Association of cardiometabolic multimorbidity pattern with dietary factors among adults in South Korea

Backgrounds Globally, cardiometabolic multimorbidity pattern (CMP) is a complexed chronic health status which shorter the life expectancy compared with single disease in adults. We aimed to identify multimorbidity patterns in Korean adults to clarify the associations between dietary factors and CMP. Methods Nationally representative data for 9,011 Korean adults aged 19-64 years are obtained from the Korean National Health and Nutrition Examination Survey (KNHANES) from 2013-2015. Multimorbidity patterns for CMP, inflammatory disease, cancer and other disease pattern were identified by exploratory factor analysis. Dietary factors including food, nutrient intake and diet habits were evaluated. Multivariable-adjusted logistic regression models examined the associations between dietary factors and CMP. Results More than half of the multimorbidity pattern was CMP (n=4,907, 54.5%); CMP subjects were more likely to be older, male, less educated, lower income, laborers, smokers, and high-risk consumers of alcohol than those of non-CMP subjects. A higher intake of calcium (OR= 0.809, 95% CI= 0.691-0.945), potassium (OR= 0.838, 95% CI= 0.704-0.998), and fruits (OR= 0.841, 95% CI= 0.736-0.960) were inversely associated with the prevalence of CMP while the consumption of irregular meals (OR=1.164, 95% CI= 1.034-1.312) and skipping breakfast (OR=1.279, 95% CI= 1.078-1.518) were associated with a 16% and 28% higher likelihood of CMP, respectively. Conclusions CMP accounts for more than half of the multimorbidity patterns in Korean population, and lower intake of calcium, potassium, fruits, and skipping meals might have strong associations with CMP.

What determines diagnostic resource consumption in emergency medicine: patients, physicians or context?

ObjectivesA major cause for concern about increasing ED visits is that ED care is expensive. Recent research suggests that ED resource consumption is affected by patients’ health status, varies between physicians and is context dependent. The aim of this study is to determine the relative proportion of characteristics of the patient, the physician and the context that contribute to ED resource consumption.MethodsData on patients, physicians and the context were obtained in a prospective observational cohort study of patients hospitalised to an internal medicine ward through the ED of the University Hospital Bern, Switzerland, between August and December 2015. Diagnostic resource consumption in the ED was modelled through a multilevel mixed effects linear regression.ResultsIn total, 473 eligible patients seen by one of 38 physicians were included in the study. Diagnostic resource consumption heavily depends on physicians’ ratings of case difficulty (p<0.001, z-standardised regression coefficient: 147.5, 95% CI 87.3 to 207.7) and—less surprising—on patients’ acuity (p<0.001, 126.0, 95% CI 65.5 to 186.6). Neither the physician per se, nor their experience, the patients’ chronic health status or the context seems to have a measurable impact (all p>0.05).ConclusionsDiagnostic resource consumption in the ED is heavily affected by physicians’ situational confidence. Whether we should aim at altering physician confidence ultimately depends on its calibration with accuracy.

Experiencing Financial Hardship Associated With Medical Bills and Its Effects on Health Care Behavior: A 2-Year Panel Study

Using 2-year panel data, this study examined (1) whether experiencing financial hardship associated with out-of-pocket medical expenditures affected delaying/missing necessary health care in the following year; (2) whether such financial hardship mediated the effects of predisposing, enabling, and need characteristics on timely health care access (i.e., significant indirect effects); and (3)whether such mediating effects are different by chronic health status (i.e., moderated mediation) among U.S. adults. The 2011 National Health Interview Survey was linked to the 2012 Medical Expenditure Panel Survey. The sample includes 8,993 adults aged between 26 and 64 years. Among them, 1,089 reported having at least one chronic health condition that had caused activity limitations. Multiple-group path analysis was conducted using Mplus 7.2. Approximately 35% experienced financial difficulties paying medical bills, including 28% who were currently paying off medical debts. Almost 14% of the respondents reported delayed/missed necessary medical treatments. In addition to direct effects, predisposing, enabling, and need factors affected access to care indirectly via financial hardship, although significant moderated mediation was found by chronic health status. However, different from the Andersen’s behavioral model of health service utilization, the effect of financial hardship due to medical bills as a barrier to the timely use of necessary health services was not smaller among adults with chronic health conditions. Policy alternatives should be explored to provide affordable financing programs and adequate safety net health services to reduce the financial burden of health care for those who are financially vulnerable, especially those suffering from chronic health conditions.

Admission Red Cell Distribution Width: A Novel Predictor of Massive Transfusion after Injury

Admission red cell distribution width (aRDW) has been shown to predict mortality in trauma patients by an unclear mechanism. It has been speculated that aRDW is a marker of chronic health status, but elevated RDW may also reflect recent hemorrhage. We hypothesized that aRDW is a predictor of major hemorrhage in trauma patients. Shock trauma patients at a Level I trauma center over 6.5 years were evaluated. Patients were stratified by aRDW quintile (Q1: less than 13%, Q2: 13.1 to 13.5%, Q3: 13.6 to 14.0%, Q4: 14.1 to 14.9%, Q5: 15.0% or greater). Massive transfusion (MT) was defined as 10 or more packed red blood cells in the first 24 hours. From multiple logistic regression, odds ratios with 95 per cent confidence intervals (CIs) were determined to evaluate the association between aRDW quintile and MT. Three thousand nine hundred ninety-four met study criteria. Overall MT incidence was 10 per cent and in-hospital mortality was 17 per cent. MT and mortality increased in a stepwise fashion by aRDW quintile ( P < 0.0001). From logistic regression, a threefold increased odds of MT was associated with aRDW Q4 (CI, 1.81 to 4.92), and a 3.5-fold increased odds of MT was associated with aRDW Q5 (CI, 2.70 to 5.83). aRDW independently predicted MT, suggesting that elevated aRDW is an indicator of major hemorrhage in trauma patients. The association between aRDW and mortality in trauma patients may be explained by acute hemorrhage rather than chronic health status.