Wanjun Cui

Tracking psychosocial health in adults with epilepsy—Estimates from the 2010 National Health Interview Survey☆

OBJECTIVE This study provides population-based estimates of psychosocial health among U.S. adults with epilepsy from the 2010 National Health Interview Survey. METHODS Multinomial logistic regression was used to estimate the prevalence of the following measures of psychosocial health among adults with epilepsy and those without epilepsy: 1) the Kessler-6 scale of serious psychological distress; 2) cognitive limitation, the extent of impairments associated with psychological problems, and work limitation; 3) social participation; and 4) the Patient-Reported Outcome Measurement Information System Global Health Scale. RESULTS Compared with adults without epilepsy, adults with epilepsy, especially those with active epilepsy, reported significantly worse psychological health, more cognitive impairment, difficulty in participating in some social activities, and reduced health-related quality of life (HRQOL). CONCLUSIONS These disparities in psychosocial health in U.S. adults with epilepsy serve as baseline national estimates of their HRQOL, consistent with Healthy People 2020 national objectives on HRQOL.

HIV testing among adults with mental illness in the United States.

Nationally representative data from the 2007 National Health Interview Survey (NHIS) were used to compare HIV testing prevalence among US adults with mental illness (schizophrenia spectrum disorder, bipolar disorder, depression, and/or anxiety) to those without, providing an update of prior work using 1999 and 2002 NHIS data. Logistic regression modeling was used to estimate the probability of ever being tested for HIV by mental illness status, adjusting for age, sex, race/ethnicity, marital status, substance abuse, excessive alcohol or tobacco use, and HIV risk factors. Based on data from 21,785 respondents, 15% of adults had a psychiatric disorder and 37% ever had an HIV test. Persons with schizophrenia (64%), bipolar disorder (63%), and depression and/or anxiety (47%) were more likely to report ever being tested for HIV than those without mental illness (35%). In multivariable models, individuals reporting schizophrenia (adjusted prevalence ratio=1.68, 95% confidence interval=1.33-2.13), bipolar disease (1.58, 1.39-1.81), and depression and/or anxiety (1.31, 1.25-1.38) were more likely to be tested for HIV than persons without these diagnoses. Similar to previous analyses, persons with mental illness were more likely to have been tested than those without mental illness. However, the elevated prevalence of HIV in populations with mental illness suggests that high levels of testing along with other prevention efforts are needed.

Health-related quality of life and asthma among United States adolescents.

OBJECTIVE To examine the direction and the magnitude of associations between asthma and health-related quality of life (HRQoL) in a population-based sample of US adolescents. STUDY DESIGN We obtained data from the 2001-2010 cross-sectional National Health and Nutrition Examination Survey. We used multinomial logistic regression and negative binomial regression to estimate corresponding percentages, prevalence ratios (PRs), and predicted days of 4 domains of HRQoL by 3 asthma status categories: never having asthma, having asthma without symptoms, and having asthma with symptoms. RESULTS Compared with those who never had asthma, adolescents with asthma with symptoms of dry cough or wheezing reported significantly worse self-rated health (13.58% [95% CI, 10.32%-17.67%] vs 7.54% [95% CI, 6.50%-8.72%] for fair or poor health), significantly impaired physical health (PR = 1.34, P = .004; adjusted physically unhealthy days, 2.7 days vs 2 days), and impaired mental health (PR = 1.26, P = .025). Among adolescents having asthma with symptoms, those who currently smoked reported 1 more physically unhealthy day and 2.4 more mentally unhealthy days than those who did not smoke and did not have asthma. Those reporting limited physical functioning reported 2 more physically unhealthy days and 1.5 more mentally unhealthy days than those who did not report limited functioning. CONCLUSION Adolescents with asthma and symptoms reported worse HRQoL compared with those with asthma not reporting symptoms and those without asthma. Those who smoked or reported limited physical functioning reported worse physical and mental HRQoL. Reducing symptoms, quitting smoking, and improving physical functioning may improve HRQoL among adolescents with asthma.

Trends in health-related quality of life among adolescents in the United States, 2001-2010.

Health-related quality of life (HRQOL) measures are often used to track changes in population health, mostly among adults. Prompted by the recent US recession, we assessed trends in adolescent HRQOL by using cross-sectional data from the 2001–2010 National Health and Nutrition Examination Survey. Adolescents’ self-rated health and reported mental health declined significantly, especially among those in low-income families, but their physical health and activity limitation did not change. Because these HRQOL declines occurred at the end of the decade and especially among adolescents from low-income families, we conclude that these declines are consistent with recession effects and warrant further study.

