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Impairment and Services Use Associated With Mood and Anxiety Disorders by Smoking Status in a Nationally Representative Sample of US Adolescents
AEP Vol. 20, No. 9 September 2010: 691–724
METHODS: A retrospective analysis was conducted from a nationally representative survey of the US civilian, noninstitutionalized MS population, aged 18 years or older, identified from the household component of the Medical Expenditure Panel Survey (MEPS). Data files for years 2002–2007 were pooled and all sampled cases of MS were identified (ICD9-CMZ340). HCRU was computed as the sum of the number of annual physician office, outpatient, emergency department and inpatient visits for MS-related reasons. RESULTS: A total of 298 sampled subjects, representing 510,543 people with MS were identified. The majority of the MS population was female (79.3%), White (85.5%), and non-Hispanic (95.7%). Age was normally distributed with a mean of 49.2 years (95% CI: 46.7–51.7). Mean HCRU was 7.31 (95% CI: 4.79–9.83), derived from mean physician office, inpatient, outpatient, and emergency department visits of 6.18, 1.02, 0.07, and 0.05, respectively. HCRU was not related to age, but was marginally greater in females vs. males (8.03 vs. 4.56, pZ0.06). HCRU of unemployed subjects was more than twice that of those employed (10.76 vs. 4.44, pZ0.02). HCRU was not strongly associated with individual measures of physical activity limitations (e.g., difficulty lifting 10 lbs, walking 10 steps). However, decreasing SF-12 physical component scores were associated with increasing HCRU: 2.91, 5.99, 8.56, and 10.21 for subjects with SF-12 scores of O50, 41–50, 25– 40, and !25, respectively (pZ0.02 for comparison between SF-12 O40 vs. !40). HCRU was not associated with the mental component of the SF-12. CONCLUSION: Health care resource use, as measured by the number of MS-related visits to medical care providers, was greater in females and was an indicator of physical (but not mental) quality of life.
P35 TEN-YEAR HIP FRACTURE INCIDENCE RATE TRENDS IN A LARGE CALIFORNIA POPULATION, 1997–2006 AL Adams, J Shi, M Takayanagi, RM Dell, T Funahashi, SJ Jacobsen, Dept of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
PURPOSE: To describe annual sex- and age-specific trends in incident hip fracture rates in a large managed care organization for the period 1997–2006, including the time during which a proactive bone health program that included increased screening and treatment was undertaken. METHODS: This 10-year ecologic trend study identified all men and women aged 45 years or older as of January 1 of each study year. We used diagnosis codes (ICD-9 codes 820–820.9) to identify all incident hip fractures within a given year, and excluded all subjects who had hip fractures prior to the start of each year. Person-time at risk for having
ABSTRACTS (ACE)
703
a hip fracture each year was ascertained from enrollment data. We calculated sexand age- specific and adjusted annual incidence rates. RESULTS: The overall annual hip fracture incidence rate for men went from 1.52/1000 person-years (p–y) in 1997 and 1.29/1000p-y in 2006, a 15.3% (95% Confidence Interval 6.2, 24.5) decrease. For women, the overall annual incidence rate was 2.65/1000p-y in 1997 and 2.24/1000p-y in 2006, a 15.3% (8.7, 21.9) decrease. Among men aged 85 years or older, incidence rates declined from 27.0/1000p-y to 18.9/1000p-y. Incidence in the oldest women declined from 32.7/1000p-y to 27.1/1000p-y. CONCLUSION: The incidence of hip fracture among older adults has been declining in all age groups over the last 10 years. While many factors could have contributed to this decline, the results are consistent with a potential benefit of the active bone health intervention.
