Prescription Medication Usage Research Articles

VISUALIZING HETEROGENEOUS TRAJECTORIES OF SUBJECTS WITH SURGICAL RELAPSE IN INFLAMMATORY BOWEL DISEASE FROM UK BIOBANK GENERAL PRACTICE DATA

Abstract BACKGROUND AND AIMS The United Kingdom (UK) Biobank (UKBB) is a large-scale biomedical database and research resource, containing in-depth health information from half a million participants in UK that have been used for detailed analyses of IBD. Using the UKBB, we examined the lab findings and prescription medication use in IBD subjects to identify trajectory patterns of disease with respect to surgical relapse. METHODS Of the 363 subjects in the UKBB with an established IBD diagnosis (UC, CD, or both) and an initial GI surgery, 116 had a subsequent surgery within 5 years of initial surgery and had follow up lab values of urine and serum creatinine, plasma and serum C-reactive protein, urine and serum albumin, urine albumin-creatinine ratio, total white blood count, urine microalbumin, total white cell count, hemoglobin estimation, and erythrocyte sedimentation rate. Additionally, data for the 9 most used IBD prescription medications: budesonide, sulfasalazine, methotrexate, hydrocortisone, balsalazide, olsalazine, prednisolone, azathioprine, and mesalamine was analyzed as well. Hidden Markov Models (HMM) using these variables and open-source packages were incorporated to label observations of each subject-visit until the subsequent surgery. Interactive visualizations using DPVis open-source package were then applied to identify individual trajectories and explore clinical characteristics. RESULTS Five hidden states were observed from HMM. The five states observed are based on differing prescription medication usage for the treatment of IBD and were assigned a color to allow for comparison (Figure 1). The majority of patients fell within the states labeled “blue” (azathioprine, sulfasalazine, and prednisone) “red” (mesalamine only) or “purple” (azathioprine, balsalazide, and prednisolone). The visualizer showed that while some transitions among states were observed, most patients fell into one of three major trajectory patterns as a factor of time to surgical relapse and were largely segregated by state. Based on the trajectories, a comparison of subjects with prescription of mesalamine-only vs. any immunosuppressive medications (azathioprine + sulfasalazine + balsalazide) in combination with prednisolone showed a significant difference in time to surgical relapse (P < 0.005) (Figure 2), with a shorter time to surgical relapse identified in patients who took mesalamine only. CONCLUSIONS We identified three distinct trajectories leading up to surgical relapse. These trajectories show distinctive medication prescription patterns (5-ASA vs. Azathioprine with steroid use), as well as significantly different times to surgical relapse. Furthermore, heterogeneity is shown within each trajectory pattern in terms of progression time and warrant further investigation. Figure 1 Three Trajectories of time to surgical relapse generated from 5-State HMM using lab values and prescription medications. Note that a patient can traverse multiple states so the summation of the observed subjects of those states exceeds the cohort size (N=116). Figure 2 Kaplan-Meier curves for the UC/CD subgroup with surgical relapse considering events from the first documented lab values and/or planned prescription at most 2 years prior to the baseline surgery up to the subsequent 5 years.

Evaluating symptom severity and urinary cytokine levels in interstitial cystitis/bladder pain syndrome patients, with and without Hunner's lesions.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a condition characterized in part by urinary urgency, frequency, and pain. There is a strong interest in gathering more data to compare and assess the differences in characteristics based on the presence of Hunner's lesions in patients with IC/BPS. Using a nationwide crowdsource effort, we collected surveys and urine samples from patients with a history of IC/BPS. Participants completed the Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI), Overactive Bladder questionnaire (OABq SF), and pain scores. In addition, participants reported any co-morbidities and lifestyle modifications. Urinary cytokine levels were measured and compared to symptom severity. 491 participants enrolled: 119 with history of ulcerative Hunner's lesions (UIC), 372 reported no lesions (NHIC), and 2 unknowns. 96.3% were female, and prevalence of UIC was equal for both genders. Average age was higher for UIC vs. NHIC group (P = 0.011), as was the duration since diagnosis (P < 0.001). Symptom scores were elevated in UIC patients (P < 0.001). Both groups widely implemented lifestyle modifications, with dietary changes being most prevalent (70.1%), followed by prescription medication usage (63.1%). More UIC compared to NHIC participants experienced co-morbidities (P = 0.010). Urine samples were analyzed for GRO, IL-6, IL-8, and MCP-1. MCP-1 levels were significantly higher in UIC patients (P = 0.044). Weak positive correlation was found between cytokines and symptom scores. Patients with UIC and NHIC from across the United States displayed distinct phenotypic and urine biological characteristics. These findings contribute to increased understanding of IC/BPS and may aid in improving our knowledge of the condition.

