Browsing by Author "Pinnamraju, Jahnavi"
Now showing 1 - 5 of 5
- Results Per Page
- Sort Options
Item The Association of Multimorbidity with Whole Health-Centric Provider Communication among Older Adults in the US(2024-03-21) Shaikh, Shawana; Sambamoorthi, Usha; Pinnamraju, JahnaviThe Association of Multimorbidity with Whole Health-centric Provider Communication among Older Adults in the US Shawana Shaikh, OMS II, Jahnavi Pinnamraju PharmD, MS, Usha Sambamoorthi, MA, PhD Background Whole Health is a person-centered approach diverging from the biomedical focus on diseases and emphasizes nutrition, recharging, spiritual, social support, physical well-being, environmental factors, and mental health. Incorporating the central tenant of “what matters to you” is key in whole health-centric patient-provider communication. This starts with inquiring patients about health goals and life quality. Nearly, 38.0 million (73%) of Americans aged > 65 years have multimorbidity. For individuals with multimorbidity, challenges exist to implementing evidence-based practices for each disease. Therefore, it is necessary to focus on the whole person and incorporate individuals' health goals and life quality for optimal management. The purpose of this study is to examine the prevalence of whole health-centered provider communication among community-dwelling older adults aged > 65 years. Methods A cross-sectional study design with data on older adults (age > 65 years) from the publicly available 2020 Medicare Current Beneficiary Survey was used. Whole health variables included how often providers asked about health goals (definitely, somewhat, never) and life quality (never, sometimes, usually, always). Multimorbidity was defined as the presence of two or more chronic conditions. Rao-Scott Chi-square tests and multinomial logistic regression were used to identify the association of multimorbidity with whole health variables while controlling for age, sex, and social determinants of health such as education, poverty, food security, supplemental health insurance, problems paying medical bills, metropolitan area, and marital status. All analyses were conducted with replicate weights using SAS 9.4 survey procedures. Results There were 5,516 older adults in our sample representing ~38.71 million older adults in the US. Overall, 43% reported that their healthcare providers 'definitely' inquired about their health goals while 31.1% reported they were 'not' asked. Additionally, only 17.5% reported being inquired ‘always’ about their life quality, while 46.5% reported 'never'. A higher percentage of those with multimorbidity were ‘definitely’ asked about health goals (69.5% vs 65.7%) compared to those without multimorbidity. However, a lower percentage of those with multimorbidity (16.5% vs. 21.6%) were ‘always’ asked about life quality. In adjusted multinomial logistic regressions, older adults with multimorbidity were more likely to 'definitely' be asked about their health goals (aOR = 1.56, 95% CI 1.26, 1.94, p < 0.001) and less likely to ‘always’ be asked about life quality (aOR = 0.65, 95% CI = 0.53, 0.79 p < 0.001) compared to those without multimorbidity. Conclusion Overall, whole health-centric communication was poor. Older adults with multimorbidity were more likely to be asked about health goals but less likely to be asked about life quality. Our findings suggest missed opportunities by providers to engage in whole health communication with patients including those with multimorbidity. Health encounters with patients can be an opportunity to empower patients to achieve person-centered health. Integrating health goals and quality-of-life questions into visits can assist providers in developing customized management to empower patients in achieving optimal and whole health.Item Association of Pediatric Head Trauma with Attention Deficit Hyperactivity Disorder (ADHD) among School-aged Children in the United States(2024-03-21) Eberwein, Andrew; Pinnamraju, Jahnavi; Sambamoorthi, UshaBackground Pediatric concussion is an important issue in healthcare that has gained recognition in recent years. Concussion may lead to negative emotional and cognitive consequences. ADHD may be a potential neurobehavioral consequence of head trauma, with evidence suggesting an increased likelihood of ADHD in individuals who have experienced concussions or have a history of head trauma. Objective This study examined disparities in pediatric head trauma and the association of a history of pediatric head trauma with ADHD using nationally representative data from the United States. Methods We performed a cross-sectional study using the 2021 National Health Interview Survey (NHIS). The study was restricted to school-aged children (5-17 years) with no missing information on ADHD or head trauma. There were 5,960 participants representing ~52.11 million US children. Our key independent variable was concussion (Yes/No) with yes indicating a positive response to any question in the 2021 NHIS survey fitting the following descriptions: “ever lost consciousness”, “ever told had a concussion”, “ever dazed or memory gap”, and “ever headache, vomit, blurred vision, or mood change after blow to the head.” ADHD was derived from a question that asked about the diagnosis of ADHD by a health professional or doctor. We performed Rao-Scott Chi-square tests and logistic regression analyses to identify the association of concussion with ADHD while controlling for other explanatory variables (sex, race & ethnicity, age, poverty status, food security, housing security, problem paying medical bills, health insurance, region, metro, family structure, adult education level). All analyses were conducted with SAS 9.4 survey procedures. Results Among the sample, 8.1% had experienced