Healthcare Utilization and Costs During the Initial Phase of Care Among Elderly Women With Breast Cancer.

Background: Understanding the patterns of healthcare utilization and costs during the initial phase of care (12 months after breast cancer [BC] diagnosis) in older women (aged ≥65 years) is crucial in the allocation of Medicare resources. The objective of this study was to determine healthcare utilization and costs during the initial phase of care in older, female, Medicare fee-for-service beneficiaries diagnosed with BC, and to determine the factors associated with higher costs. Methods: A retrospective observational study using the SEER-Medicare linked database was conducted in 69,307 women aged ≥66 years diagnosed with primary incident BC in 2003-2009 to determine healthcare utilization, average costs, and costs for specific services during the initial phase of care. Generalized linear model regression was conducted to identify the factors associated with higher costs in a multivariate framework. Results: A total of 96% of women were treated with surgery during the initial phase of BC care, whereas 21% and 54% underwent chemotherapy and radiotherapy, respectively. Costs during the initial phase of care totalled $28,075 in 2012 USD, comprising $13,344 for physician services and $7,456 for outpatient services. Factors associated with higher costs during the initial phase of care were younger age (66-69 years), African American race, higher household income, advanced stages of BC, initial BC treatment, higher number of primary care physician visits, and presence of comorbidities and/or a mental condition. Conclusions: The economic burden of BC is substantial during the initial phase of care. Physician and outpatient services accounted for the highest proportion of costs. Predisposing factors, need-related factors, healthcare use, and external environmental healthcare factors significantly predicted costs during the initial phase of care.

Sleep duration and self-rated health: the national health interview survey 2008.

BACKGROUND: Self-rated health (SRH) has been shown to consistently predict overall mortality and cardiovascular mortality in several population-based studies across the world. Similarly sleep duration have been found to be associated with cardiovascular disease (CVD) and mortality. However, relatively few studies have examined the association between sleep duration and SRH, and the results have not been consistent. METHODS: We conducted a cross-sectional study of n = 20,663 National Health Interview Survey 2008 participants ≥ 18 years of age (56.2% women). Sleep duration was categorized as ≤ 5 h, 6 h, 7 h, 8 h, and ≥ 9 h. The main outcome interest was fair/poor SRH (n = 3043). RESULTS: We found both short and long sleep duration to be independently associated with fair/poor SRH, independent of age, sex, race-ethnicity, smoking, alcohol intake, body mass index, physical activity, depression, diabetes mellitus, hypertension, and CVD. Compared with a sleep duration of 7 h (referent), the multivariate odds ratio (95% confidence interval) of fair/poor SRH was 2.29 (1.86-2.83), 1.68 (1.42-2.00), 1.38 (1.18-1.61), and 1.98 (1.63-2.40) for sleep duration ≤ 5, 6, 8, and ≥ 9 h. This association persisted in subgroup analyses by gender, race-ethnicity, and body mass index categories. CONCLUSION: Compared with sleep duration of 7 h, there was a positive association between both shorter and longer sleep duration and fair/poor self-rated health in a representative sample of US adults.

Examination of the Association between Insufficient Sleep and Cardiovascular Disease and Diabetes by Race/Ethnicity.

Background. We examined the association between insufficient rest/sleep and cardiovascular disease or diabetes mellitus separately among non-Hispanic whites, non-Hispanic blacks, Hispanic Americans, and other races in a contemporary sample of US adults. Methods. Multiethnic, nationally representative, cross-sectional survey (2008 BRFSS) participants who were >20 years of age (n = 369, 217; 50% women). Self-reported insufficient rest/sleep in the previous month was categorized into: zero, 1-13, 14-29, and all 30 days. Outcomes were: (1) any CVD, (2) coronary artery disease (CHD), (3) stroke, and (4) diabetes mellitus. Results. Insufficient rest/sleep was found to be positively associated with (1) any CVD, (2) CHD, and (3) stroke among all race-ethnicities. In contrast, insufficient rest/sleep was positively associated with diabetes mellitus in all race-ethnicities except non-Hispanic blacks. The odds ratio of diabetes association with insufficient rest/sleep for all 30 days was 1.37 (1.26-1.48) among non-Hispanic whites, 1.11 (0.90-1.36) among non-Hispanic blacks, 1.88 (1.46-2.42) among Hispanic Americans, and 1.48 (1.10-2.00) among other race/ethnicities. Conclusion. In a multiethnic sample of US adults, perceived insufficient rest/sleep was associated with CVD, among all race-ethnicities. However, the association between insufficient rest/sleep and diabetes mellitus was present among all race-ethnicities except non-Hispanic blacks.

Cell-phone use and self-reported hypertension: national health interview survey 2008.