Sedentary Time and Prescription Medication Use Among US Adults: 2017-2018 National Health and Nutrition Examination Survey.

Prescription medication usage has been used as a predictor of disease prevalence and overall health status. Evidence suggests an inverse relationship exists between polypharmacy, which is the use of 5 or more medications, and physical activity participation. However, there is limited evidence examining the relationship between sedentary time and polypharmacy in adults. The aim of this study was to examine the associations between sedentary time and polypharmacy in a large nationally representative sample of US adults. Study sample (N = 2879) included nonpregnant adult (≥20y old) participants from the 2017-2018 National Health and Nutrition Examination Survey. Self-reported minutes per day of sedentary time were converted to hours per day. The dependent variable was polypharmacy (≥5 medications). Analysis revealed that for every hour of sedentary time, there was 4% greater odds of polypharmacy (odds ratio, 1.04; 95% confidence interval, 1.00-1.07, P = .04) after adjusting for age, race/ethnicity, education, waist circumference, and the interaction term between race/ethnicity and education. Our findings suggest increased sedentary time is associated with an increased risk of polypharmacy among a large nationally representative sample of US adults.

Childhood abuse and opioid prescription use in adulthood: Differences between non-Hispanic Whites and non-Hispanic Blacks in the United States.

Despite the rapid rise in opioid prescription medication usage, little research has examined the role of early life adversity, such as childhood abuse, particularly in the context of race, in opioid prescription usage in adulthood. Guided by the life course perspective, the current study investigates whether experiencing childhood abuse increases the risk of opioid prescription use in adulthood and whether this association varies by race. Data were sourced from the second wave of the Midlife in the United States (MIDUS) study (2004-2005). The analytic sample consisted of two groups: non-Hispanic Whites (n = 714) and non-Hispanic Blacks (n = 151). Opioid prescription use was identified from the participants' medication list using the MULTUM Lexicon Drug Database Classification System. Three types of childhood abuse-emotional, physical, and sexual-were assessed via summary scales derived from the Childhood Trauma Questionnaire. The results indicate a significant interaction between childhood physical abuse and race. Among non-Hispanic Whites, higher exposure to physical abuse during childhood was associated with greater odds of opioid prescription use in adulthood, even after adjusting for chronic pain, physical and mental health, and sociodemographic characteristics. However, the association between childhood physical abuse and opioid prescription use in adulthood was non-significant among non-Hispanic Black individuals. These findings underscore the long-term adverse health effects of physical abuse in childhood, particularly for non-Hispanic Whites, and suggest support for developing and implementing tailored intervention strategies.

Citizenship status and cost-related nonadherence in the United States, 2017-2021.

To assess inequities in prescription medication use and subsequent cost-related nonadherence (CRN) and cost-saving strategies by citizenship status in the United States. National Health Interview Survey (2017-2021). This cross-sectional study examined noncitizen (n = 8596), naturalized citizen (n = 12,800), and US-born citizen (n = 120,195) adults. We also examined older adults (≥65 years) separately, including noncitizens without Medicare (a group of importance given their immigration-related barriers to health care access). Multiple mediation analysis was used to examine differences in CRN and determine whether economic, health care, and immigration factors explain observed inequities. Noncitizens (41.9%) were less likely to use prescription medications than naturalized (60.5%) and US-born citizens (68.2%). Among prescription medication users, noncitizens (13.8%) were more likely to report CRN than naturalized (9.5%) and US-born citizens (11.0%). CRN differences between noncitizens and naturalized citizens (OR 1.38, 95% CI 1.21-1.44) and between noncitizens and US-born citizens (OR 1.23, 95% CI 1.07-1.35) were explained by insurance status and food insecurity. Only 4.9% of medication users turned to alternative therapies to lower their drug costs, but there were no substantial differences across citizenship status. More medication users requested lower-cost prescriptions (19.0%); however, noncitizens were less likely to make these requests. Older noncitizens without Medicare, of whom 23.9% requested lower-cost drugs, were an exception. Noncitizens (5.8%), particularly older noncitizens without Medicare (21.8%), were more likely to import their drugs than naturalized (3.5%) and US-born citizens (1.2%). Noncitizens experience a high burden of cost-related barriers to prescription medications. Efforts to reduce these inequities should focus on dismantling health care and food access barriers, regardless of citizenship status.

