Exploring comorbidity and pharmacological treatment patterns in psoriasis - a retrospective population-based cross-sectional study
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ABSTRACT:
SUBMITTER: Hamgard N
PROVIDER: S-EPMC10617277 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:BackgroundMultimorbidity is associated with physical-mental health comorbidity (PMHC). However, the scope of overlap between physical and mental conditions, associated factors, as well as types of mental illness involved are not well described in Eastern Europe. This study aims to assess the PMHC burden in the Estonian population.MethodsIn this population-based cross-sectional study we obtained health claims data for 55 chronic conditions from the Estonian Health Insurance Fund (EHIF) database, which captures data for all publicly insured individuals (n = 1 240 927 or 94.1% of the total population as of 31 December 2017). We assessed the period-prevalence (3 years) of chronic physical and mental health disorders, as well as associations between them, by age and sex.ResultsHalf of the individuals (49.1% (95% CI 49.0-49.3)) had one or more chronic conditions. Mental health disorders (MHD) were present in 8.1% (8.1-8.2) of individuals, being higher among older age groups, women, and individuals with a higher number of physical conditions. PMHC was present in 6.2% (6.1-6.2) of the study population, and 13.1% (13.0-13.2) of the subjects with any chronic physical disorder also presented with at least one MHD. Dominating MHDs among PMHC patients were anxiety and depression. The prevalence of MHD was positively correlated with the number of physical disorders. We observed variation in the type of MHD as the number of physical comorbidities increased. The prevalence of anxiety, depression, and mental and behavioral disorders due to the misuse of alcohol and other psychoactive substances increased as physical comorbidities increased, but the prevalence of schizophrenia and dementia decreased with each additional physical disease. After adjusting for age and sex, this negative association changed the sign to a positive association in the case of dementia and mental and behavioral disorders due to psychoactive substance misuse.ConclusionsThe burden of physical-mental comorbidity in the Estonian population is relatively high. Further research is required to identify clusters of overlapping physical and mental disorders as well as the interactions between these conditions. Public health interventions may include structural changes to health care delivery, such as an increased emphasis on integrated care models that reduce barriers to mental health care.
| S-EPMC8638860 | biostudies-literature
Project description:OBJECTIVE:To (1) examine the burden of multiple chronic conditions (MCC) in an urban health system, and (2) propose a methodology to identify subpopulations of interest based on diagnosis groups and costs. DESIGN:Retrospective cross-sectional study. SETTING:Mount Sinai Health System, set in all five boroughs of New York City, USA. PARTICIPANTS:192 085 adult (18+) plan members of capitated Medicaid contracts between the Healthfirst managed care organisation and the Mount Sinai Health System in the years 2012 to 2014. METHODS:We classified adults as having 0, 1, 2, 3, 4 or 5+ chronic conditions from a list of 69 chronic conditions. After summarising the demographics, geography and prevalence of MCC within this population, we then described groups of patients (segments) using a novel methodology: we combinatorially defined 18 768 potential segments of patients by a pair of chronic conditions, a sex and an age group, and then ranked segments by (1) frequency, (2) cost and (3) ratios of observed to expected frequencies of co-occurring chronic conditions. We then compiled pairs of conditions that occur more frequently together than otherwise expected. RESULTS:61.5% of the study population suffers from two or more chronic conditions. The most frequent dyad was hypertension and hyperlipidaemia (19%) and the most frequent triad was diabetes, hypertension and hyperlipidaemia (10%). Women aged 50 to 65 with hypertension and hyperlipidaemia were the leading cost segment in the study population. Costs and prevalence of MCC increase with number of conditions and age. The disease dyads associated with the largest observed/expected ratios were pulmonary disease and myocardial infarction. Inter-borough range MCC prevalence was 16%. CONCLUSIONS:In this low-income, urban population, MCC is more prevalent (61%) than nationally (42%), motivating further research and intervention in this population. By identifying potential target populations in an interpretable manner, this segmenting methodology has utility for health services analysts.
