or alternative to traditional medicine. Guided by the Comprehensive Model of Information Seeking, this study examined use of herbal remedies among mothers of young children living in the Central Appalachian Region. Methods. A cross-sectional study was conducted among mothers of young children (). The outcome measure of interest was the use of any herbal remedy in the past six months. Two scales were developed to measure information seeking channels and to measure beliefs about the safety/efficacy of herbal remedies. Results. One-third reported using herbal remedies in the past six months, with fenugreek being the most common. Most reported using herbal remedies to increase breast milk production and to relieve cold/flu-like symptoms. Women scoring highest in information seeking channels were three times as likely to use herbal remedies. Women scoring highest in the beliefs about the safety/efficacy of herbal remedies were four times as likely to use herbal remedies. Conclusion. Herbal remedies are commonly used among women living in the Central Appalachian Region, a region with lower education and income level. Therefore, public health interventions about the types, safety, and efficacy of herbal remedies may improve health within this population

Polypharmacy among patients with diabetes: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia

Abstract Patients with diabetes are at high risk for polypharmacy (ie, use of multiple medications) for treatment of diabetes, associated comorbidities and other coexisting conditions. This study aims to estimate the prevalence of polypharmacy and factors associated with polypharmacy among adult patients with diabetes.Methods A cross-sectional retrospective observational study of adults with diabetes, who visited the outpatient clinic of a tertiary teaching hospital in Saudi Arabia, was conducted. Data were extracted from the Electronic Health Record database for a period of 12 months (January– December 2016). Polypharmacy was defined as the cumulative use of five or more medications. Polypharmacy among adults with diabetes was measured by calculating the average number of medications prescribed per patient. A multivariable logistic regression model was used to examine the factors associated with polypharmacy. Results A total of 8932 adults with diabetes were included in this study. Of these, nearly 78% had polypharmacy which was more likely among women as compared with men and more likely among older adults (age ≥60 years) as compared with the adults. Also, polypharmacy was two times as likely among patients with coexisting cardiovascular conditions (adjusted OR (AOR)=2.89; 95% CI 2.54 to 3.29), respiratory disease (AOR=2.42; 95% CI 1.92 to 3.03) and mental health conditions (AOR=2.19; 95% CI 1.74 to 2.76), and three times as likely among patients with coexisting musculoskeletal disease (AOR=3.16; 95% CI 2.31 to 4.30) as compared with those without these coexisting chronic conditions categories. Conclusions Polypharmacy is common among patients with diabetes, with an even higher rate in older adults patients. Healthcare providers can help in detecting polypharmacy and in providing recommendations for simplifying medication regimens and minimising medications to enhance the outcome of diabetes care

The socioeconomic burden of spinal muscular atrophy in Saudi Arabia: a cross-sectional pilot study

BackgroundSpinal muscular atrophy (SMA) is a rare debilitating condition with a significant burden for patients and society. However, little is known about how it affects Saudi Arabia's population. The socioeconomic and medical characteristics of affected SMA patients and their caregivers are lacking.PurposeThis study aimed to describe the socioeconomic and medical characteristics of SMA patients and caregivers in Saudi Arabia.Patients and methodsA cross-sectional questionnaire-based study was conducted using snowball sampling. Assessment tools including EuroQol (EQ-5D-5L) and visual analog scale (EQ-VAS), Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire (PHQ-9), and Costs for Patients Questionnaire (CoPaQ) were used to assess the quality of life (QoL), anxiety, depression, and out-of-pocket expenditures.ResultsSixty-four caregivers of SMA patients participated. Type I patients had higher sibling concordance, ICU hospitalization, and mechanical support needs. Type III patients had better QoL. Type I patients' caregivers had higher depression scores. Type III patients' caregivers had higher out-of-pocket expenditures. Forty-eight percent received supportive care, while others received SMA approved therapies.ConclusionSMA imposes a significant socioeconomic burden on patients and caregivers, requiring more attention from the healthcare system. Access to innovative therapies varied across SMA types. Pre-marital screening and early detection are crucial to reduce disease incidence and ensure timely treatment

Sex Differences in the Use of Complementary and Alternative Medicine among Adults with Multiple Chronic Conditions

Objective. To examine sex differences in complementary and alternative medicine (CAM) use among adults with multiple chronic conditions. Methods. This study used a cross-sectional design with data from the 2012 National Health Interview Survey. The participants were interviewed in 2012 and the reference period for the questions in the survey varied from 1 week to 12 months prior to the interview date. The study included adults (age > 21 years) with no missing data on CAM use variables and who had multiple chronic conditions. Multivariable regression analyses were used to examine the association between sex and CAM use. Results. A significantly higher percentage of women compared to men had ever used CAM (51.5% versus 44.3%); women were more likely to have ever used CAM (AOR = 1.49, 95% CI = 1.35–1.65). Among CAM users, a higher percentage of women compared to men used CAM in the past 12 months (53.5% vs. 42.7%); women were more likely to use CAM in the past 12 months (AOR = 1.71, 95% CI = 1.49–1.97). Factors associated with CAM use in the past 12 months were different for men and women; income and obesity were associated with CAM use in the past 12 months among women and not among men. Conclusion. Among adults with multiple chronic conditions, women were more likely to use CAM as compared to men