P36 IMPAIRMENT AND SERVICES USE ASSOCIATED WITH MOOD AND ANXIETY DISORDERS BY SMOKING STATUS IN A NATIONALLY REPRESENTATIVE SAMPLE OF US ADOLESCENTS A Kalaydjian Richardson, L Curry, J He, D Vallone, K Merikangas, Legacy, Washington DC
PURPOSE: There is a well-known association between smoking and mood and anxiety disorders in adolescents, but there is little information on whether and to what degree smoking status affects impairment and services use related to these psychiatric disorders. METHODS: We combined two waves of cross-sectional data on 4240 adolescents, 12–19 years, from the National Health and Nutrition Examination Surveys. Data from The National Institute of Mental Health Diagnostic Interview Schedule for Children was used to derive DSM-IV diagnoses, impairment and services variables. Logistic regression analysis was used to compare never and eversmoking adolescents on these factors. RESULTS: Ever smokers had more than three times the odds of having an anxiety disorder (ORZ3.39, 95% CI: 1.50, 7.62) and more than twice the odds of a mood disorder (ORZ2.67, 95% CI: 1.48, 4.80) as compared to never smokers. Furthermore, they were more likely to suffer impairment, and these increases spanned across multiple domains, including peers, schoolwork, and teacher relations. Smokers were more likely to seek services for mood disorder symptoms (ORZ4.09, 95% CI: 2.33, 7.15). CONCLUSIONS: Adolescent ever-smokers are at increased risk not only of mood and anxiety disorders, but also of impairment related to mood and anxiety symptoms. Given the range of domains in which this increased impairment is felt, targeted efforts should be directed at smoking
704
ABSTRACTS (ACE)
adolescents to reduce the burden associated with these mental disorders. P37 BURDEN OF CARDIOVASCULAR DISEASE IN ASIAN AMERICANS EC Wong1, AT Holland1, DS Lauderdale2, LP Palaniappan1, 1 Palo Alto Medical Foundation Research Institute, Palo Alto, CA, 2University of Chicago, Chicago, IL
PURPOSE: To compare the prevalence of stroke, coronary heart disease (CHD) and peripheral vascular disease (PVD) across Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and Non-Hispanic Whites (NHW) in an multispecialty, healthcare organization in California. METHODS: Electronic health records of 98,451 Asian and NHW patients were examined. Billing and problem list codes were used to define prevalent stroke (ICD-9: 430–438), CHD (410–414), and PVD (415.1, 440.2, 440.3, 443.9, 451, 453) from 2007–2010. Age-adjusted rates were calculated using logistic regression, and compared to NHWs as the referent group. RESULTS: The range of age-adjusted rates for men and women were as follows: stroke (0.8–1.2%; 0.5–1.2%), CHD (1.5–4.6%; 0.2–1.3%), PVD (0.2–1.5%; 0.4–1.6%). Compared to NHWs, ischemic stroke rates were higher in Filipina women (OR: 1.77, 95% CI: 1.16–2.69). CHD rates were higher in Asian Indian men (1.83, 1.48–2.26) and in Filipino men (1.45, 1.04–2.02) and women (1.64, 1.12– 2.40). CHD rates were lower in Chinese men (0.78, 0.65– 0.92) and women (0.74, 0.58–0.96). Lower rates of PVD were noted for men and women in nearly all Asian racial/ ethnic subgroups when compared to NHWs. CONCLUSION: There is considerable heterogeneity in Asian subgroups with regard to stroke, CHD and PVD. Filipinos and Asian Indians generally diverge from other Asian subgroups. While high rates of CHD among Asian Indians are increasingly recognized, Filipinos are less well studied. Future studies should strive to disaggregate Asian subgroups and disparate cardiovascular outcomes to better understand variation in these disease patterns. P38 CHANGE IN QUALITY OF LIFE AMONG CONGESTIVE HEART FAILURE PATIENTS MM Donneyong, CA Hornung, Department of Epidemiology, University of Louisville, Louisville, KY
PURPOSE: To determine the combined effect of severity of congestive heart failure (CHF), type of patient management, and compliance to the American Heart Association (AHA)/ American College of Cardiologists (ACC) treatment guidelines on change in quality of life among CHF patients.
