Heesoo Joo

Racial/ethnic- and education-related disparities in the control of risk factors for cardiovascular disease among individuals with diabetes.

OBJECTIVE There is limited information on whether recent improvements in the control of cardiovascular disease (CVD) risk factors among individuals with diabetes have been concentrated in particular sociodemographic groups. This article estimates racial/ethnic- and education-related disparities and examines trends in uncontrolled CVD risk factors among adults with diabetes. The main racial/ethnic comparisons made are with African Americans versus non-Latino whites and Mexican Americans versus non-Latino whites. RESEARCH DESIGN AND METHODS The analysis samples include adults aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 1988–1994 and the NHANES 1999–2008 who self-reported having diabetes (n = 1,065, NHANES 1988–1994; n = 1,872, NHANES 1999–2008). By use of logistic regression models, we examined the correlates of binary indicators measuring 1) high blood glucose, 2) high blood pressure, 3) high cholesterol, and 4) smoking. RESULTS Control of blood glucose, blood pressure, and cholesterol improved among individuals with diabetes between the NHANES 1988–1994 and the NHANES 1999–2008, but there was no change in smoking prevalence. In the NHANES 1999–2008, racial/ethnic minorities and individuals without some college education were more likely to have poorly controlled blood glucose compared with non-Latino whites and those with some college education. In addition, individuals with diabetes who had at least some college education were less likely to smoke and had better blood pressure control compared with individuals with diabetes without at least some college education. CONCLUSIONS Trends in CVD risk factors among individuals with diabetes improved over the past 2 decades, but racial/ethnic- and education-related disparities have emerged in some areas.

Cost of informal caregiving associated with stroke among the elderly in the United States

Objectives: We estimated the informal caregiving hours and costs associated with stroke. Methods: We selected persons aged 65 years and older in 2006 and who were also included in the 2008 follow-up survey from the Health and Retirement Study. We adapted the case-control study design by using self-reported occurrence of an initial stroke event during 2006 and 2008 to classify persons into the stroke (case) and the nonstroke (control) groups. We compared informal caregiving hours between case and control groups in 2006 (prestroke period for case group) and in 2008 (poststroke period for case group) and estimated incremental informal caregiving hours attributable to stroke by applying a difference-in-differences technique to propensity score–matched populations. We used a replacement approach to estimate the economic value of informal caregiving. Results: The weekly incremental informal caregiving hours attributable to stroke were 8.5 hours per patient. The economic value of informal caregiving per stroke survivor was

Cost of informal caregiving for patients with heart failure.

8,211 per year, of which

Hospital Costs Associated With Atrial Fibrillation for Patients With Ischemic Stroke Aged 18–64 Years in the United States

4,356 (53%) was attributable to stroke. At the national level, the annual economic burden of informal caregiving associated with stroke among elderly was estimated at

Use of intravenous tissue plasminogen activator and hospital costs for patients with acute ischaemic stroke aged 18–64 years in the USA

14.2 billion in 2008. Conclusions: Recent changes in public health and social support policies recognize the economic burden of informal caregiving. Our estimates reinforce the high economic burden of stroke in the United States and provide up-to-date information for policy development and decision-making.

BEWARE OF BEING UNAWARE: RACIAL/ETHNIC DISPARITIES IN CHRONIC ILLNESS IN THE USA

BACKGROUND Heart failure is a serious health condition that requires a significant amount of informal care. However, informal caregiving costs associated with heart failure are largely unknown. METHODS We used a study sample of noninstitutionalized US respondents aged ≥50 years from the 2010 HRS (n = 19,762). Heart failure cases were defined by using self-reported information. The weekly informal caregiving hours were derived by a sequence of survey questions assessing (1) whether respondents had any difficulties in activities of daily living or instrumental activities of daily living, (2) whether they had caregivers because of reported difficulties, (3) the relationship between the patient and the caregiver, (4) whether caregivers were paid, and (5) how many hours per week each informal caregiver provided help. We used a 2-part econometric model to estimate the informal caregiving hours associated with heart failure. The first part was a logit model to estimate the likelihood of using informal caregiving, and the second was a generalized linear model to estimate the amount of informal caregiving hours used among those who used informal caregiving. Replacement approach was used to estimate informal caregiving cost. RESULTS The 943 (3.9%) respondents who self-reported as ever being diagnosed with heart failure used about 1.6 more hours of informal caregiving per week than those who did not have heart failure (P < .001). Informal caregiving hours associated with heart failure were higher among non-Hispanic blacks (3.9 hours/week) than non-Hispanic whites (1.4 hours/week). The estimated annual informal caregiving cost attributable to heart failure was

A comparative cost analysis of the Vaccination Program for US-bound Refugees☆

3 billion in 2010. CONCLUSION The cost of informal caregiving was substantial and should be included in estimating the economic burden of heart failure. The results should help public health decision makers in understanding the economic burden of heart failure and in setting public health priorities.

Cost of informal care for patients with cardiovascular disease or diabetes: current evidence and research challenges

Background and Purpose— Hospital costs associated with atrial fibrillation (AFib) among patients with stroke have not been well-studied, especially among people aged <65 years. We estimated the AFib-associated hospital costs in US patients aged 18 to 64 years. Methods— We identified hospital admissions with a primary diagnosis of ischemic stroke from the 2010 to 2012 MarketScan Commercial Claims and Encounters inpatient data sets, excluding those with capitated health insurance plans, aged <18 or >64 years, missing geographic region, hospital costs below the 1st or above 99th percentile, and having carotid intervention (n=40 082). We searched the data for AFib and analyzed the costs for nonrepeat and repeat stroke admissions separately. We estimated the AFib-associated costs using multivariate regression models controlling for age, sex, geographic region, and Charlson comorbidity index. Results— Of the 33 500 nonrepeat stroke admissions, 2407 (7.2%) had AFib. Admissions with AFib cost

Age-specific Cost Effectiveness of Using Intravenous Recombinant Tissue Plasminogen Activator for Treating Acute Ischemic Stroke

4991 more than those without AFib (

Examining the Education Gradient in Chronic Illness

23 770 versus