Center for Disease Prevention and Health Interventions for Diverse Populations

Charleston, United States

Center for Disease Prevention and Health Interventions for Diverse Populations

Charleston, United States
SEARCH FILTERS
Time filter
Source Type

Ellis C.,Center for Disease Prevention and Health Interventions for Diverse Populations | Ellis C.,Medical University of South Carolina | Simpson A.N.,Medical University of South Carolina | Bonilha H.,Medical University of South Carolina | And 2 more authors.
Stroke | Year: 2012

Background and Purpose-Little is known about the contribution of aphasia to the cost of care for patients who experience stroke. Methods-We retrospectively examined a cohort of South Carolina Medicare beneficiaries who experienced ischemic stroke in 2004 to determine the attributable cost of aphasia. Univariate analyses were used to compare demographic, comorbidity, and severity differences between individuals with poststroke aphasia and those without aphasia. Differences in payments by Medicare because of stroke were examined using a gamma-distributed generalized linear multivariate model. Results-Three thousand, two hundred Medicare beneficiaries experienced ischemic stroke in South Carolina in 2004, and 398 beneficiaries had poststroke aphasia. Patients with aphasia experienced longer length of stays, greater morbidity, and greater mortality than did those without aphasia. In adjusted models that controlled for relevant covariates, the attributable 1-year cost of aphasia was estimated at $1703. Conclusions-Aphasia adds to the cost of stroke-related care, above the cost of stroke alone. © 2012 American Heart Association, Inc.


Ellis C.,Medical University of South Carolina | Ellis C.,Center for Disease Prevention and Health Interventions for Diverse Populations
Disability and Health Journal | Year: 2010

Background: Stroke among young adults is generally considered a rare event, although few studies have considered national data. Objective: The objective of this paper was to profile stroke in young adults in the United States using a national dataset. Methods: Data from the 2007 Nationwide Inpatient Sample were examined to estimate the number of patients, mean length of stay, mean costs, and discharge disposition of young adults (aged 18-44 y) with a diagnosis of stroke. Results: Estimates indicate that 41,587 (or 4.9%) of individuals experiencing a stroke in 2007 were young adults: 32,438 had an ischemic stroke, 4662 had a subarachnoid hemorrhage, and 4487 had an intracerebral hemorrhage. The average length of stay was 4.7 days for ischemic stroke, 11.6 days for subarachnoid hemorrhage, and 11.2 days for intracerebral hemorrhage. Approximately 5% (2013) of young adults died of stroke. Most young adults were discharged routinely to home at an average cost associated with their hospital stay of $34,886 for ischemic stroke, $146,307 for subarachnoid hemorrhage, and $94,482 for intracerebral hemorrhage. Conclusions: A substantial number of young adults experience stroke in the United States at costs that are higher than those for stroke patients overall. © 2010 Elsevier Inc. All rights reserved.


Egede L.E.,Medical University of South Carolina | Egede L.E.,Center for Disease Prevention and Health Interventions for Diverse Populations | Hernandez-Tejada M.A.,Medical University of South Carolina
Expert Review of Pharmacoeconomics and Outcomes Research | Year: 2013

This review outlines the effect of depression on quality of life (QoL) in patients with Type 2 diabetes mellitus (T2DM). The prevalence and medical, psychological and financial burden of T2DM in the USA are briefly discussed, similar to the findings related to patients living with T2DM and depression in terms of health-related QoL. Recommendations for future research include studying mechanisms by which depression affects the QoL of T2DM patients, outlining effects of positive emotions on managing consequences of distress and depression in these patients, and developing interventions to address both depression and diabetes that minimize the treatment burden and costs for patients. © 2013 Expert Reviews Ltd.


Egede L.E.,Medical University of South Carolina | Egede L.E.,Center for Disease Prevention and Health Interventions for Diverse Populations | Osborn C.Y.,Vanderbilt University
Diabetes Educator | Year: 2010

Purpose The mechanism by which depression influences health outcomes in persons with diabetes is uncertain. The purpose of this study was to test whether depression is related to self-care behavior via social motivation and indirectly related to glycemic control via self-care behavior. Methods Patients with diabetes were recruited from an outpatient clinic. Information gathered pertained to demographics, depression, and diabetes knowledge (information); diabetes fatalism (personal motivation); social support (social motivation); and diabetes self-care (behavior). Hemoglobin A1C values were extracted from the patient medical record. Structural equation models tested the predicted pathways. Results Higher levels of depressive symptoms were significantly related to having less social support and decreased performance of diabetes self-care behavior. In addition, when depressive symptoms were included in the model, fatalistic attitudes were no longer associated with behavioral performance. Conclusions Among adults with diabetes, depression impedes the adoption of effective self-management behaviors (including physical activity, appropriate dietary behavior, foot care, and appropriate self-monitoring of blood glucose behavior) through a decrease in social motivation. © 2010 The Author(s).