AEP Vol. 20, No. 9 September 2010: 691–724
METHODS: Data was analyzed from a three-arm treatment, multi-site randomized control study. A total of 134 participants were enrolled in the study for 9 months with follow up at 12 months. The Kansas City Cardiomyopathy Questionnaire was administered at baseline and follow up to determine change in quality of life (QoL) among participants. Three categories of change in QoL (decline, no change, and improvement) were defined based on Cohen’s small effect size parameter estimate (0.2 standard deviation). Multinomial logistic regression models were fitted between change in QoL (outcome) and arm of treatment, NHYA class, and compliance to AHA/ACC guidelines (as predictor variables) controlling for potential confounders. RESULTS: While 46% of the population had improved QoL, 18% and 36% had no change and decline in QoL respectively. NYHA class III&IV were associated with increased odds of decline as well as improvement in QoL compared to class I&II. Compliance to AHA/ACC guidelines was associated with increased odds of decline but reduced odds of improvement. CONCLUSION: NHYA class III&IV status suggested stability in QoL while compliance to AHA/ACC guidelines may lead to decline in QoL. P39 DIABETES AND KIDNEY CANCER: A DIRECT OR INDIRECT ASSOCIATION? RP Ojha, EL Evans, TN Offutt-Powell, BS Nuwayhid, ZD Mulla, Department of Epidemiology, UNT Health Science Center, Fort Worth, TX
PURPOSE: Several studies have reported increased relative risks of kidney cancer among diabetics, but these estimates may not indicate the direct association because certain factors mediate this exposure-outcome relation. Therefore, we analyzed case-control data to estimate the total (i.e. indirect and direct) and direct associations between diabetes and kidney cancer. METHODS: Discharge data (with International Classification of Diseases – 9 codes) from 2001 for hospitals throughout Florida were used to construct a case-control population of inpatients aged 45 years. Cases (nZ1,909) were inpatients with malignant kidney cancer and controls (nZ6,451) were inpatients with motor vehicle injuries. Diabetes status was ascertained for cases and controls. Covariates that required adjustment to estimate the total (age, gender, ethnicity, obesity, and smoking) and direct (age, gender, ethnicity, obesity, smoking, hypertension, and kidney disease) associations were identified in a directed acyclic graph. Unconditional logistic regression was used to estimate the adjusted total and direct odds ratios (ORs) and corresponding 95% confidence intervals (CIs) of kidney cancer for diabetics. RESULTS: The odds of kidney cancer were higher for inpatients with diabetes than inpatients without diabetes when
METHODS: A retrospective analysis was conducted from a nationally representative survey of the US civilian, noninstitutionalized MS population, aged 18 years or older, identified from the household component of the Medical Expenditure Panel Survey (MEPS). Data files for years 2002–2007 were pooled and all sampled cases of MS were identified (ICD9-CMZ340). HCRU was computed as the sum of the number of annual physician office, outpatient, emergency department and inpatient visits for MS-related reasons. RESULTS: A total of 298 sampled subjects, representing 510,543 people with MS were identified. The majority of the MS population was female (79.3%), White (85.5%), and non-Hispanic (95.7%). Age was normally distributed with a mean of 49.2 years (95% CI: 46.7–51.7). Mean HCRU was 7.31 (95% CI: 4.79–9.83), derived from mean physician office, inpatient, outpatient, and emergency department visits of 6.18, 1.02, 0.07, and 0.05, respectively. HCRU was not related to age, but was marginally greater in females vs. males (8.03 vs. 4.56, pZ0.06). HCRU of unemployed subjects was more than twice that of those employed (10.76 vs. 4.44, pZ0.02). HCRU was not strongly associated with individual measures of physical activity limitations (e.g., difficulty lifting 10 lbs, walking 10 steps). However, decreasing SF-12 physical component scores were associated with increasing HCRU: 2.91, 5.99, 8.56, and 10.21 for subjects with SF-12 scores of O50, 41–50, 25– 40, and !25, respectively (pZ0.02 for comparison between SF-12 O40 vs. !40). HCRU was not associated with the mental component of the SF-12. CONCLUSION: Health care resource use, as measured by the number of MS-related visits to medical care providers, was greater in females and was an indicator of physical (but not mental) quality of life.