Assessment of psychotropic medications prescribing pattern in Gebretsadik Shawo General Hospital, South West Ethiopia.

due to the widespread prescription of antipsychotic medications, their usage is cumulative. Evidence on the trends of medication use in Ethiopia and other parts of the world is lacking. The scant information on prescription trends and medication usage suggests that drug use is generally not sensible in both industrialized and emerging nations. So, the aim of this study was to assess the psychotropic medications prescribing pattern in Gebretsadik Shawo General Hospital, South West Ethiopia. from June 1st to July 31st, 2019, a cross-sectional study on prescriptions for psychiatric drugs was conducted at Gebretsadik Shawo General Hospital. Using systematic random sampling, prescription records were obtained from the pharmacy dispensing book. Version 21 of the statistical program for social science was used to code and analyze the data. the study included 355 prescription records containing psychotropic drugs in total. The bulk of those taking the psychotropic medication were aged 20 to 49. The most often administered classes of drugs remained antipsychotic, followed by tricyclic antidepressants, antiepileptics, anxiolytics/sedatives, anticholinergic and selective serotonin reuptake inhibitors. The most often ordered antipsychotic medication, which included 102 (23.18%) medications, was chlorpromazine. Tricyclic antidepressants, which included 56 medicines (12.73%) and 24 medications (5.45%), included amitriptyline and imipramine. the results of this investigation showed that psychiatrists preferred traditional psychotropic medications, such as Antipsychotic tricyclic, antidepressants (TCAs) and phenothiazines, in high amounts possibly because these medications were readily available in this hospital and their prices suited patients' needs. Health care workers' interdisciplinary relationships and coherence would improve for the benefit of patients and services of higher quality.

Preventive Medication Use among Adults Aged 40 and over in the United States: National Health and Nutrition Examination Survey, 2015-2018.

Objectives: 1. To estimate the prevalence of preventive medication use among adults in the United States (US); 2. To identify the socioeconomic, demographic and clinical factors associated with preventive prescription medication use; 3. To identify the diagnoses associated with preventive prescription medication use. Methods: Data from two cycles of the National Health and Nutrition Examination Survey, 2015–2016 and 2017–2018, are analyzed. Results: Among US adults aged 40 years or older (N = 7634), 31% use a preventive medication. Specifically, 27% of them use aspirin and 9% use other preventive prescription medications. Among those who use other preventive prescription medications, 27% report using one of the cardiovascular agents and 24% reported using anticoagulants and/or antiplatelet agents. High percentages of preventive prescription medication users report using medications to prevent heart attacks/myocardial infarctions (25%) or blood clots (23%). Uninsured adults are less likely to use preventive medications (OR: 0.656; p-value = 0.009) as compared with their counterparts with private insurance. On the other hand, older adults and those with diabetes, heart disease, arthritis and hypertension are more likely to use preventive medications. Furthermore, past smokers and adults who never smoked are more likely to use preventive medications as compared with those who currently smoke. Conclusion: Policies are needed to increase access to preventive care for uninsured adults. Further research needs to review the benefits and harms of the chronic use of preventive medication among older adults in the US.