Background. Cell-phone usage has increased dramatically over the last decade, along with a rising public concern over the health effects of using this device. The association between cell-phone usage and hypertension has not been examined before. Methods. We analysed data from 21,135 adults aged ≥18 years who participated in the 2008 National Health Interview Survey. Based on reported cell-phone use, participants were categorized as cell-phone nonusers, predominantly landline users, dual users of cell phone and landline, and predominantly cell-phone users. The main outcome of interest was self-reported physician-diagnosed hypertension (n = 6,793). Results. 43.5% of the participants were cell-phone nonusers, while 13.8% were predominantly cell-phone users. We found that cell-phone use was inversely associated with hypertension, independent of age, sex, race/ethnicity, smoking, alcohol consumption, education, body mass index (BMI), and physical activity. Compared to cell-phone nonusers, the multivariable odds ratio (95% confidence interval) of hypertension was 0.86 (0.75-0.98, P trend = .005) among predominantly cell-phone users. This inverse association between cell-phone use and hypertension was stronger in women, those aged <60 years, whites, and those with BMI <25 kg/m(2). Conclusion. We found that cell-phone usage was protectively associated with self-reported hypertension in a nationally representative sample of US adults.

Serum 25-hydroxyvitamin d levels and prediabetes among subjects free of diabetes.

OBJECTIVE: Animal studies suggest that low serum 25-hydroxyvitamin D (25[OH]D) may impair insulin synthesis and secretion and be involved in the pathogenesis of diabetes. Results in studies in humans have not been consistent, however. Prediabetes is a stage earlier in the hyperglycemia/diabetes continuum where individuals are at increased risk of developing diabetes and where prevention efforts have been shown to be effective in delaying or preventing the onset of diabetes. However, previous studies have not examined the association between low serum 25(OH)D levels and prediabetes. RESEARCH DESIGN AND METHODS: We examined the 12,719 participants (52.5% women) in the third National Health and Nutrition Examination Survey aged >20 years who were free of diabetes. Serum 25(OH)D levels were categorized into quartiles (≤ 17.7, 17.8-24.5, 24.6-32.4, >32.4 ng/mL). Prediabetes was defined as a 2-h glucose concentration of 140-199 mg/dL, or a fasting glucose concentration of 110-125 mg/dL, or an A1C value of 5.7-6.4%. RESULTS: Lower serum 25(OH)D levels were associated with prediabetes after adjusting for age, sex, race/ethnicity, season, geographic region, smoking, alcohol intake, BMI, outdoor physical activity, milk consumption, dietary vitamin D, blood pressure, serum cholesterol, C-reactive protein, and glomerular filtration rate. Compared with quartile 4 of 25(OH)D (referent), the odds ratio of prediabetes associated with quartile 1 was 1.47 (95% CI 1.16-1.85; P = 0.001 for trend). Subgroup analyses examining the relation between 25(OH)D and prediabetes by sex, BMI, and hypertension categories also showed a consistent positive association. CONCLUSIONS: Lower serum 25(OH)D levels are associated with prediabetes in a representative sample of U.S. adults.

Insufficient rest or sleep and its relation to cardiovascular disease, diabetes and obesity in a national, multiethnic sample.

BACKGROUND: A new question on insufficient rest/sleep was included in the 2008 Behavioral Risk Factor Surveillance System (BRFSS) for the 50 states, District of Columbia, and three US territories. No previous study, however, has examined perceived insufficient rest/sleep in relation to cardiovascular disease (CVD) or diabetes mellitus. We examined the association between self-reported insufficient rest/sleep and CVD, diabetes, and obesity in a contemporary sample of US adults. METHODS: Multiethnic, nationally representative, cross-sectional survey (2008 BRFSS) participants were >20 years of age (n=372, 144, 50% women). Self-reported insufficient rest/sleep in the previous month was categorized into four groups: zero, 1-13, 14-29, and 30 days. There were five outcomes: 1) any CVD, 2) coronary heart disease (CHD), 3) stroke, 4) diabetes mellitus, and 5) obesity (body mass index≥30 kg/m2). We employed multivariable logistic regression to calculate odds ratio (OR), (95% confidence interval (CI), of increasing categories of insufficient rest/sleep, taking zero days of insufficient rest/sleep as the referent category. PRINCIPAL FINDINGS: Insufficient rest/sleep was found to be associated with 1) any CVD, 2) CHD, 3) stroke, 4) diabetes mellitus, and 5) obesity, in separate analyses. Compared to those reporting zero days of insufficient sleep (referent), the OR (95% CI) associated with all 30 days of insufficient sleep was 1.67 (1.55-1.79) for any cardiovascular disease, 1.69(1.56-1.83) for CHD, 1.51(1.36-1.68) for stroke, 1.31(1.21-1.41) for diabetes, and 1.51 (1.43-1.59) for obesity. CONCLUSIONS: In a multiethnic sample of US adults, perceived insufficient rest/sleep was found to be independently associated with CHD, stroke, diabetes mellitus and obesity.