P35 TEN-YEAR HIP FRACTURE INCIDENCE RATE TRENDS IN A LARGE CALIFORNIA POPULATION, 1997–2006 AL Adams, J Shi, M Takayanagi, RM Dell, T Funahashi, SJ Jacobsen, Dept of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
PURPOSE: To describe annual sex- and age-specific trends in incident hip fracture rates in a large managed care organization for the period 1997–2006, including the time during which a proactive bone health program that included increased screening and treatment was undertaken. METHODS: This 10-year ecologic trend study identified all men and women aged 45 years or older as of January 1 of each study year. We used diagnosis codes (ICD-9 codes 820–820.9) to identify all incident hip fractures within a given year, and excluded all subjects who had hip fractures prior to the start of each year. Person-time at risk for having
ABSTRACTS (ACE)
703
a hip fracture each year was ascertained from enrollment data. We calculated sexand age- specific and adjusted annual incidence rates. RESULTS: The overall annual hip fracture incidence rate for men went from 1.52/1000 person-years (p–y) in 1997 and 1.29/1000p-y in 2006, a 15.3% (95% Confidence Interval 6.2, 24.5) decrease. For women, the overall annual incidence rate was 2.65/1000p-y in 1997 and 2.24/1000p-y in 2006, a 15.3% (8.7, 21.9) decrease. Among men aged 85 years or older, incidence rates declined from 27.0/1000p-y to 18.9/1000p-y. Incidence in the oldest women declined from 32.7/1000p-y to 27.1/1000p-y. CONCLUSION: The incidence of hip fracture among older adults has been declining in all age groups over the last 10 years. While many factors could have contributed to this decline, the results are consistent with a potential benefit of the active bone health intervention.
P36 IMPAIRMENT AND SERVICES USE ASSOCIATED WITH MOOD AND ANXIETY DISORDERS BY SMOKING STATUS IN A NATIONALLY REPRESENTATIVE SAMPLE OF US ADOLESCENTS A Kalaydjian Richardson, L Curry, J He, D Vallone, K Merikangas, Legacy, Washington DC
PURPOSE: There is a well-known association between smoking and mood and anxiety disorders in adolescents, but there is little information on whether and to what degree smoking status affects impairment and services use related to these psychiatric disorders. METHODS: We combined two waves of cross-sectional data on 4240 adolescents, 12–19 years, from the National Health and Nutrition Examination Surveys. Data from The National Institute of Mental Health Diagnostic Interview Schedule for Children was used to derive DSM-IV diagnoses, impairment and services variables. Logistic regression analysis was used to compare never and eversmoking adolescents on these factors. RESULTS: Ever smokers had more than three times the odds of having an anxiety disorder (ORZ3.39, 95% CI: 1.50, 7.62) and more than twice the odds of a mood disorder (ORZ2.67, 95% CI: 1.48, 4.80) as compared to never smokers. Furthermore, they were more likely to suffer impairment, and these increases spanned across multiple domains, including peers, schoolwork, and teacher relations. Smokers were more likely to seek services for mood disorder symptoms (ORZ4.09, 95% CI: 2.33, 7.15). CONCLUSIONS: Adolescent ever-smokers are at increased risk not only of mood and anxiety disorders, but also of impairment related to mood and anxiety symptoms. Given the range of domains in which this increased impairment is felt, targeted efforts should be directed at smoking
704
ABSTRACTS (ACE)
adolescents to reduce the burden associated with these mental disorders. P37 BURDEN OF CARDIOVASCULAR DISEASE IN ASIAN AMERICANS EC Wong1, AT Holland1, DS Lauderdale2, LP Palaniappan1, 1 Palo Alto Medical Foundation Research Institute, Palo Alto, CA, 2University of Chicago, Chicago, IL