Sex Differences in the Use of Complementary and Alternative Medicine among Adults with Multiple Chronic Conditions

Objective. To examine sex differences in complementary and alternative medicine (CAM) use among adults with multiple chronic conditions. Methods. This study used a cross-sectional design with data from the 2012 National Health Interview Survey. The participants were interviewed in 2012 and the reference period for the questions in the survey varied from 1 week to 12 months prior to the interview date. The study included adults (age \u3e 21 years) with no missing data on CAM use variables and who had multiple chronic conditions. Multivariable regression analyses were used to examine the association between sex and CAM use. Results. A significantly higher percentage of women compared to men had ever used CAM (51.5% versus 44.3%); women were more likely to have ever used CAM (AOR = 1.49, 95% CI = 1.35–1.65). Among CAM users, a higher percentage of women compared to men used CAM in the past 12 months (53.5% vs. 42.7%); women were more likely to use CAM in the past 12 months (AOR = 1.71, 95% CI = 1.49–1.97). Factors associated with CAM use in the past 12 months were different for men and women; income and obesity were associated with CAM use in the past 12 months among women and not among men. Conclusion. Among adults with multiple chronic conditions, women were more likely to use CAM as compared to men

Gender Differences in Potentially Inappropriate Medication Use among Older Adults

Background: Use of potentially inappropriate medication (PIMs) is a prominent concern that leads to significant medication-related issues among older adults. Notably, older women tend to utilize more medicines than men; older women frequently take more drugs. In addition, some evidence suggests that prescription PIMs vary by gender. This study examines the gender-based variation in prescribing PIM among older adults in Saudi Arabia. Methods: A cross-sectional retrospective analysis of electronic medical records from a large hospital in Saudi Arabia was carried out. Patients over the age of 65 who received ambulatory treatment were included in the study. The utilization of PIM was assessed based on Beers criteria. Descriptive statistics and logistic regression were employed to describe patterns of PIM utilization and identify factors associated with their use. All statistical analyses were performed using Version 9.4 of the Statistical Analysis Software (SAS® 9.4). Results: The study comprised 4062 older people (age 65) who visited ambulatory care clinics; the average age was (72.6 ± 6.2) years. The majority of the study sample was women (56.8%). Among older adults, 44.7% of older men and 58.3% of older women reported having PIMs that should be avoided, indicating a higher prevalence of PIMs among women compared to men. In terms of the PIM categories used, women had a much higher utilization rate of cardiovascular and gastrointestinal drugs than men. In men, the use of PIMs was frequently associated with hypertension, ischemic heart disease, asthma, osteoarthritis, and cancer, while in women PIM use was associated with age, dyslipidemia, chronic kidney disease, and osteoporosis. Conclusions: This study revealed sex differences in PIM prescribing among older adults; PIM use is more common among women. Sex differences exist in clinical and socioeconomic characteristics and factors related to using potentially inappropriate medications. This study revealed essential areas that could be targeted by further interventions to improve drug-prescribing practices among older adults at risk of PIM

Type of Multimorbidity and Complementary and Alternative Medicine Use among Adults

Objective. To examine the association between type of multimorbidity and CAM use among adults with multimorbidity. Methods. The current study used a cross-sectional design with retrospective data from 2012 National Health Interview Survey. Multimorbidity was classified into two groups: (1) adults with coexisting physical and mental illnesses and (2) adults with two or more chronic physical illnesses only. CAM use was measured using a set of 18 variables. Logistic regression and multinomial logistic regressions were used to assess the association between the type of multimorbidity and ever used CAM, CAM use in the past 12 months, and type of CAM. Results. Overall, 31.2% of adults with coexisting physical and mental illnesses and 20.1% of adults with only physical illnesses used CAM in the past 12 months. Adults with coexisting physical and mental illnesses were more likely to ever use CAM (AOR = 1.68, 95% CI = 1.49, 1.90), use CAM in the past 12 months (AOR = 1.32, 95% CI = 1.15, 1.52), and use mind-body therapies in the past 12 months (AOR = 1.36, 95% CI = 1.16, 1.59) compared to adults with only physical illnesses. Conclusion. Multimorbidity of chronic physical and mental illnesses was associated with higher CAM use