| S-EPMC6797368 | biostudies-literature
Project description:IntroductionThis study evaluated patient characteristics and treatment patterns according to weight in pediatric patients with psoriasis in a real-world setting.MethodsPrimary care and specialist physicians treating pediatric patients with psoriasis aged 6-17 years in five European countries were surveyed in the 2019-2020 Adelphi Real World Pediatric Psoriasis Disease Specific Programme. At least two patients with current or previous biologic use were included per physician. Patient characteristics and treatment patterns were analyzed overall and for patients weighing 25-50 kg or more than 50 kg.ResultsData from 772 patients weighing 25-50 kg and 1147 weighing more than 50 kg were analyzed. Median age at diagnosis was significantly less in lighter than heavier patients (10.0 vs. 14.0 years; p < 0.001), as was median disease duration (2.2 vs. 3.0 years; p < 0.001). Topical treatments were prescribed in 59.0% of patients overall (70.3% of lighter and 51.4% of heavier patients; p < 0.001), and were used to treat mild rather than moderate-to-severe psoriasis. Conventional systemic use was low (10.8% of patients overall) and predominantly for moderate-to-severe psoriasis. In this biologic-enriched sample, most biologics (78.2%) were prescribed in older (> 13 years) patients. Biologic use increased with line of therapy (6.6% of first-line, 18.0% of second-line, 33.7% of third-line, 44.7% of fourth-line treatments).ConclusionBiologics are predominantly prescribed in older (> 13 years) and heavier (> 50 kg) patients, with little first- or second-line use. The low use of biologics in European pediatric patients with psoriasis may represent an unmet treatment need, as topical or conventional systemic agents remain the main treatment option for moderate or severe psoriasis in these patients through the treatment pathway.
| S-EPMC9357581 | biostudies-literature
Project description:Purpose: This study aimed to determine the patterns associated with adult mandibular fractures from a Level-I trauma center in southern Taiwan. Methods: The data of adult trauma patients admitted between 1 January 2009 and 31 December 2014 were retrieved from the Trauma Registry System and retrospectively reviewed. Fracture site and cause of injury were categorized into groups for comparison, and corresponding odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by multivariate logistic regression. Results: Motorcycle accidents were the most common cause of mandibular fractures (76.3%), followed by falls (10.9%), motor vehicle accidents (4.8%), and being struck by/against objects (4.5%). Of the 503 cases of mandibular fractures, the condylar neck and head were the most common sites (32.0%), followed by the parasymphysis (21.7%), symphysis (19.5%), angle and ramus (17.5%), and body (9.3%). The location of mandibular fractures in patients who had motorcycle accidents was similar to that in all patients. Motor vehicle accidents resulted in a significantly higher number of body fractures (OR 3.3, 95% CI 1.24-8.76, p = 0.017) and struck injury in a significantly higher number of angle and ramus fractures (OR 3.9, 95% CI 1.48-10.26, p = 0.006) compared to motorcycle accidents. The helmet-wearing status and body weight were not associated with the location of mandibular fractures in motorcycle accidents. Conclusions: Our study revealed that the anatomic fracture sites of mandible were specifically related to different etiologies. In southern Taiwan, motorcycle accidents accounted for the major cause of mandibular fractures and were associated with the condylar neck and head as the most frequent fracture sites. In contrast, motor vehicle accidents and struck injuries tended to cause more body fracture as well as angle and ramus fracture compared to motorcycle accidents. Furthermore, the status of helmet-wearing and body weight were not associated with the location of mandible fractures caused by motorcycle accidents.
| S-EPMC5551259 | biostudies-other
Project description:The knowledge of the development of comorbidities in patients with ankylosing spondylitis (AS) is limited. The aim of this study was to analyse associations between AS disease characteristics and comorbidity and to evaluate patterns of comorbidities in patients with AS. Patients with AS, fulfilling the modified New York Criteria, were identified (n = 346, mean age 56 ± 15 years, 75% men, 99% HLA B27 positive). Through a review of the patient records, data on disease activity parameters, laboratory results, disease manifestations, and diagnoses of any clinically significant comorbidity was obtained. Four categories of comorbidities of interest were identified: A. arrhythmias, conduction disorders, and valvular heart disease; B. atherosclerosis and atherosclerotic CVD; C. spinal and non-spinal fractures; and D. obstructive sleep apnoea syndrome. Associations between AS disease characteristics and comorbidities in categories were assessed in logistic regression models. Differences in proportions of comorbidities was analysed using two-sided chi-square. Age was associated with all four categories of comorbidities, and male sex with arrhythmias, conduction disorders, valvular heart disease, and obstructive sleep apnoea syndrome. Early disease onset and long disease duration, respectively, were associated with arrhythmias, conduction disorders, and valvular heart disease. Obstructive sleep apnoea syndrome was associated with features of the metabolic syndrome. Patients with atherosclerotic cardiovascular disease had an increased risk of most other comorbidities, similar to, but more pronounced than patients with arrhythmias, conduction disorders and valvular heart disease. Comorbid conditions motivate clinical awareness among patients with AS. Longitudinal studies are needed to establish preventive measures.