Egede L.E.,Medical University of South Carolina | Egede L.E.,Center for Disease Prevention and Health Interventions for Diverse Populations | Ellis C.,Center for Disease Prevention and Health Interventions for Diverse Populations | Ellis C.,Medical University of South Carolina
Diabetes Research and Clinical Practice | Year: 2010

Background: Diabetes and depression are highly prevalent conditions and have significant impact on health outcomes. This study reviewed the literature on the prevalence, burden of illness, morbidity, mortality, and cost of comorbid depression in people with diabetes as well as the evidence on effective treatments. Methods: Systematic review of the literature on the relationship between diabetes and depression was performed. A comprehensive search of the literature was performed on Medline from 1966 to 2009. Studies that examined the association between diabetes and depression were reviewed. A formal meta-analysis was not performed because of the broad area covered and the heterogeneity of the studies. Instead, a qualitative aggregation of studies was performed. Results: Diabetes and depression are debilitating conditions that are associated with significant morbidity, mortality, and healthcare costs. Coexisting depression in people with diabetes is associated with decreased adherence to treatment, poor metabolic control, higher complication rates, decreased quality of life, increased healthcare use and cost, increased disability and lost productivity, and increased risk of death. Conclusion: The coexistence of diabetes and depression is associated with significant morbidity, mortality, and increased healthcare cost. Coordinated strategies for clinical care are necessary to improve clinical outcomes and reduce the burden of illness. © 2010 Elsevier Ireland Ltd. All rights reserved.


Strom J.L.,Medical University of South Carolina | Egede L.E.,Medical University of South Carolina | Egede L.E.,Center for Disease Prevention and Health Interventions for Diverse Populations
Current Diabetes Reports | Year: 2012

Diabetes is one of the fastest growing chronic diseases globally and in the United States. Although preventable, type 2 diabetes accounts for 90 % of all cases of diabetes worldwide and continues to be a source of increased disability, lost productivity, mortality, and amplified health-care costs. Proper disease management is crucial for achieving better diabetes-related outcomes. Evidence suggests that higher levels of social support are associated with improved clinical outcomes, reduced psychosocial symptomatology, and the adaptation of beneficial lifestyle activities; however, the role of social support in diabetes management is not well understood. The purpose of this systematic review is to examine the impact of social support on outcomes in adults with type 2 diabetes. © Springer Science+Business Media, LLC 2012.


Bains S.S.,Medical University of South Carolina | Egede L.E.,Medical University of South Carolina | Egede L.E.,Center for Disease Prevention and Health Interventions for Diverse Populations
Diabetes Technology and Therapeutics | Year: 2011

Objective: This study assessed associations among health literacy, diabetes knowledge, self-care, and glycemic control in a low income, predominately minority population with type 2 diabetes. Methods: One hundred twenty-five adults with diabetes were recruited from a primary care clinic. Subjects completed validated surveys to measure health literacy, diabetes knowledge, and self-care (medication adherence, diet, exercise, blood sugar testing, and foot care). Hemoglobin A1c values were extracted from the medical record. Spearman's correlation and multiple linear regression were used to assess the relationship among health literacy, diabetes knowledge, self-care, and glycemic control controlling for covariates. Results: Cronbach's α was 0.95 for the Revised Rapid Estimate of Adult Literacy in Medicine. The majority of the sample was <65 years old (50.7%), female (72.5%), and African American (71.4%), had less than a high school education (68.2%) and a household income <$15,000 (64.2%), and reported their health status as worse than last year (73.9%). In adjusted models that examined the associations among health literacy, diabetes knowledge, medication adherence, and self-care, health literacy was only significantly associated with diabetes knowledge (β=0.55; 95% confidence interval [CI] 0.29, 0.82). In the final adjusted model for independent factors associated with glycemic control, both diabetes knowledge (β=0.12; 95% CI 0.01, 0.23) and perceived health status (β=1.14; 95% CI 0.13, 2.16) were significantly associated with glycemic control, whereas health literacy was not associated with glycemic control (β=-0.03; 95% CI -0.19, 0.13). Conclusions: Diabetes knowledge and perceived health status are the most important factors associated with glycemic control in this population. Health literacy appears to exert its influence through diabetes knowledge and is not directly related to self-care or medication adherence. © Copyright 2011, Mary Ann Liebert, Inc. 2011.


Egan B.M.,Medical University of South Carolina | Zhao Y.,Medical University of South Carolina | Axon R.N.,Medical University of South Carolina | Axon R.N.,Center for Disease Prevention and Health Interventions for Diverse Populations | And 2 more authors.
Circulation | Year: 2011