Sedentary Time And Prescription Medication Use In United States Adults: 2017-2018 NHANES

Prescription medication usage has been used as a predictor of disease prevalence and overall health status. Evidence suggests a deleterious relationship exists between increased medication usage and physical activity participation. However, there is limited evidence examining the relationship between sedentary time and increased prescription medication usage in adults. PURPOSE: Examine the associations between sedentary time and increased prescription medication usage in a large nationally representative sample of U.S. adults. METHODS: Study sample (n=3,063) included non-pregnant adult (≥ 20 years old) participants in the 2017-2018 National Health and Nutrition Examination Survey. Self-reported minutes per day of sedentary time were converted to hours per day of sedentary time. The dependent variable was increased medication usage (≥ 5 medications). Logistic regression analysis was adjusted for age, race, and education level. RESULTS: Analysis revealed that for every hour of sedentary time, there was a 5% greater odds of increased medication usage (Odds Ratio 1.05; 95% Confidence Interval 1.01-1.08, P-value=0.0144). A significant positive dose-response relationship was seen between sedentary time and prescription medication use (P for trend <0.0001). CONCLUSIONS: Our findings suggest increased sedentary time is associated with increased prescription medication usage among a large nationally representative sample of U.S. adults.

Depression/anxiety symptoms and self-reported difficulty managing medication regimen among community-dwelling older adults

ObjectiveTo examine the associations between depression/anxiety severity and changes in severity and self-reported difficulty managing medications among a representative sample of community-residing US Medicare beneficiaries without a reported dementia diagnosis. MethodWe used the 2018 and 2019 National Health and Aging Trend Study (analysis sample N = 3198, 98% age 70+). Depression/anxiety was measured with the PHQ-4, and difficulty managing medication was self-reported. Following descriptive statistics, we fit a multinomial logistic regression model to examine the associations between depression/anxiety symptoms in 2018 and changes in severity between 2018 and 2019 and self-reported level of difficulty managing medication in 2019. ResultsOf past-month prescription medication users in 2019, 85.2%, 10.7%, and 4.1% reported no difficulty, a little/some difficulty, and a lot of difficulty or partial/full reliance on other's help for health/functioning reasons, respectively. Both mild and moderate/severe levels of depression/anxiety in 2018 were associated with significantly higher risks of a little/some difficulty and a lot of difficulty/other's help in 2019. Compared to no change in depression/anxiety symptoms between 2018 and 2019, decreased symptoms were associated with lower risk (RRR = 0.47, 95% CI = 0.28–0.78) and increased symptoms were associated with higher risk (RRR = 1.73, 95% CI = 1.12–2.67) of a little/some difficulty managing one's medication. ConclusionsDecrease and increase in depression/anxiety are associated with decreased and increased risk, respectively, of medication self-management difficulty among community-residing older adults. Healthcare providers should more carefully assess for medication management problems in their older adults with depression and anxiety symptoms and provide individually tailored interventions for those with great difficulty self-managing medication.

Hospital Length of Stay in Patients with and without Serious and Persistent Mental Illness: Evidence of Racial and Ethnic Differences.

Background: Prior studies have documented racial and ethnic differences in mental healthcare utilization, and extensively in outpatient treatment and prescription medication usage for mental health disorders. However, limited studies have investigated racial and ethnic differences in length of inpatient stay (LOS) in patients with and without Serious and Persistent Mental Illness. Understanding racial and ethnic differences in LOS is necessary given that longer stays in hospital are associated with adverse health outcomes, which in turn contribute to health inequities. Objective: To examine racial and ethnic differences in length of stay among patients with and without serious and persistent mental illness (SPMI) and how these differences vary in two age cohorts: patients aged 18 to 64 and patients aged 65+. Methods: This study employed a retrospective cohort design to address the research objective, using the 2018 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample. After merging the 2018 National Inpatient Sample’s Core and Hospital files, Generalized Linear Model (GLM), adjusting for covariates, was applied to examine associations between race and ethnicity, and length of stay for patients with and without SPMI. Results: Overall, patients from racialized groups were likely to stay longer than White patients regardless of severe mental health status. Of all races and ethnicities examined, Asian patients had the most extended stays in both age cohorts: 8.69 days for patients with SPMI and 5.73 days for patients without SPMI in patients aged 18 to 64 years and 8.89 days for patients with SPMI and 6.05 days for patients without SPMI in the 65+ cohort. For individuals aged 18 to 64, differences in length of stay were significantly pronounced in Asian patients (1.6 days), Black patients (0.27 days), and Native American patients/patients from other races (0.76 days) if they had SPMI. For individuals aged 65 and older, Asian patients (1.09 days) and Native American patients/patients from other races (0.45 days) had longer inpatient stays if they had SPMI. Conclusion: Racial and ethnic differences in inpatient length of stay were most pronounced in Asian patients with and without SPMI. Further studies are needed to understand the mechanism(s) for these differences.

