This study determined the impact of preexisting mental illnesses on guideline-consistent breast cancer treatment and breast cancer-related health care utilization. This was a retrospective, longitudinal, cohort study conducted using data from the 2006-2008 Medicaid Analytic Extract files. The target population for the study consisted of female Medicaid enrollees who were aged 18-64 years and were newly diagnosed with breast cancer in 2007. Guideline-consistent breast cancer treatment was defined according to established guidelines. Breast cancer-related health care use was reported in the form of inpatient, outpatient, and emergency room visits. Statistical analyses consisted of multivariable hierarchical regression models. A total of 2142 newly diagnosed cases of breast cancer were identified. Approximately 38% of these had a preexisting mental illness. Individuals with any preexisting mental illness were less likely to receive guideline-consistent breast cancer treatment compared to those without any preexisting mental illness (adjusted odds ratio: 0.793, 95% confidence interval [CI]: 0.646-0.973). A negative association was observed between preexisting mental illness and breast cancer-related outpatient (adjusted incident rate ratio (AIRR): 0.917, 95% CI: 0.892-0.942) and emergency room utilization (AIRR: 0.842, 95% CI: 0.709-0.999). The association between preexisting mental illnesses and breast cancer-related inpatient utilization was statistically insignificant (AIRR: 0.993, 95% CI: 0.851-1.159). The findings of this study indicate that breast cancer patients with preexisting mental illnesses experience disparities in terms of receipt of guideline-consistent breast cancer treatment and health care utilization. The results of this study highlight the need for more focused care for patients with preexisting mental illness.
IMPORTANCE Health care costs associated with diagnosis and care among older adults with multiple myeloma (MM) are substantial, with cost of care and the factors involved differing across various phases of the disease care continuum, yet little is known about cost of care attributable to MM from a Medicare perspective.OBJECTIVE To estimate incremental phase-specific and lifetime costs and cost drivers among older adults with MM enrolled in fee-for-service Medicare.
DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study was conducted using population-based registry data from the 2007-2015 Surveillance, Epidemiology, and End Results database linked with 2006-2016 Medicare administrative claims data. Data analysis included 4533 patients with newly diagnosed MM and 4533 matched noncancer Medicare beneficiaries from a 5% sample of Medicare to assess incremental MM lifetime and phase-specific costs (prediagnosis, initial care, continuing care, and terminal care) and factors associated with phase-specific incremental MM costs. The study was conducted from June 1, 2019, to April 30, 2021. MAIN OUTCOMES AND MEASURES Incremental MM costs were calculated for the disease lifetime and the following 4 phases of care: prediagnosis, initial, continuing care, and terminal.
RESULTSOf the 4533 patients with MM included in the study, 2374 were women (52.4%), 3418 (75.4%) were White, and mean (SD) age was 75.8 (6.8) years (2313 [51.0%] aged Ն75 years). The characteristics of the control group were similar; however, mean (SD) age was 74.2 (8.8
ObjectiveWe hypothesized that greater pericardial fat volume would be associated with increased risk of incident atrial fibrillation (AF).MethodsIn the Multi-Ethnic Study of Atherosclerosis (MESA) and Jackson Heart Study (JHS), pericardial fat volume was quantified by computed tomography. Incident AF was identified from discharge diagnosis codes, study electrocardiograms, and Medicare claims.ResultsAmong 7991 participants, 40% were African-American, 32% white, 18% Hispanic, and 10% Chinese-American; mean age was 62 years; 55% were women. During an average of 10.0 years of follow-up in MESA and 4.5 years in JHS, 756 incident AF cases were identified. After adjustment for age, sex, study, race/ethnicity, height, glucose status, systolic blood pressure, treated hypertension, and body mass index (BMI), greater pericardial fat volume was associated with higher AF risk in Hispanics (HR 1.24 per SD, 95%CI 1.05-1.46), but not overall (HR 1.06, 95%CI 0.97-1.15). In mediation analysis, pericardial fat volume partially mediated the association of BMI with incident AF in Hispanics.ConclusionsAfter adjustment for BMI, greater pericardial fat volume was associated with incident AF in Hispanics but not overall. Additional research is needed on the mechanisms by which pericardial fat volume is related to increased AF risk and possible differences by race/ethnicity.
We explored the effect of the Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism (rs6265) on correlation between changes in plasma BDNF levels with cognitive function and quality of life (QoL) after 12 weeks of treatment in bipolar disorder (BD). Symptom severity and plasma BDNF levels were assessed upon recruitment and during weeks 1, 2, 4, 8 and 12. QoL, the Wisconsin Card Sorting Test (WCST), and the Conners’ Continuous Performance Test (CPT) were assessed at baseline and endpoint. The BDNF Val66Met polymorphism was genotyped. Changes in cognitive function and QoL over 12 weeks were reduced using factor analysis for the evaluation of their correlations with changes in plasma BDNF. Five hundred forty-one BD patients were recruited and 65.6% of them completed the 12-week follow-up. Changes in plasma BDNF levels with factor 1 (WCST) were significantly negatively correlated (r = −0.25, p = 0.00037). After stratification of BD subtypes and BDNF genotypes, this correlation was significant only in BP-I and the Val/Met genotype (r = −0.54, p = 0.008). We concluded that changes in plasma BDNF levels significantly correlated with changes in WCST scores in BD and is moderated by the BDNF Val66Met polymorphism and the subtype of BD.
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