| S-EPMC5835056 | biostudies-literature
Project description:BackgroundPsoriasis is a chronic skin disease that needs continuous medical care. During COVID-19, delivering medical service was negatively affected.AimsTo describe the impact of COVID-19 on psoriasis healthcare delivery, management, and practice.MethodsThis observational cross-sectional study was conducted on 197 dermatologists using a validated online questionnaire. The survey evaluated the effect of COVID-19 on the decisions, prescription patterns, appointments rescheduling, and healthcare delivery for psoriasis patients by dermatologists. The questionnaire was developed and validated with a reliability score >0.7.ResultsDuring the pandemic, most dermatologists delayed initiating biological/immunosuppressive therapy for psoriasis unless urgently needed by the patient. For patients already receiving biologics or immunosuppressive treatment, most dermatologists favored continuation of therapy. Almost half (44.2%) of participants do not perform SARS-CoV-2 PCR screening before initiating biologics/immunosuppressive therapy. Dermatologists also reported an increased prescription of topical medications (79.2%), natural sunlight (28.4%), acitretin (26.9%), and home UVB (21.3%). Opinions regarding the use of hydroxychloroquine for COVID-19 treatment/prophylaxis for psoriasis patients were controversial. Intervals between face-to-face follow-up visits were prolonged by 71.6% of dermatologists. More than half of participants reported that their patients discontinued treatment without medical consultation. More than three fourth of responders either agreed or strongly agreed that COVID-19 negatively affected psoriasis patients.ConclusionsThe COVID-19 pandemic has a negative impact on psoriasis management and healthcare delivery. Dermatologists are cautious about using biologics and immunosuppressive drugs during the pandemic, making case-by-case decisions. Psoriasis patients need compliance monitoring, and psychological support during the pandemic, which can be facilitated by teledermatology.
| S-EPMC8250824 | biostudies-literature
Project description:ObjectiveTo assess the prevalence of hypertension, impaired fasting capillary glucose (IFCG) and coexistence of both as well as determinants of these conditions among rural adolescents.DesignA retrospective cross-sectional population-based study.SettingThree rural communities in southeast Nigeria.ParticipantsA total of 401 adolescents (10 - 19 years) selected through a five-stage sampling technique completed the study. Sick adolescents, pregnant and nursing adolescent mothers were excluded.Primary outcome measuresPrevalence and determinants of hypertension, IFCG and comorbidity of both were assessed through weight, height, blood pressure, fasting capillary glucose measurements and statistical analysis.ResultsPrehypertension (10.7%), hypertension alone (12.7%), IFCG alone (11.0%), diabetes (0.2%) and hypertension with IFCG (6.2%) were prevalent among the adolescents. The adolescents aged 15 - 19 years were less likely to be affected by hypertension alone (adjusted OR (AOR)=0.36, 95% CI 0.18 to 0.74, p<0.01). The likelihood of having hypertension alone was three times higher among those who smoked any substance (AOR=3.43, 95% CI 1.34 to 8.78, p<0.05) and 2.85 times higher among those who consumed alcohol (AOR=2.85, 95% CI 1.33 to 6.10, p<0.01). Meal skipping (AOR=2.69, 95% CI 1.16 to 6.25, p<0.05), consumption of fried/baked snacks (AOR=15.46, 95% CI 1.62 to 147.37, p<0.05) and vegetables (AOR=2.27, 95% CI 1.11 to 4.66, p<0.05) were also significant risk factors of hypertension alone. Skipping meals (AOR=2.15, 95% CI 0. 93 to 4.99, p>0.05) and longer than 7 hours of night sleep (AOR=1.88, 95% CI 0.94 TO 3.73, p>0.05) increased the risk of IFCG alone by twofold. Female adolescents (AOR=0.29, 95% CI 0.10 to 0.78, p<0.05) and those who consumed fried/baked snacks (AOR=0.09, 95% CI 0.02 to 0.37, p<0.01) were less likely to have hypertension with IFPG than males and those who consumed non-fried/baked snacks, respectively.ConclusionThis study reported relatively low prevalence of hypertension alone, IFCG alone, hypertension with IFCG and epidemiological characteristics that can become focus of interventions to curtail the emergence of cardiovascular events at an early age. Awareness creation through health and nutrition education is emphasised.