Polypharmacy and premature aromatase inhibitor (AI) discontinuation in older women with breast cancer.

6568 Background: Treatment with AI therapy for at least five years is recommended to reduce risk of cancer recurrence in postmenopausal women with hormone-positive breast cancer, but up to 50% prematurely discontinue their AI. Prior studies have demonstrated higher rates of nonadherence in older patients. Higher rates of comorbidities are also present in older patients, many of which require treatment with prescription medications. However, in prior studies, the impact of polypharmacy on AI persistence in older women has been variable. We evaluated the relationship between use of prescription and over-the-counter (OTC) medications and AI discontinuation in older women in a randomized controlled trial of AI therapy. Methods: In the Exemestane and Letrozole Pharmacogenetics (ELPh) trial, postmenopausal women with stage 0-III hormone-positive breast cancer were randomized to receive exemestane or letrozole and followed for two years. Prescription medication and OTC supplement usage was prospectively collected. Only enrolled participants at least 65 years of age were included in this analysis. Univariate and multivariable Cox proportional hazards models evaluated the association between baseline prescription medications, OTC medications, initial assigned AI medication, and time to discontinuation of initial AI. Results: 131 women at least 65 years old with baseline medication and OTC supplement information were identified. The average age was 70.4 (SD 5). 58 participants (44%) were randomized to exemestane and 73 (56%) to letrozole. 21% had previously received tamoxifen and 18% received taxane-based chemotherapy. The average number of prescription medications at AI initiation was 4.95, and 127 patients reported taking at least one. The average number of OTC medications was 3.23, and 107 patients reported taking at least one. There was no difference in number of prescription medications or OTC medications by study arm. As previously reported, exemestane was associated with premature discontinuation (HR 1.92 [95%CI 1.06-3.50], p = 0.032). Controlling for AI, the risk of discontinuation decreased by 12% for every additional prescription medication (HR 0.88 [95%CI 0.78-0.99], p = 0.038). OTC medication use was not significantly associated with AI duration. Conclusions: Increased prescription medication usage at AI initiation was associated with decreased risk of premature discontinuation of AI. Further research is needed to evaluate this interaction and identify characteristics that impact AI persistence in older women with breast cancer. Clinical trial information: NCT00228956.

Polypharmacy, Potentially Inappropriate Medications, and Drug-Drug Interactions in Vulnerable Older Adults With Advanced Cancer Initiating Cancer Treatment.

PurposePolypharmacy is prevalent in older adults starting cancer treatment and associated with potentially inappropriate medications (PIM), potential drug-drug interactions (DDI), and drug-cancer treatment interactions (DCI). For a large cohort of vulnerable older adults with advanced cancer starting treatment, we describe patterns of prescription and nonprescription medication usage, the prevalence of PIM, and the prevalence, severity, and type of DDI/DCI.MethodsThis secondary analysis used baseline data from a randomized study enrolling patients aged ≥70 years with advanced cancer starting a new systemic cancer treatment (University of Rochester Cancer Center [URCC] 13059; PI: Mohile). PIM were categorized using 2019 Beers criteria and Screening Tool of Older Persons’ Prescriptions. Potential DDI/DCI were evaluated using Lexi-Interact Online. Medication classification followed the World Health Organization Anatomical Therapeutic Chemical system. Bivariate associations were evaluated between sociodemographic and geriatric assessment (GA) measures and medication measures. Chord diagrams and network analysis were used to understand and describe DDI/DCI.ResultsAmong 718 patients (mean age 77.6 years), polypharmacy (≥5 medications), excessive polypharmacy (≥10 medications), and ≥1 PIM were identified in 61.3%,14.5%, and 67.1%, respectively. Cardiovascular medications were the most prevalent (47%), and nonprescription medications accounted for 26% of total medications and 40% of PIM. One-quarter of patients had ≥1 potential major DDI not involving cancer treatment, and 5.4% had ≥1 potential major DCI. Each additional medication increased the odds of a potential major DDI and DCI by 39% and 12%, respectively. Polypharmacy and PIM are associated with multiple GA domains.ConclusionIn a cohort of vulnerable older adults with advanced cancer starting treatment, polypharmacy, PIM, and potential DDI/DCI are very common. Nonprescription medications are frequently PIMs and/or involved in potential DDI/DCI.

