Browsing Theses and Dissertations School of Pharmacy by Subject "Mortality"
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Influence of Comorbid Depression on Mortality among SSDI-eligible Medicare Beneficiaries with Chronic Obstructive Pulmonary DiseaseBackground: Chronic obstructive pulmonary disease (COPD) is a condition with high mortality and morbidity. Comorbid depression can place COPD patients at increased risk of adverse outcomes. Although both COPD and depression are associated with significant morbidity, to date few studies addressing COPD-related outcomes have included individuals who receive Social Security Disability Insurance (SSDI). Objectives: To examine the influence of comorbid depression on mortality among a nationally-representative sample of Medicare beneficiaries suffering from COPD by SSDI-eligibility status. Methods: This retrospective cohort study used a 5% random sample of the 2006-2008 Chronic Condition Warehouse administrative data. The study cohort included 93,019 Medicare beneficiaries diagnosed with COPD who lived through 2006 and were continuously enrolled in Medicare Parts A, B, and D. Two-year (2007-2008) all-cause mortality was the study outcome. Comorbid depression was measured in 2006-2008. SSDI-eligibility was defined using the original reason for Medicare entitlement. Multivariable generalized estimating equations models estimated the association between SSDI-eligibility and depression, as well as the modification effect of SSDI-eligibility on their relationship. Survival analyses using extended Cox proportional hazards models further estimated risk of death from depression and antidepressant treatment among beneficiaries aged 65 and older (n=75,699) by SSDI-eligibility. Results: About two-fifths (39.4%) of beneficiaries with COPD had a depression diagnosis in 2006-2008; of those, 79.5% received antidepressant treatment. SSDI-eligibility was not only associated with a 12% (95%CI=10%,15%) higher likelihood of depression but also modified factors in regard to depression diagnosis and receipt of antidepressant treatment. COPD beneficiaries with a baseline depression diagnosis had a higher risk of death (HR=1.13; 95%CI=1.09, 1.18) in non-SSDI-eligible beneficiaries. Those who received antidepressant treatment had reduced risk of death, with greater benefits on mortality in SSDI-eligible than non-SSDI-eligible beneficiaries. Conclusions: This study provides the first evidence suggesting that SSDI-eligibility is not only associated with higher likelihood of having a depression diagnosis, but also is a significant effect modifier of the relationship between antidepressant treatment and mortality in Medicare beneficiaries with COPD. Findings demonstrate the benefits of antidepressant treatment on mortality in both SSDI-eligible and non-SSDI-eligible beneficiaries. In practice, clinicians should consider timely antidepressant treatment to improve outcomes for this population.
Management of Traumatic Brain Injury with Statins among Older Medicare BeneficiariesBackground: Traumatic brain injury (TBI) is a major health concern for older adults aged 65 and older. Older TBI patients are at increased risk of primary injury (in-hospital and all-cause mortality) and secondary injury (stroke, depression, and Alzheimer's disease and related dementias (ADRD)). There is limited research regarding optimal pharmacotherapeutic options and management of TBI patients; however, several studies have highlighted statins, used to treat hyperlipidemia, as potential pharmacologic agents to reduce inflammation and improve impaired cerebral blood flow associated with primary and secondary injury. The objectives of the study are to: 1) quantify statin utilization, and 2) determine the associations between statin use and primary and secondary injury among TBI patients. Methods: Statin use (atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin), primary injury, and secondary injury were examined among Medicare beneficiaries hospitalized with a TBI between 2006 and 2010. Logistic regression was used to investigate the relationship between pre-TBI statin use and in-hospital mortality, while discrete time analysis was used to investigate the relationship between statin use following TBI and all-cause mortality and secondary injury. Results: Among the 75,698 beneficiaries who met study criteria, 37,874 (50.0%) beneficiaries used a statin at least once during the study period. The most common statin used was simvastatin, followed by atorvastatin. Fluvastatin was the least used statin. Pre-TBI use of atorvastatin (odds ratio (OR) 0.88; 95% confidence interval (CI) 0.82, 0.96), simvastatin (OR 0.84; 95% CI 0.79, 0.91), and rosuvastatin (OR 0.79; 95% CI 0.67, 0.94) were associated with significant decreases in the risk of in-hospital mortality. Any statin use was associated with reduced all-cause mortality following TBI-hospitalization discharge. Atorvastatin and simvastatin use also were associated with reductions in all secondary injury outcomes. Conclusion: Tens of thousands of older adults are hospitalized annually with TBI and experience disabling primary and secondary injury; findings from these analyses have salient implications for reducing the risk of TBI complications among older adults. The evidence generated suggests that preemptive use of statins may decrease the risk of in-hospital and all-cause mortality, as well as reduce the likelihood of stroke, depression, and ADRD.