Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-8 (of 8 Records) |
Query Trace: Cisternas MG[original query] |
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All-cause opioid prescriptions dispensed: The outsized role of adults with arthritis
Murphy LB , Cisternas MG , Theis KA , Brady TJ , Bohm MK , Guglielmo D , Hootman JM , Barbour KE , Boring MA , Helmick CG . Am J Prev Med 2020 59 (3) 355-366 INTRODUCTION: Limited estimates of prescribed opioid use among adults with arthritis exist. All-cause (i.e., for any condition) prescribed opioid dispensed (referred to as opioid prescription in the remainder of this abstract) in the past 12 months among U.S. adults aged ≥18 years (n=35,427) were studied, focusing on adults with arthritis (n=12,875). METHODS: In 2018-2019, estimates were generated using Medical Expenditure Panel Survey data: (1) 2015 prevalence of 1 or more opioid prescriptions to U.S. adults overall and by arthritis status and (2) in 2014-2015, among adults with arthritis, multivariable-adjusted associations between 1 or more opioid prescriptions and sociodemographic characteristics, health status, and healthcare utilization characteristics. RESULTS: In 2015, the age-standardized prevalence of 1 or more opioid prescriptions among adults with arthritis (29.6%) was almost double of that for all adults (15.4%). Adults with arthritis represented more than half of all adults (55.3%) with at least 1 opioid prescription; among those with 1 or more prescriptions, 43.2% adults had 4 or more prescriptions. The strongest multivariable-adjusted associations with 1 or more opioid prescriptions were ambulatory care visits (1-4: prevalence ratios=1.9-2.0, 5-8: prevalence ratios=2.5-2.7, 9 or more: prevalence ratios=3.4-3.7) and emergency room visits (1: prevalence ratios=1.6, 2-3: prevalence ratios=1.9-2.0, 4 or more: prevalence ratios=2.4); Ref for both: no visits. CONCLUSIONS: Adults with arthritis are a high-need target group for improving pain management, representing more than half of all U.S. adults with 1 or more opioid prescriptions. The association with ambulatory care visits suggests that providers have routine opportunities to discuss comprehensive and integrative pain management strategies, including low-cost evidence-based self-management approaches (e.g., physical activity, self-management education programs, cognitive behavioral therapy). Those with multiple opioid prescriptions may need extra support if transitioning to nonopioid and nonpharmacologic pain management strategies. |
Walking and the 2-year risk of functional decline: An observational study of US adults with arthritis
Cisternas MG , Murphy LB , Carlson SA . Prev Med 2018 119 100-107 Recent studies of middle age and older adults with, or at risk for, arthritis demonstrate that engaging in physical activities like walking - even at levels below the current aerobic physical activity guideline of >/=150min of moderate-intensity activity - can protect against onset of functional limitations. Using a large nationally representative sample of US adults >/=18years with arthritis, we investigated whether, among those not meeting the aerobic activity guideline, walking >/=10min/week vs. <10min/week reduced the risk of six outcomes (fair/poor health and five physical limitations) over 2years. We conducted a prospective cohort study among adults with arthritis in the 2010 National Health Interview Survey who participated in the 2011-2012 Medical Expenditure Panel Survey (n=1426). Among adults not meeting the guideline, we examined the effect of walking on risk of developing each of six outcomes using hazard ratios (HRs) estimated from multivariable Cox regression models. Among adults with arthritis not meeting the guideline, compared to walking <10min/week, walking >/=10min/week was associated with a statistically significant decreased risk for all five limitations: walking three blocks (HR: 0.3 [95% CI=0.2-0.6]), climbing 10 stairs (HR: 0.5 [95% CI=0.3-0.8]), stooping/kneeling (HR: 0.4 [95% CI=0.2-0.8]), reaching overhead (HR: 0.5[95% CI=0.5-0.8]), and grasping (HR: 0.4 [95% CI=0.2-0.7]). The decrease in risk was not significant for fair/poor health. Even limited walking may prevent the onset of physical limitations among adults with arthritis of all ages not meeting the aerobic activity guideline. |