The relationship between health behaviors and emergency department visits and hospitalizations after traumatic spinal cord injury.

Cross-sectional study. To identify demographic, injury, and behavioral predictors of emergency department (ED) visits and ED-related hospitalizations among individuals with chronic traumatic spinal cord injury (SCI). An academic medical center in the Southeastern United States. 4057 participants who were at least 18 years of age and 1 year post traumatic SCI with residual neurologic impairment were identified from three cohorts: a rehabilitation specialty hospital in the Southeastern USA and two SCI Surveillance System Registries, one in the Midwestern and one in the Southeastern USA. The participants completed a self-reported assessment on ED visits and ED hospitalizations (yes/no) in the past 12 months. Logistic regression models were used to examine the relationship between ED visits/hospitalizations and eight behavioral indicators, including body weight, healthy diet, drinking, smoking, non-medical substance usage, prescription medication usage, prescription medication misuse, and the planned exercise. During the study period, 41% of participants reported having at least one ED visit and 21% participants reported hospitalization after ED visit in the past 12 months. High frequency of prescription medication usage, prescription medication misuse, and lack of planned exercise were associated with greater odds of at least one ED visit and at least one ED-related hospitalization, while smoking was only associated with ED visits. Health care professionals should be aware that ED visit and related hospitalization prevalence remain high among people with chronic SCI, and there is significant need for intervention of managing risk behaviors and promoting healthy behaviors after SCI.

Burden of chronic low back pain: Association with pain severity and prescription medication use in five large European countries.

ObjectiveThis study assessed associations between severity of, and prescription medication use for, chronic low back pain (CLBP) and health‐related quality of life, health status, work productivity, and healthcare resource utilization.MethodsThis cross‐sectional study utilized SF‐12, EQ‐5D‐5L, and work productivity and activity impairment (WPAI) questionnaires, and visits to healthcare providers among adults with self‐reported CLBP participating in the National Health and Wellness Survey in Germany, France, UK, Italy, and Spain. Respondents were stratified into four groups according to pain severity (mild or moderate/severe) and prescription medication use (Rx‐treated or Rx‐untreated). Differences between groups were estimated using generalized linear models controlling for sociodemographics and health characteristics.ResultsOf 2086 respondents with CLBP, 683 had mild pain (276 Rx‐untreated, 407 Rx‐treated) and 1403 had moderate/severe pain (781 Rx‐untreated, 622 Rx‐treated). Respondents with moderate/severe pain had significantly worse health‐related quality of life (SF‐12v2 physical component summary), health status (EQ‐5D‐5L), and both absenteeism and presenteeism compared with those with mild pain, including Rx‐untreated (moderate/severe pain Rx‐untreated vs. mild pain Rx‐untreated, p ≤ 0.05) and Rx‐treated (moderate/severe pain Rx‐treated vs. mild pain Rx‐treated, p ≤ 0.05) groups. Significantly more visits to healthcare providers in the last 6 months were reported for moderate/severe pain compared with mild pain for Rx‐treated (least squares mean 13.01 vs. 10.93, p = 0.012) but not Rx‐untreated (8.72 vs. 7.61, p = 0.072) groups. Health‐related quality of life (SF‐12v2 physical component summary) and health status (EQ‐5D‐5L), as well as absenteeism and presenteeism, were significantly worse, and healthcare utilization was significantly higher, in the moderate/severe pain Rx‐treated group compared with all other groups (all p ≤ 0.05).ConclusionGreater severity of CLBP was associated with worse health‐related quality of life, health status, and absenteeism and presenteeism, irrespective of prescription medication use. Greater severity of CLBP was associated with increased healthcare utilization in prescription medication users.

