Comorbidities Of Interest Research Articles

Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review

In North America, the prevalence of nonmedical prescription opioid use (NMPOU), and morbidity and mortality related to prescription opioid analgesics (POAs) has risen sharply. Epidemiologic studies have suggested a high prevalence of mental health and pain comorbidities in NMPOU samples. Given the potential importance for interventions, a narrative review was conducted on studies reporting data on the co-occurrence of NMPOU with mental health problems and pain symptoms in general, treatment, or special populations. A search of MEDLINE, PubMed, PsycINFO, and Web of Science using defined search terms yielded 74 studies on NMPOU and mental health and (or) pain. Thirty-nine studies published between 1997 and 2009 were included in the review-based on the data they provided on NMPOU and mental health and pain comorbidities. Our review found strong associations between NMPOU and the comorbidities of interest. Associations between NMPOU and mental health were strongest for depression (OR range 1.2 to 4.3) followed by anxiety disorders (OR range 1.2 to 3.0) in general and treatment populations. The prevalence of pain ranged from 14.5% to 61.5% in general, treatment, and street drug user samples reporting NMPOU. The extensive associations observed between NMPOU and mental health and pain comorbidities suggest that effective preventive or treatment interventions for NMPOU must consider and attend to these comorbidities. As POAs are widely available and used in North America, POAs may increasingly be used in nonmedical ways for pain or mental health problems not effectively diagnosed or treated.

Validation of a Self-Report Comorbidity Questionnaire for Multiple Sclerosis

Background/Aims: Researchers increasingly recognize the high frequency of comorbidity in multiple sclerosis (MS) and the negative impact on quality of life and disability, but little work has evaluated methods of comorbidity measurement in MS. We aimed to validate a self-report questionnaire for assessing comorbidity in MS. Methods: Patients with MS were recruited from the MS Clinic in Winnipeg, Canada and the Mellen Center (Cleveland Clinic, Cleveland, Ohio, USA) from October 2008 to 2009. Using a questionnaire, participants reported the presence or absence of 36 comorbidities, sociodemographic characteristics, and disability status. ors blinded to questionnaire results collected data regarding the comorbidities of interest and their treatments. Using the medical record as the gold standard, we determined the sensitivity, specificity, positive and negative predictive values of the questionnaire data. To measure agreement we calculated kappa (ĸ) statistics. Results: We enrolled 404 participants. Agreement between self-report and medical records was high (ĸ >0.82) for diabetes and hypertension; substantial (ĸ = 0.62–0.80) for hyperlipidemia, thyroid disease, glaucoma, and lung disease; moderate (ĸ = 0.43–0.56) for osteoporosis, irritable bowel syndrome, migraine, depression, heart disease, and anxiety disorders. Agreement was slight to fair for the remaining comorbidities. Conclusions: Self-report is a valid way to capture comorbidities affecting MS patients.

Effects of Noncardiovascular Comorbidities on Antihypertensive Use in Elderly Hypertensives

Although the benefits of antihypertensive drugs have been clearly established, they remain underused by vulnerable older populations. We examined whether the presence of noncardiovascular comorbidity deters use of antihypertensives in elderly with hypertension. We conducted a retrospective cohort study among 51,517 patients > or =65 years of age in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) Program during 1999 and 2000. All were hypertensive and had diagnoses and used treatments during 1999 to qualify for entry into 1 of the following 5 mutually exclusive cohorts: asthma/chronic obstructive pulmonary disease (COPD), depression, gastrointestinal (GI) disorders, osteoarthritis, or none of the 4 comorbidities. Proportions using antihypertensives in 2000 were assessed. Logistic regression analysis was used to identify the independent effects on antihypertensive use of the 4 comorbidities of interest, sociodemographic characteristics, other cardiovascular and noncardiovascular comorbidity, and health care utilization variables. After adjustments in multivariable analyses, antihypertensive use was consistently lower in patients with asthma/COPD (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.40 to 0.47), depression (OR, 0.50; 95% CI, 0.45 to 0.55), GI disorders (OR, 0.59; 95% CI, 0.54 to 0.64), and osteoarthritis (OR, 0.63; 95% CI, 0.59 to 0.67) relative to those without these conditions. Reduced antihypertensive use was also associated with older age, female gender, white race, more severe other comorbidities, absence of some cardiovascular indications, hospitalizations, nursing home care, physician visits, and use of fewer other medications. Highly prevalent, noncardiovascular conditions appear to deter use of antihypertensives in elderly with hypertension.