Health care provider counseling for weight loss among adults with arthritis and overweight or obesity - United States, 2002-2014
Guglielmo D , Hootman JM , Murphy LB , Boring MA , Theis KA , Belay B , Barbour KE , Cisternas MG , Helmick CG . MMWR Morb Mortal Wkly Rep 2018 67 (17) 485-490 In the United States, 54.4 million adults report having doctor-diagnosed arthritis (1). Among adults with arthritis, 32.7% and 38.1% also have overweight and obesity, respectively (1), with obesity being more prevalent among persons with arthritis than among those who do not have arthritis (2). Furthermore, severe joint pain among adults with arthritis in 2014 was reported by 23.5% of adults with overweight and 31.7% of adults with obesity (3). The American College of Rheumatology recommends weight loss for adults with hip or knee osteoarthritis and overweight or obesity,* which can improve function and mobility while reducing pain and disability (4,5). The Healthy People 2020 target for health care provider (hereafter provider) counseling for weight loss among persons with arthritis and overweight or obesity is 45.3%.(dagger) Adults with overweight or obesity who receive weight-loss counseling from a provider are approximately four times more likely to attempt to lose weight than are those who do not receive counseling (6). To estimate changes in the prevalence of provider counseling for weight loss reported by adults with arthritis and overweight or obesity, CDC analyzed National Health Interview Survey (NHIS) data.( section sign) Overall, age-standardized estimates of provider counseling for weight loss increased by 10.4 percentage points from 2002 (35.1%; 95% confidence interval [CI] = 33.0-37.3) to 2014 (45.5%; 95% CI = 42.9-48.1) (p<0.001). Providing comprehensive behavioral counseling (including nutrition, physical activity, and self-management education) and encouraging evidence-based weight-loss program participation can result in enhanced health benefits for this population. |
Medical expenditures and earnings losses among US adults with arthritis in 2013
Murphy LB , Cisternas MG , Pasta DJ , Helmick CG , Yelin EH . Arthritis Care Res (Hoboken) 2017 70 (6) 869-876 OBJECTIVE: We estimated the economic impact of arthritis using 2013 US Medical Expenditure Panel Survey (MEPS) data. METHODS: We calculated arthritis-attributable and all-cause medical expenditures for adults age ≥ 18 years and arthritis-attributable earnings losses among those 18-64 years who had ever worked. We calculated arthritis-attributable costs using multi-stage regression-based methods, and conducted sensitivity analyses to estimate costs for two other arthritis definitions in MEPS. RESULTS: In 2013, estimated total national arthritis-attributable medical expenditures were $139.8 billion (range= $135.9 - $157.5). Across expenditure categories, ambulatory care expenditures accounted for nearly half of arthritis-attributable expenditures. All-cause expenditures among adults with arthritis represented 51% of the $1.2 trillion national medical expenditures among all US adults in MEPS. Estimated total national arthritis-attributable earning losses were $163.7 billion (range= $163.7 - $170.0). The percentage with arthritis who worked in the past year was 7.2 percentage points lower than those without arthritis (76.8%; 95% CI= 75.0-78.6 and 84.0%; 95% CI= 82.5-85.5, respectively; adjusted for socio-demographics and chronic conditions). Total arthritis-attributable medical expenditures and earnings losses were $303.5 billion (range=$303.5 - $326.9). CONCLUSION: Total national arthritis-attributable medical care expenditures and earnings losses among adults with arthritis were $303.5 billion in 2013. High arthritis-attributable medical expenditures might be reduced by greater efforts to reduce pain and improve function. The high earnings losses were largely attributable to the substantially lower prevalence of working among those with arthritis compared with those without, signaling the need for interventions that keep people with arthritis in the work force. This article is protected by copyright. All rights reserved. |