head trauma, and 10.6% had been diagnosed with ADHD. A lower percentage of Non-Hispanic Blacks (NHB) experienced head trauma (5.5% vs. 9.6%) compared to Non-Hispanic Whites (NHW). A higher percentage of males (9.1% vs. 7.0%) had head trauma compared to females. The prevalence of head trauma was higher in minors 14-17 years (13.3% vs. 4.9%) compared to 5–10-year-old children. A higher percentage of those with head trauma (20.7% vs 9.8%) had ADHD compared to those without head trauma. After adjustment for other covariates, children with concussion were more likely to report ADHD (aOR = 1.81, 95% CI = 1.34, 2.45) compared to those without concussion. Conclusion NHWs, males, and minors aged between 14-17 years were more likely to report a history of head trauma. Head trauma was associated with ADHD even when adjusted for confounding variables. It has been speculated in the past that NHW predominance in head trauma may represent greater prevalence of reporting rather than an actual increase in head trauma in this group raising the question of whether lack of injury recognition in minority demographics represents a possible area of improvement for improved health outcomes. In addition, the positive correlation between ADHD and pediatric head trauma warrants further investigation to establish possible causal relationships.Item The Association of Sleep Problems with Mild Cognitive Impairment in Older Adults in the United States (US): A Cohort Study(2024-03-21) Nguimatsa, Arthur; Pinnamraju, Jahnavi; Sambamoorthu, UshaBackground: The neuroprotective aspects of sleep include improvement of memory, problem-solving, creativity, emotional processing, and judgment. Sleep problems lead to neurological damage in the hippocampus. People with sleep problems have a higher risk of developing MCI. Examining the association of sleep problems with MCI is important for surveillance and prevention efforts of dementia because MCI often leads to dementia in 10%-15% of older adults. Objective: To examine the association of type of sleep problems with MCI among older adults (age > 50 years) using Health and Retirement Study (HRS), a nationally representative prospective cohort of older adults in the US. Methods: We used baseline (2018) and follow-up (2020) data from the HRS. We restricted the analysis to adults aged 50 years or older at baseline, alive in 2020, and did not have dementia in baseline and follow-up. All sleep variables were measured at baseline and MCI was measured during the follow-up period. The dependent variable (MCI) was based on the composite measure (immediate word recall test, delayed word recall, the serial 7s, counting backward), and total scores between 7-11 represent MCI without dementia. Sleep variables were based on responses (most of the time, some, and rare/never) to the following questions: “How often do you have trouble falling asleep?”, “How often do you have trouble waking up during the night?”, “How often do you have trouble with waking up too early and not being able to fall asleep again?” and “How often do you feel rested in the morning?”. Rao- unadjusted associations were tested with Rao-Scott chi-square and adjusted associations were examined with multivariable logistic regressions. All analyses accounted for the complex survey design, and SAS 9.4 Survey procedures were used. Results: Overall, 49.1% had trouble falling asleep, 62.2% had trouble waking up, 46.1% waking up too early, and 84.1% did not feel rested in the morning. A higher percentage of adults with trouble falling asleep (18.6% vs.11.7%), trouble waking up(15.5% vs, 12.3%), and waking up too early(18.9% vs. 11.1%) had MCI compared to those without sleep problems. In logistic regression that adjusted for sex, age, race and ethnicity, living alone, education, employment, poverty, and health insurance, those with sleep problems had higher odds of MCI (trouble sleeping: aOR=1.28(95%CI:1.05 1.56), waking up too early: aOR=1.48(95%CI:1.14, 1.94) compared to those without sleep problems. However, these associations became statistically insignificant when adjusted for health status and depression. In the fully-adjusted logistic regression, never feeling rested in the morning was associated with lower odds of MCI (aOR= 0.71,95% CI=0.55, 0.91, P<0.01). Conclusion: Most older adults reported sleep problems in trouble waking up or not feeling rested in the morning. Our study adds to the conflicting evidence in the literature; some studies report no association between sleep disturbance and cognition while others even report slightly better cognitive functioning in those with sleep problems. Our study findings suggest that the association of sleep disturbances with MCI varies by type of sleep problems.Item Prevalence and Factors Associated with SSRI Use Among Adults with Depressive and Thyroid Disorders in the United States(2023) Arif, Atiqa; Pinnamraju, Jahnavi; Sambamoorthi, UshaBackground: Patients with hypothyroidism and hyperthyroidism are at high risk for developing anxiety and depression. Sixty percent of adults in the United States with thyroid disorders have depression. Selective serotonin reuptake inhibitors (SSRIs) are used to treat depression. However, SSRIs reduce thyroid function during treatment suggesting SSRIs may not be used in treating depression among adults with thyroid disorders. Few studies have investigated the prevalence and factors associated with SSRI use in adults with diagnosed depression and thyroid disorders. Objective: This study estimated the prevalence of SSRI use in adults with diagnosed thyroid and depressive disorders in the United States and examined the factors associated with SSRI use. Methods: The study used a cross-sectional design using pooled data from multiple years (2018-2020) of the Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the civilian non-institutionalized population in the US, to gain an adequate sample size. The study was restricted to adults with diagnosed thyroid and depressive disorders with health insurance. The final sample was (Unweighted N=729; Weighted N= 3,090,551). SSRI use was identified from prescription drug files using Multum drug classifications. Rao-Scott Chi-square tests were used to examine the unadjusted group differences in SSRI use. Multivariable logistic regression was used to analyze factors associated with SSRI use. The logistic regressions adjusted for age, sex, race and ethnicity, education, income, insurance coverage, prescription drug coverage, polypharmacy (>6 drug classes excluding antidepressants and thyroid hormones), perceived physical and mental health rating, pain, and thyroid hormones. Results: A majority (61.6%) of adults diagnosed with thyroid and depression used SSRIs. A lower percentage of African Americans (28.5%vs.61.9%; p<.05) used SSRIs compared to NHWs; Only 47.0% of those reporting poor health used SSRI compared to those reporting excellent physical health (73.8%) (p<0.01). A lower percentage of adults with extreme pain (49.5%vs.65.8%) used SSRIs compared to those with mild or no pain (p<.05). A lower percentage of adults with moderate to vigorous physical activity of 5 days/week used SSRIs compared to adults with no exercise. (54.2%vs.65.3%; p<.05). A lower percentage of adults with polypharmacy (53.0%vs.67.5%; p<0.01) used SSRI compared to those without polypharmacy. In multivariable logistic regression, African Americans had lower odds of SSRI use (AOR=0.28; 95% CI=0.09, 0.88) compared to NHWs. Lower ratings of physical health were associated with SSRI use. Adults with polypharmacy had lower odds of SSRI use (AOR=0.65; 95% CI=0.44, 0.96). Conclusion: 6 in 10 adults with thyroid and depressive disorders used SSRIs. Racial disparities in SSRI use were observed. We speculate that SSRI use rates may be lower in those with polypharmacy and poor health to reduce the risk of drug-drug interactions and drug-disease interactions. Strengths and Limitations: Limitations include cross-sectional study design, self-reported data, no distinction between hyperthyroidism and hypothyroidism, and a small sample size despite pooling multiple years. Nevertheless, the study used nationally representative data adjusted for a comprehensive list of clinical, demographic, and psychosocial factors.Item Weighing Inequities: The Role of Obesity, Social Determinants of Health, with Glucagon-like Peptide-1 Receptor Agonist Use in Adults with Type 2 Diabetes in the United States(2024-03-21) Collins, Dallas; Kelly, Brittany; Aguiniga, Ashlyn; Pinnamraju, Jahnavi; Sambamoorthi, UshaTitle Weighing Inequities: The Role of Obesity, Social Determinants of Health, with Glucagon-like Peptide-1 Receptor Agonist Use in Adults with Type 2 Diabetes in the United States Authors Dallas Collins, Brittany Kelly, Ashlyn Aguiniga, Jahnavi Pinnamraju, Usha Sambamoorthi Abstract Background Glucagon-like peptide-1 receptor agonists (GLP-1) contribute to glycemic control and weight loss in patients with type 2 diabetes mellitus (T2DM). Although obesity is an important determinant of GLP-1 use, research studies have suggested racial, ethnic, and socioeconomic inequities in GLP-1 use may also exist. The purpose of this study is to determine associations of obesity and social determinants of health (SDOH) with GLP-1 use in a large, nationally representative sample of US households. Methods This is a cross-sectional analysis of adults (age > 18 years) with T2DM using pooled data from multiple years of the Medical Expenditure Panel Survey (2016, 2018, and 2020). The MEPS is a nationally representative survey of civilian non-institutionalized households in the US. Diabetes was identified from both medical conditions and household files. GLP-1 use was extracted from prescription drug event files using the multum classification therapeutic sub-sub class codes. Obesity was measured using body mass index categories using the CDC standards. We restricted our analysis to adults without missing data on body mass index. Rao-Scott chi-square tests were used to assess the unadjusted associations of categorical variables with GLP-1 use. Multivariable logistic regression with survey weights was conducted to analyze the association of obesity and SDOH variables (education, poverty, health insurance, metro area, and marital status) after controlling for gender, age, and health conditions. All analyses were conducted with SAS 9.4 survey procedures. Results There were 7,298 participants representing ~27.3 million US adults with T2DM. Overall, 7.7% of adults reported using GLP-1 and 55.2% had obesity. A higher percentage of obese adults reported GLP-1 use compared to normal and underweight adults (10.2% vs. 4.2%). Those with college education had higher rates of GLP-1 use compared to those with less than high school education (10.2 vs. 4.0%). Multivariable fully adjusted logistic regression confirmed that obesity was associated with higher odds of GLP-1 use (AOR=2.44, 95% CI= 1.58-3.76 p < 0.001) and lower less than high school (AOR=0.40, 95% CI=0.25-0.62 p <0.001) and high school education (AOR=0.72, 95% CI= 0.52-0.99, p=0.0434) were associated with lower odds of GLP-1 use. Conclusion Approximately one in 14 adults used GLP-1, with obesity being an important correlate. Our study findings suggest that socioeconomic status may act as a barrier to a medication with established benefits and may contribute to exasperating inequalities in diabetes care leading to disparities in health outcomes of adults with diabetes. Cohort studies may be needed to better understand the association of SDOH with GLP-1 use.