Health behaviors among people with epilepsy—Results from the 2010 National Health Interview Survey

OBJECTIVES This study aimed to estimate and compare the prevalence of selected health behavior-alcohol use, cigarette smoking, physical activity, and sufficient sleep-between people with and without a history of epilepsy in a large, nationally representative sample in the United States. METHODS We used data from the 2010 cross-sectional National Health Interview Survey (NHIS) to compare the prevalence of each health behavior for people with and without epilepsy while adjusting for sex, age, race/ethnicity, and family income. We also further categorized those with epilepsy into active epilepsy and inactive epilepsy and calculated their corresponding prevalences. RESULTS The percentages of adults with a history of epilepsy (50.1%, 95% CI=45.1%-55.2%) and with active epilepsy (44.4%, 95% CI=37.6%-51.5%) who were current alcohol drinkers were significantly lower than that of those without epilepsy (65.1%, 95% CI=64.2%-66.0%). About 21.8% (95% CI=18.1%-25.9%) of adults with epilepsy and 19.3% (95% CI=18.7%-19.9%) of adults without epilepsy were current smokers. Adults with active epilepsy were significantly less likely than adults without epilepsy to report following recommended physical activity guidelines for Americans (35.2%, 95% CI=28.8%-42.1% vs. 46.3%, 95% CI=45.4%-47.2%) and to report walking for at least ten minutes during the seven days prior to being surveyed (39.6%, 95% CI=32.3%-47.4% vs. 50.8%, 95% CI=49.9%-51.7%). The percentage of individuals with active epilepsy (49.8%, 95% CI=42.0%-57.7%) who reported sleeping an average of 7 or 8h a day was significantly lower than that of those without epilepsy (61.9%, 95% CI=61.2%-62.7%). CONCLUSIONS Because adults with epilepsy are significantly less likely than adults without epilepsy to engage in recommended levels of physical activity and to get the encouraged amount of sleep for optimal health and well-being, promoting more safe physical activity and improved sleep quality is necessary among adults with epilepsy. Ending tobacco use and maintaining low levels of alcohol consumption would also better the health of adults with epilepsy.

Suicide among people with epilepsy: A population-based analysis of data from the U.S. National Violent Death Reporting System, 17 states, 2003-2011.

OBJECTIVE This study analyzed suicide data in the general population from the U.S. National Violent Death Reporting System (NVDRS) to investigate suicide burden among those with epilepsy and risk factors associated with suicide and to suggest measures to prevent suicide among people with epilepsy. METHODS The NVDRS is a multiple-state, population-based, active surveillance system that collects information on violent deaths including suicide. Among people 10years old and older, we identified 972 suicide cases with epilepsy and 81,529 suicide cases without epilepsy in 17 states from 2003 through 2011. We estimated their suicide rates, evaluated suicide risk among people with epilepsy, and investigated suicide risk factors specific to epilepsy by comparing those with and without epilepsy. In 16 of the 17 states providing continual data from 2005 through 2011, we also compared suicide trends in people with epilepsy (n=833) and without epilepsy (n=68,662). RESULTS From 2003 through 2011, the estimated annual suicide mortality rate among people with epilepsy was 16.89/100,000 per persons, 22% higher than that in the general population. Compared with those without epilepsy, those with epilepsy were more likely to have died from suicide in houses, apartments, or residential institutions (81% vs. 76%, respectively) and were twice as likely to poison themselves (38% vs. 17%) (P<0.01). More of those with epilepsy aged 40-49 died from suicide than comparably aged persons without epilepsy (29% vs. 22%) (P<0.01). The proportion of suicides among those with epilepsy increased steadily from 2005 through 2010, peaking significantly in 2010 before falling. SIGNIFICANCE For the first time, the suicide rate among people with epilepsy in a large U.S. general population was estimated, and the suicide risk exceeded that in the general population. Suicide prevention efforts should target people with epilepsy 40-49years old. Additional preventive efforts include reducing the availability or exposure to poisons, especially at home, and supporting other evidence-based programs to reduce mental illness comorbidity associated with suicide.