Background-: Despite progress, many hypertensive patients remain uncontrolled. Defining characteristics of uncontrolled hypertensives may facilitate efforts to improve blood pressure control. Methods and results-: Subjects included 13 375 hypertensive adults from National Health and Nutrition Examination Surveys (NHANESs) subdivided into 1988 to 1994, 1999 to 2004, and 2005 to 2008. Uncontrolled hypertension was defined as blood pressure 140/90 mm Hg and apparent treatment-resistant hypertension (aTRH) when subjects reported taking 3 antihypertensive medications. Framingham 10-year coronary risk was calculated. Multivariable logistic regression was used to identify clinical characteristics associated with untreated, treated uncontrolled on 1 to 2 blood pressure medications, and aTRH across all 3 survey periods. More than half of uncontrolled hypertensives were untreated across surveys, including 52.2% in 2005 to 2008. Clinical factors linked with untreated hypertension included male sex, infrequent healthcare visits (0 to 1 per year), body mass index <25 kg/m, absence of chronic kidney disease, and Framingham 10-year coronary risk <10% (P<0.01). Most treated uncontrolled patients reported taking 1 to 2 blood pressure medications, a proxy for therapeutic inertia. This group was older, had higher Framingham 10-year coronary risk than patients controlled on 1 to 2 medications (P<0.01), and comprised 34.4% of all uncontrolled and 72.0% of treated uncontrolled patients in 2005 to 2008. We found that aTRH increased from 15.9% (1998-2004) to 28.0% (2005-2008) of treated patients (P<0.001). Clinical characteristics associated with aTRH included 4 visits per year, obesity, chronic kidney disease, and Framingham 10-year coronary risk >20% (P<0.01). CONCLUSION-: Untreated, undertreated, and aTRH patients have consistent characteristics that could inform strategies to improve blood pressure control by decreasing untreated hypertension, reducing therapeutic inertia in undertreated patients, and enhancing therapeutic efficiency in aTRH. © 2011 American Heart Association, Inc.


Osborn C.Y.,Vanderbilt University | Egede L.E.,Center for Disease Prevention and Health Interventions for Diverse Populations | Egede L.E.,Medical University of South Carolina
General Hospital Psychiatry | Year: 2012

Objective: Medication adherence promotion interventions are needed that target modifiable behavioral factors contributing to the link between depressive symptoms and poor adherence to diabetes self-care behaviors. In an effort to identify what factors contribute to this link, we examined the role of social support as a mediator of the relationship between depressive symptoms and medication nonadherence. Method: We recruited 139 subjects with type 2 diabetes. Using an indirect effect test with bias-corrected (BC) bootstrapping, we tested whether depressive symptoms had an indirect effect on medication nonadherence through a lack of social support. Results: More depressive symptoms were associated with medication nonadherence (total effect=.06, P<.001), more depressive symptoms were associated with less social support (direct effect of the predictor on the mediator=-.96, P=.02), and less social support was associated with medication nonadherence (direct effect of the mediator on the outcome=-.01, P<.01). While the relationship between more depressive symptoms and medication nonadherence persisted with social support in the predicted pathway, the degree of this relationship was partially explained by a relationship between more depressive symptoms and less social support (indirect effect=.01, 95% BC bootstrapped confidence interval of .0005 to .0325). Conclusion: Providing social support to patients with diabetes who have symptoms of depression may ameliorate some of the deleterious effects of depressive symptoms on medication nonadherence, but social support alone is not enough. © 2012 Elsevier Inc.


Egede L.E.,Medical University of South Carolina | Egede L.E.,Center for Disease Prevention and Health Interventions for Diverse Populations | Ellis C.,Medical University of South Carolina
Journal of General Internal Medicine | Year: 2010

Objective: This study describes the development and validation of the Diabetes Fatalism Scale (DFS) in adults with type 2 diabetes. Methods: Thirty-five items were derived from focus groups, literature review, and expert opinion. The items were pilot tested on 20 adults with diabetes and then administered to 216 primary care patients with type 2 diabetes to assess the validity and reliability of the scale. Exploratory factor analysis (Principal Component Analysis with Varimax rotation) yielded a 12-item scale with three subscales. Pearson's correlation was used to test the DFS's association with diabetes self-care, HbA1c and quality of life. Multiple linear regression was used to assess association between the DFS and HbA1c controlling for demographics, comorbidity and insulin use. Results: Cronbach's alpha for the 12-item DFS scale was 0.804 indicating internal consistency. The DFS is scored in such a way that higher scores represent greater diabetes fatalism. The DFS scores were not significantly correlated with age, years of education, or diabetes duration. Whites, men, those with government or no insurance, and those with 3+ comorbid conditions had significantly higher DFS scores. DFS was significantly correlated with self management understanding (r=-0.35, p<0.001), control problems (r=0.22, p=0.002), self-care ability (r=-0.30, p<0.001), and self-care adherence (r=-0.23, p<0.001). The DFS was significantly correlated with HbA1c (r=0.20, p=0.004) and mental health component of SF-12 (r=-0.24, p=0.001). In multivariate models, adjusting for demographics, comorbidity and insulin use, the DFS was independently associated with increased HbA1c (beta 0.21, p=0.005). Conclusions: The DFS is a valid and reliable measure of diabetes fatalism. Diabetes fatalism is associated with self-care problems, poor glycemic control, and decreased quality of life. © 2009 Society of General Internal Medicine.

Loading Center for Disease Prevention and Health Interventions for Diverse Populations collaborators
Loading Center for Disease Prevention and Health Interventions for Diverse Populations collaborators