The incidence and prevalence of systemic lupus erythematosus in San Francisco County, California: The California Lupus Surveillance Project
Dall'Era M , Cisternas MG , Snipes K , Herrinton LJ , Gordon C , Helmick CG . Arthritis Rheumatol 2017 69 (10) 1996-2005 OBJECTIVE: Estimates of the incidence and prevalence of systemic lupus erythematosus (SLE) in the US have varied widely. The purpose of this study was to conduct the California Lupus Surveillance Project (CLSP) to determine credible estimates of SLE incidence and prevalence, with a special focus on Hispanics and Asians. METHODS: The CLSP, which is funded by the Centers for Disease Control and Prevention, is a population-based registry of individuals with SLE residing in San Francisco County, CA, from January 1, 2007 through December 31, 2009. Data sources included hospitals, rheumatologists, nephrologists, commercial laboratories, and a state hospital discharge database. We abstracted medical records to ascertain SLE cases, which we defined as patients who met ≥4 of the 11 American College of Rheumatology classification criteria for SLE. We estimated crude and age-standardized incidence and prevalence, which were stratified by sex and race/ethnicity. RESULTS: The overall age-standardized annual incidence rate was 4.6 per 100,000 person-years. The average annual period prevalence was 84.8 per 100,000 persons. The age-standardized incidence rate in women and men was 8.6 and 0.7 per 100,000 person-years, respectively. This rate was highest among black women (30.5), followed by Hispanic women (8.9), Asian women (7.2), and white women (5.3). The age-standardized prevalence in women per 100,000 persons was 458.1 in blacks, 177.9 in Hispanics, 149.7 in Asians, and 109.8 in whites. Capture-recapture modeling estimated 33 additional incident cases and 147 additional prevalent cases. CONCLUSION: Comprehensive methods that include intensive case-finding provide more credible estimates of SLE in Hispanics and Asians, and confirm racial and ethnic disparities in SLE. The disease burden of SLE is highest in black women, followed by Hispanic women, Asian women, and white women. |
Defining arthritis for public health surveillance: Methods and estimates in four US population health surveys
Murphy LB , Cisternas MG , Greenlund KG , Giles W , Hannan C , Helmick CG . Arthritis Care Res (Hoboken) 2016 69 (3) 356-367 OBJECTIVE: To determine variability of arthritis prevalence in 4 US population health surveys. METHODS: We estimated annualized arthritis prevalence in 2011/12, among adults ≥ 20 years, using 2 definition methods, both based on self-report: 1) doctor/health care provider diagnosed arthritis in the Behavioral Risk Factor Surveillance Survey (BRFSS), National Health and Nutrition Examination Survey (NHANES), National Health Interview Survey (NHIS), and Medical Expenditure Panel Survey (MEPS); and 2) three ICD-9-CM based arthritis definitions in MEPS (National Arthritis Data Workgroup Arthritis and Rheumatic Conditions [NADW-AORC], Clinical Classification System [CCS], and Centers for Disease Control and Prevention [CDC]). RESULTS: Diagnosed arthritis prevalence percentages were within 3 percentage points (BRFSS= 26.2% [99% CI=26.0 - 26.4], MEPS= 26.1 [99% CI=25.0-27.2], NHIS=23.5 [99% CI = 22.9-24.1], NHANES=23.0% [99% CI=19.2-26.8]) and ICD-9-CM within 5 (CCS=25.8%; 99% CI=24.6-27.1; CDC=28.3%; 99% CI=27.0-29.6; and NADW=30.7%; 95% CI=29.4-32.1). Range in estimated number (in millions) affected with diagnosed arthritis was 7.8 (BRFSS=58.5 [99% CI=58.1-59.1]; MEPS=59.3 [99% CI=55.6-63.1]; NHANES=51.5 [99% CI=37.2-65.5], and NHIS=52.6 [99% CI=50.9-54.4]) and ICD-9-CM definitions was 11.1 (CCS=58.7 [99% CI=54.5-62.9]; CDC=64.3 [99% CI=59.9-68.6], and NADW=69.9 [99% CI=65.2-74.5]). Most (57% to 70%) reporting diagnosed arthritis also reported ICD-9-CM arthritis; respondents reporting diagnosed arthritis were older than those meeting ICD-9-CM definitions. Proxy response status affected arthritis prevalence differently across surveys. CONCLUSION: Public health practitioners and decision makers are frequently charged with choosing a single number to represent arthritis prevalence in the US population. We encourage them to consider the surveys' purpose, design, measurement methods, and statistical precision when choosing an estimate. |