Seizures in children and adolescents Aged 6-17 years - United States, 2010-2014

A seizure is a brief change in normal electrical brain activity resulting in alterations in awareness, perception, behavior, or movement. Seizures affect persons of all ages, but are particularly common in childhood. There are many causes of seizures in children, including epilepsy; high fever (febrile seizures); head injuries; infections (e.g., malaria, meningitis, and gastrointestinal illness); metabolic, neurodevelopmental, and cardiovascular conditions; and complications associated with birth (1–3). Outcomes associated with single or recurring seizures in children vary by seizure type (febrile compared with nonfebrile) and multiple risk factors (age, illness, family history, and family context). Outcomes range from no complications to increased risk for behavioral problems, epilepsy, or sudden unexpected death (3–6). No nationally representative estimates have been reported for the number of U.S. children and adolescents with seizures, co-occurring conditions, or health service utilization. To address these information gaps, CDC analyzed combined data on children and adolescents aged 6–17 years from the National Health Interview Survey (NHIS) for the period 2010–2014. Overall, 0.7% of children and adolescents (weighted national estimate = 336,000) were reported to have had at least one seizure during the preceding year. Compared with children and adolescents without seizures, a higher percentage of those with seizures were socially and economically disadvantaged. Children and adolescents with seizures had higher prevalences of various mental, developmental, physical, and functional co-occurring conditions than those without seizures; however, only 65.6% of those with seizures had visited a medical specialist (defined as a medical doctor who specializes in a particular medical disease or problem, other than an obstetrician/gynecologist, psychiatrist, or ophthalmologist) during the preceding 12 months. Public health agencies can work with other health and human service agencies to raise awareness about childhood seizures, implement strategies to prevent known causes and risk factors for seizures, study the associations between sociodemographic characteristics and seizure incidence, and ensure linkages for children with seizures to appropriate clinical and community providers.... Language: en

Adults with an epilepsy history fare significantly worse on positive mental and physical health than adults with other common chronic conditions—Estimates from the 2010 National Health Interview Survey and Patient Reported Outcome Measurement System (PROMIS) Global Health Scale☆☆☆

Healthy People 2020, a national health promotion initiative, calls for increasing the proportion of U.S. adults who self-report good or better health. The Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Scale (GHS) was identified as a reliable and valid set of items of self-reported physical and mental health to monitor these two domains across the decade. The purpose of this study was to examine the percentage of adults with an epilepsy history who met the Healthy People 2020 target for self-reported good or better health and to compare these percentages to adults with history of other common chronic conditions. Using the 2010 National Health Interview Survey, we compared and estimated the age-standardized prevalence of reporting good or better physical and mental health among adults with five selected chronic conditions including epilepsy, diabetes, heart disease, cancer, and hypertension. We examined response patterns for physical and mental health scale among adults with these five conditions. The percentages of adults with epilepsy who reported good or better physical health (52%) or mental health (54%) were significantly below the Healthy People 2020 target estimate of 80% for both outcomes. Significantly smaller percentages of adults with an epilepsy history reported good or better physical health than adults with heart disease, cancer, or hypertension. Significantly smaller percentages of adults with an epilepsy history reported good or better mental health than adults with all other four conditions. Health and social service providers can implement and enhance existing evidence-based clinical interventions and public health programs and strategies shown to improve outcomes in epilepsy. These estimates can be used to assess improvements in the Healthy People 2020 Health-Related Quality of Life and Well-Being Objective throughout the decade.

Among adults with epilepsy reporting recent seizures, one of four on antiseizure medication and three of four not on medication had not seen a neurologist/epilepsy specialist within the last year, the 2010 and 2013 US National Health Interview Surveys

We combined 2010 and 2013 National Health Interview Survey (NHIS) data to examine the prevalence of seeing a neurologist/epilepsy specialist and/or a general doctor among US adults with active epilepsy who either took antiseizure medications or had at least one seizure in the past 12months. Among adults with recent seizures, about 76% of adults who did not take antiseizure medication (including 55% of those who saw only a general doctor and 21% of those who saw neither a specialist nor a general doctor) and 26% of those who took medication (including 23% of those who saw only a general doctor and 3% of those who saw neither a specialist nor a general doctor) had not seen a specialist within the past year-indicating gaps in quality care putting patients with uncontrolled seizures at risk of negative outcomes. The US Healthy People 2020 objectives call for increasing the proportion of people with epilepsy and uncontrolled seizures who receive appropriate medical care. Epilepsy stakeholders can work with community services/organizations to improve provider education about epilepsy, eliminate barriers to specialized care, and promote self-management support to reduce the burden of uncontrolled seizures in people with epilepsy.

More than 40% of those not taking antiseizure medication with recent seizures reported that epilepsy or its treatment interfered with their recent activities, 2010 and 2013 US National Health Interview Surveys ☆

From the combined 2010 and 2013 National Health Interview Surveys, we estimated US national age-standardized prevalence of adults with active epilepsy who reported that a nervous system/sensory organ condition caused a limitation (e.g., walking; memory; or physical, mental, or emotional problems) and, separately, that epilepsy interfered with their activities (e.g., working, schooling, or socializing) during the 30days preceding the survey. Sixty-one percent of adults who took antiseizure medication and had recent seizures and 51% of those who took medication and had no seizures reported having limitations caused by a nervous system/sensory organ condition. Sixty-two percent of adults who took antiseizure medication and had recent seizures and 20% of those who took medication and had no seizures reported that epilepsy or its treatment interfered with their recent activities. Forty-one percent of those who did not take medication and had recent seizures also reported that epilepsy interfered with their activities. To reduce activity limitations in people with epilepsy, health and social service providers can ensure that adequate policies and practices that promote access to high quality care and social participation are in effect in organizations and communities.