| S-EPMC8103371 | biostudies-literature
Project description:BackgroundThis paper focuses on the period from 2019 to 2021 and investigates the factors associated with the high prevalence of C-section deliveries in South India. We also examine the nuanced patterns, socio-demographic associations, and spatial dynamics underlying C-section choices in this region. A cross-sectional study was conducted using large nationally representative survey data.MethodsNational Family Health Survey data (NFHS) from 2019 to 2021 have been used for the analysis. Bayesian Multilevel and Geospatial Analysis have been used as statistical methods.ResultsOur analysis reveals significant regional disparities in C-section utilization, indicating potential gaps in healthcare access and socio-economic influences. Maternal age at childbirth, educational attainment, healthcare facility type size of child at birth and ever pregnancy termination are identified as key determinants of method of C-section decisions. Wealth index and urban residence also play pivotal roles, reflecting financial considerations and access to healthcare resources. Bayesian multilevel analysis highlights the need for tailored interventions that consider individual household, primary sampling unit (PSU) and district-level factors. Additionally, spatial analysis identifies regions with varying C-section rates, allowing policymakers to develop targeted strategies to optimize maternal and neonatal health outcomes and address healthcare disparities. Spatial autocorrelation and hotspot analysis further elucidate localized influences and clustering patterns.ConclusionIn conclusion, this research underscores the complexity of C-section choices and calls for evidence-based policies and interventions that promote equitable access to quality maternal care in South India. Stakeholders must recognize the multifaceted nature of healthcare decisions and work collaboratively to ensure more balanced and effective healthcare practices in the region.
| S-EPMC11403902 | biostudies-literature
Project description:ObjectivesAtrial fibrillation (AF) is a predominant risk factor of ischaemic stroke and treatment with oral anticoagulants (OACs) is recommended in all patients with risk factors. This study sought to examine treatment patterns of OACs in older patients with AF.DesignRetrospective, cross-sectional study.SettingDanish nationwide administrative and clinical registers and databases.ParticipantsA total of 40 027 patients, >75 years of age, after their first hospital contact due to AF between 2010 and 2018.Primary and secondary outcomes measuresThe primary event of interest was claimed prescriptions for OACs within 180 days after first hospital contact due to AF. Proportions of patients treated with OACs were estimated and clinical factors associated with the probability of receiving OAC treatment were identified using adjusted logistic regression models.ResultsA total of 40 027 patients were included with a slight majority of women (54%). The median age was 81 years (IQR 78-86). We found that an overall 32 235 patients (81%) were prescribed an OAC after their first hospital contact due to AF with a marked increase in the proportion of patients treated from 2010 to 2018. Factors related to a decreased probability of receiving treatment were bleeding risk factors such as a history of haemorrhagic stroke (OR 0.21, 95% CI 0.16 to 0.27), any bleeding (OR 0.58, 95% CI 0.53 to 0.62) as well as markers of frailty such as osteoporosis (OR 0.78, 95% CI 0.71 to 0.85).ConclusionIn this large nationwide study, we found that in older patients with AF, the overall rates of OAC prescription were generally high (~80%) and increasing during the last decade. Factors associated with not receiving guideline recommended OAC treatment were generally related to bleeding risk factors or frailty.
| S-EPMC9438197 | biostudies-literature
Project description:Depression is a highly prevalent, often underrecognized and undertreated comorbidity of Parkinson's disease closely correlated to health-related quality of life. National trends in depression care for patients with Parkinson's disease are not well documented. This paper identifies a cohort of patients with Parkinson's disease from nationally representative survey data and analyzes trends in depression care. Using data from the 2005-2006 through 2015-2016 waves of the National Health and Nutrition Examination Survey (NHANES), individuals were classified as Parkinson's patients by reported medication use. PHQ-9 scores were used to identify individuals screening positive for depression. A composite treatment variable examined the reported use of mental health services and antidepressant medication. Survey participants with probable PD screened positive for depression, reported the use of antidepressant medication, and reported visits to mental health services more frequently than the control group. Survey participants with PD who screened positive for depression were more likely to report limitations in physical functioning due to an emotional problem than controls. While depression is highly prevalent among individuals with Parkinson's disease, they are more likely to receive any treatment. Further research is required to investigate differences in patterns of treatment, contributing factors of emotions to limitations in physical functioning, and appropriate interventions.
| S-EPMC8392211 | biostudies-literature