PND115 TREATMENT PATTERNS AND HEALTH CARE EXPENDITURES IN PATIENTS WITH CLUSTER HEADACHE: RESULTS FROM CHINA HEALTH INSURANCE RESEARCH ASSOCIATION (CHIRA) DATABASE

To understand the treatment patterns and health care expenditures among patients with cluster headache (CH) in China. We retrospectively analyzed data from China Health Insurance Research Association (CHIRA) database, which was collected from 87 sampling cities and over 19 million insured patients in the calendar year of 2016 and 2017. Patients aged≥ 18 years old, having at least one CH diagnosis (ICD-10 code G44.0 supplemented by physician’s Chinese characters description), without cancer, schizophrenia, stroke, and hemodialysis or peritoneal dialysis were included for analysis. Descriptive analyses were performed to evaluate demographics, comorbidities, prescription medication usage and direct medical cost per visit in patients with CH. Of 90,948 people with outpatient claims for headache, 79 (0.087%) patients with 90 visits had CH diagnosis. The mean (SD) age was 50.1 (14.4) years old and 43.0% were female. The most common comorbidities were anxiety (6.3%) and major depressive disorder (2.5%). Hospital visits were more frequent in autumn and winter with the top two most frequently-visited months being September (14.4%) and January (12.2%). The majority (54.6%) of patients’ initial visits were from tertiary-level hospitals. Among CH patients, 30 (38.0%) patients had at least one prescription for acute treatments. Of the patients with any acute medication, the most common prescriptions are No patients were prescribed with oxygen. Only 10.1% of patients received preventive medications, with verapamil or prednisolone prescribed in 3 patients. Traditional Chinese medications were prescribed in 58.9% visits. The average cost per visit was USD 44.1±55.3 (median=27.4). The proportion of CH in headache patients is extremely low. CH is likely to be undertreated in China, both in acute and preventive aspects. Given the burden of the disease, improving availability of effective therapies might be in urgent need.

The Carrot Battle: An Acupuncture Wonder

Chronic pain is among the most common reasons for seeking medical attention. In the United States, 1 in 5 adults had chronic pain in 2016 and it is estimated to cost over $500 billion annually in direct medical costs and disability. It is a prevalent problem among residents in the nursing home. Non-pharmacologic therapies are the most preferred treatment for chronic pain as pharmacological therapies, such as opioids, have proven to be less effective and associated with numerous side effects among older adults. Battlefield acupuncture (BFA) is an emerging non-pharmacological method that is safe and effective in treating chronic pain. BFA also has the potential to treat complications of chronic pain, such as poor hygiene and infection. This method stems from ancient Chinese medicine and is an integrative pain treatment option to decrease prescription medication usage.

Immigrant Usage Patterns of Natural Health Products: Role in Pharmacoeconomics

Background: Understanding patterns and drivers for natural health product (NHP) usage among immigrants is essential in the provision of appropriate health care; many studies have elucidated NHP utilization among immigrants; however, few have considered impacts of concurrent NHP and prescription medication usage. Objective: The study aims to determine new immigrant NHP usage patterns (including concurrent usage with prescription medications) and to discern economic impacts driving concurrent usage. Methods: A survey questionnaire was administered to local new immigrants during English Language Training classes. Results: Most participants understood the NHP definition and would take an NHP for the same disease or condition they would normally take a prescription medication for. Many participants agreed that NHPs are not safe however were unable to provide robust examples of unsafe NHP usage. With regard to purchases of medicines for short and long term illnesses, a high percentage of participants would purchase the prescription medication for a short term illness over the NHP; however this percentage decreases in the event of a long term illness, with more participants relying on NHPs to remedy their long term illness symptoms. Conclusion: Pharmacoeconomics tends to be a major driver for immigrant utilization of NHPs, and is a stronger influencer of use compared to ethnicity or parenteral usage of such products. This pharmacoeconomic correlation in the preference to use NHPs over prescription medications tends to be more observable for chronic and long term conditions (compared to short term illnesses).