Alternative methods for defining osteoarthritis and the impact on estimating prevalence in a US population-based survey
Cisternas MG , Murphy L , Sacks JJ , Solomon DH , Pasta DJ , Helmick CG . Arthritis Care Res (Hoboken) 2015 68 (5) 574-80 OBJECTIVE: Provide a contemporary estimate of osteoarthritis (OA) by comparing accuracy and prevalence of alternative definitions of OA. METHODS: The Medical Expenditure Panel Survey (MEPS) household component (HC) records respondent-reported medical conditions as open-ended responses; professional coders translate these responses into ICD-9-CM codes for the medical conditions files. Using these codes and other data from the MEPS-HC medical conditions files, we constructed three case definitions of OA and assessed them against medical provider diagnoses of ICD-9-CM 715 [osteoarthrosis and allied disorders] in a MEPS subsample. The three definitions were: 1) strict = ICD-9-CM 715; 2) expanded = ICD-9-CM 715, 716 [other and unspecified arthropathies], OR 719 [other and unspecified disorders of joint]); and 3) probable = strict OR expanded + respondent-reported prior diagnosis of OA or other arthritis excluding rheumatoid arthritis (RA). RESULTS: Sensitivity and specificity of the three definitions were: strict - 34.6% and 97.5%; expanded - 73.8% and 90.5%; and probable - 62.9% and 93.5%. CONCLUSION: The strict definition for OA (ICD-9-CM 715) excludes many individuals with OA. The probable definition of OA has the optimal combination of sensitivity and specificity relative to the two other MEPS-based definitions and yields a national annual estimate of 30.8 million adults with OA (13.4% of US adult population) for 2008 - 2011. |
Trends in medical care expenditures of US adults with arthritis and other rheumatic conditions 1997 to 2005
Cisternas MG , Murphy LB , Yelin EH , Foreman AJ , Pasta DJ , Helmick CG . J Rheumatol 2009 36 (11) 2531-8 OBJECTIVE: To examine trends in annual medical expenditures from 1997 to 2005 among adults with arthritis and other rheumatic conditions (denoted Arthritis group). METHODS: We analyzed annual medical expenditures (2005 US dollars) among adults with Arthritis using the Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the US civilian, noninstitutionalized population. Expenditures were stratified by Arthritis and comorbidity status. RESULTS: The Arthritis population increased by 22% (36.8 to 44.9 million) during this period, attributable entirely to the subpopulation with at least one comorbid condition (31.8 to 40.3 million). The overall, inflation-adjusted annual mean medical expenditures for adults with Arthritis increased from $6,848 in 1997 to $7,854 in 2005. In 1997, inpatient care was the most expensive component of overall expenditures (mean $2,702), but beginning in 2001, mean inpatient and ambulatory expenditures were almost identical. Mean prescription expenditures increased nearly every year, almost doubling from $970 in 1997 to $1,811 in 2005. Aggregate total expenditures for the Arthritis population increased markedly during this period, from $252.0 to $353.0 billion (+40%). Most of this increase was attributable to the population increase in the Arthritis and comorbid condition subgroup. CONCLUSION: Mean annual ambulatory and prescription expenditures for adults with Arthritis increased far above the rate of medical inflation, offsetting a relative decline in inpatient expenditures. Increases in overall mean and aggregate total expenditures are attributable to the increasing number of adults with Arthritis and at least one comorbid chronic condition. Projected increases in this population suggest that these expenditures will continue to rise. |
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