PURPOSE: To compare the prevalence of stroke, coronary heart disease (CHD) and peripheral vascular disease (PVD) across Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and Non-Hispanic Whites (NHW) in an multispecialty, healthcare organization in California. METHODS: Electronic health records of 98,451 Asian and NHW patients were examined. Billing and problem list codes were used to define prevalent stroke (ICD-9: 430–438), CHD (410–414), and PVD (415.1, 440.2, 440.3, 443.9, 451, 453) from 2007–2010. Age-adjusted rates were calculated using logistic regression, and compared to NHWs as the referent group. RESULTS: The range of age-adjusted rates for men and women were as follows: stroke (0.8–1.2%; 0.5–1.2%), CHD (1.5–4.6%; 0.2–1.3%), PVD (0.2–1.5%; 0.4–1.6%). Compared to NHWs, ischemic stroke rates were higher in Filipina women (OR: 1.77, 95% CI: 1.16–2.69). CHD rates were higher in Asian Indian men (1.83, 1.48–2.26) and in Filipino men (1.45, 1.04–2.02) and women (1.64, 1.12– 2.40). CHD rates were lower in Chinese men (0.78, 0.65– 0.92) and women (0.74, 0.58–0.96). Lower rates of PVD were noted for men and women in nearly all Asian racial/ ethnic subgroups when compared to NHWs. CONCLUSION: There is considerable heterogeneity in Asian subgroups with regard to stroke, CHD and PVD. Filipinos and Asian Indians generally diverge from other Asian subgroups. While high rates of CHD among Asian Indians are increasingly recognized, Filipinos are less well studied. Future studies should strive to disaggregate Asian subgroups and disparate cardiovascular outcomes to better understand variation in these disease patterns. P38 CHANGE IN QUALITY OF LIFE AMONG CONGESTIVE HEART FAILURE PATIENTS MM Donneyong, CA Hornung, Department of Epidemiology, University of Louisville, Louisville, KY
PURPOSE: To determine the combined effect of severity of congestive heart failure (CHF), type of patient management, and compliance to the American Heart Association (AHA)/ American College of Cardiologists (ACC) treatment guidelines on change in quality of life among CHF patients.
AEP Vol. 20, No. 9 September 2010: 691–724
METHODS: Data was analyzed from a three-arm treatment, multi-site randomized control study. A total of 134 participants were enrolled in the study for 9 months with follow up at 12 months. The Kansas City Cardiomyopathy Questionnaire was administered at baseline and follow up to determine change in quality of life (QoL) among participants. Three categories of change in QoL (decline, no change, and improvement) were defined based on Cohen’s small effect size parameter estimate (0.2 standard deviation). Multinomial logistic regression models were fitted between change in QoL (outcome) and arm of treatment, NHYA class, and compliance to AHA/ACC guidelines (as predictor variables) controlling for potential confounders. RESULTS: While 46% of the population had improved QoL, 18% and 36% had no change and decline in QoL respectively. NYHA class III&IV were associated with increased odds of decline as well as improvement in QoL compared to class I&II. Compliance to AHA/ACC guidelines was associated with increased odds of decline but reduced odds of improvement. CONCLUSION: NHYA class III&IV status suggested stability in QoL while compliance to AHA/ACC guidelines may lead to decline in QoL. P39 DIABETES AND KIDNEY CANCER: A DIRECT OR INDIRECT ASSOCIATION? RP Ojha, EL Evans, TN Offutt-Powell, BS Nuwayhid, ZD Mulla, Department of Epidemiology, UNT Health Science Center, Fort Worth, TX
PURPOSE: Several studies have reported increased relative risks of kidney cancer among diabetics, but these estimates may not indicate the direct association because certain factors mediate this exposure-outcome relation. Therefore, we analyzed case-control data to estimate the total (i.e. indirect and direct) and direct associations between diabetes and kidney cancer. METHODS: Discharge data (with International Classification of Diseases – 9 codes) from 2001 for hospitals throughout Florida were used to construct a case-control population of inpatients aged 45 years. Cases (nZ1,909) were inpatients with malignant kidney cancer and controls (nZ6,451) were inpatients with motor vehicle injuries. Diabetes status was ascertained for cases and controls. Covariates that required adjustment to estimate the total (age, gender, ethnicity, obesity, and smoking) and direct (age, gender, ethnicity, obesity, smoking, hypertension, and kidney disease) associations were identified in a directed acyclic graph. Unconditional logistic regression was used to estimate the adjusted total and direct odds ratios (ORs) and corresponding 95% confidence intervals (CIs) of kidney cancer for diabetics. RESULTS: The odds of kidney cancer were higher for inpatients with diabetes than inpatients without diabetes when