Bone Health and BMD Research in Pediatric and Adolescent Individuals with ASD: Current Data, Evaluation, and Next Steps

Austin spectrum disorder (ASD) is a complex neurodevelopmental disorder that can include impairments in communication skills and social interaction as well as behavioral challenges. Recent research has evaluated bone health and bone mineral density (BMD) in cohorts of pediatric, adolescent, and young adult participants. Consistent findings across publications indicate that individuals with ASD have decreased BMD when compared to non-ASD age-matched peers. Factors raised in the literature for consideration of impact on BMD status include dietary intake, feeding behavior, nutrient status, gastrointestinal (GI) symptoms and diagnoses, physical activity, and prescription medication usage. This review aims to provide a comprehensive overview of published research evaluating BMD in those with ASD, analyze potential issues of correlation with lowered BMD in this population, offer perspective for future research consideration, and propose evaluation and intervention strategies to address and potentially ameliorate both the short-term and long-term impact of decreased BMD in children and adolescents.

Blood Lead Concentration and Prescription Medication Use Among US Children and Adolescents

TPS 636: Metals and health 2, Johan Friso Foyer, Floor 1, August 28, 2019, 3:00 PM - 4:30 PM Background: Lead is a toxicant to many organ systems, and it is especially harmful to children during developmental stages. Prescription medication use prevalence in children and adolescent indicates shifting disease burdens, as well as over-prescription of inappropriate or ineffective treatments. There may be relationships between environmental pollutants and prescription medication but it has not been explored. Methods: We used serial cross-sectional data of children and adolescents aged 1 to 19 years in the US National Health and Nutrition Examination Survey (NHANES), from 1999 to 2014. A total of 17 categories of prescription medications commonly used by children and adolescents were involved. We used multivariate linear and logistic regression to explore the relationship of blood lead concentration (independent variable) and prescription medication use (dependent variable), adjusted for age, gender, race, income, education, insurance and health condition. Results: In this serial cross-sectional study that included 24412 subjects, the mean blood lead concentration decreased from 1.61 µg/dL to 0.76 µg/dL. Blood lead concentration was not correlated with overall use of prescription medications in the last 30 days. Each µg/dL increase in blood lead concentration was associated with lower odds ratio of asthma medications (OR=0.88, 95%CI: 0.82 to 0.94) (p<0.005) and higher odds ratio of antibiotics amoxicillin/clavulanate (OR=1.10, 95%CI: 1.05 to 1.14) (p<0.005). Higher blood lead level was also associated with more use of overall antibiotics, narcotic-containing analgesics and ADHD medications (amphetamines), and less use of tetracyclines, antidiabetic agents, antipsychotics, contraceptives, proton pump inhibitors and dermatological agents (p<0.05). Conclusions: Blood lead concentration is related to prescription medication usage use among children and adolescents in the US.

A prospective study of health behaviors and risk of all-cause and cause-specific mortality after spinal cord injury.

Prospective cohort study OBJECTIVES: Identify the association between health behaviors and risk of all-cause and cause-specific mortality in adults with chronic spinal cord injury (SCI) SETTING: A large rehabilitation hospital in the Southeastern United States. Participants included 3070 adults (>18 years old) with chronic (>1-year) traumatic SCI. Behavioral data were collected by mail-in self report assessment between 1997-1998 and 2007-2010. Mortality status was determined using the National Death Index as of December 2016. We examined the associations between six behavioral domains (prescription medication usage, alcohol use, smoking, two nutrition factors, and fitness) and risk of all-cause and cause-specific mortality, including deaths due to sepsis (ICD-10-CM A40-A41), pneumonia and influenza (J09-J18), cancer (C00-D49), heart and blood vessel diseases (I00-I99), unintentional injuries (V01-X59, Y40-Y84, Y88), and all other causes. All health behaviors, except one nutrition factor, were associated with risk of all-cause mortality. Prescription medication usage was related to an increase in the risk of deaths caused by sepsis, unintentional injuries, and other causes of death. Alcohol usage was associated with an increased hazard of deaths due to unintentional injuries. Smoking was associated with increased risk of deaths due to cancer, heart and blood vessel diseases, and all other causes. Fitness level was protective from deaths due to heart and blood vessel diseases and other causes, as was the other nutrition factor. The results identify relationships between health behaviors and specific causes of death and affirm their importance as targets for SCI rehabilitation research and intervention.