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101. The impact of HIV-related illness on employment

Author

Yelin, Edward H., Greenblatt, Ruth M., Hollander, Harry, and McMaster, James R.

Subjects
AIDS patients -- Employment, AIDS patients -- Care and treatment, Employment surveys -- Health aspects, AIDS (Disease) -- Economic aspects, Entitlement spending -- Health aspects, Government, Health care industry
Abstract

The economic impact of AIDS is largely a result of work loss rather than the cost of medical care, because the disease is most likely to affect people in the early years of their careers. So far, the loss of employment has not been measured. In interviews with 193 predominantly male homosexual AIDS patients, with an average age of 38 years, this study attempted to assess the impact of losing employment. Among the men with at least one symptom of AIDS, half had stopped working within one year, and all had stopped within 10 years. Following the loss of their jobs, many patients became eligible for several entitlement programs, including unemployment compensation, Supplemental Social Security (SSI), Medicaid, Social Security Disability Insurance, and perhaps Medicare. AIDS patients with more physically demanding work and less control of scheduling and work pace were more likely to stop working, a finding noted in previous studies of chronic diseases. There was no difference between male homosexuals and intravenous drug users in terms of work status. As treatment for AIDS progresses from simply prolonging survival to enabling patients to continue functioning, AIDS will begin to resemble other chronic diseases. Although the effect would only be temporary, it is suggested that people with AIDS should be given less demanding work with greater flexibility over schedules and work pace. In addition, changes in insurance coverage to include long-term care would help remove the incentive to quit working as a means of obtaining long-term health care services. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1991

106. An integrated model of environmental factors in adult asthma lung function and disease severity: a cross-sectional study

Author

Katz Patricia P, Hammond S Katharine, Eisner Mark D, Chen Hubert, Balmes John R, Trupin Laura, Lurmann Fred, Quinlan Patricia J, Thorne Peter S, Yelin Edward H, and Blanc Paul D

Subjects
Industrial medicine. Industrial hygiene, RC963-969, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Diverse environmental exposures, studied separately, have been linked to health outcomes in adult asthma, but integrated multi-factorial effects have not been modeled. We sought to evaluate the contribution of combined social and physical environmental exposures to adult asthma lung function and disease severity. Methods Data on 176 subjects with asthma and/or rhinitis were collected via telephone interviews for sociodemographic factors and asthma severity (scored on a 0-28 point range). Dust, indoor air quality, antigen-specific IgE antibodies, and lung function (percent predicted FEV1) were assessed through home visits. Neighborhood socioeconomic status, proximity to traffic, land use, and ambient air quality data were linked to the individual-level data via residential geocoding. Multiple linear regression separately tested the explanatory power of five groups of environmental factors for the outcomes, percent predicted FEV1 and asthma severity. Final models retained all variables statistically associated (p < 0.20) with each of the two outcomes. Results Mean FEV1 was 85.0 ± 18.6%; mean asthma severity score was 6.9 ± 5.6. Of 29 variables screened, 13 were retained in the final model of FEV1 (R2 = 0.30; p < 0.001) and 15 for severity (R2 = 0.16; p < 0.001), including factors from each of the five groups. Adding FEV1 as an independent variable to the severity model further increased its explanatory power (R2 = 0.25). Conclusions Multivariate models covering a range of individual and environmental factors explained nearly a third of FEV1 variability and, taking into account lung function, one quarter of variability in asthma severity. These data support an integrated approach to modeling adult asthma outcomes, including both the physical and the social environment.

Published
2010
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110. Pulmonary and allergy subspecialty care in adults with asthma: treatment, use of services, and health outcomes

Author

Blanc, Paul D., Katz, Patricia P., Henke, Jonathan, Smith, Sherman, and Yelin, Edward H.

Subjects
Medical care -- Utilization, Respiratory disease nursing -- Usage, Asthma -- Care and treatment, Health, Care and treatment, Usage
Abstract

To study the relationship between physician subspecialty practice type and health measures in patient with adult asthma, we prospectively studied 601 adults with asthma. The subjects were recruited from a random sample of board-certified pulmonary or allergy internal medicine subspecialists practicing in northern California; 539 patients (90%) were restudied after 18 months. Structured telephone interviews were used to elicit demographics, clinical variables, and measures of asthma severity, asthma-specific quality of life, and physical function status. At baseline and follow-up, 283 subjects (53%) reported their principal asthma care provider type as a pulmonary specialist throughout and 150 (28%) as an allergy specialist throughout, 53 (10%) switched provider type during follow-up, and 53 (10%) reported that their principal asthma care physician was from neither subspecialist group. Taking into account illness severity and other demographic and clinical covariates, the group whose principal asthma care came from an allergy subspecialist was more likely than the pulmonary specialist-care group to report possessing a peak expiratory flow rate meter (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.8 to 4.6) and less likely to be receiving high-dose inhaled steroids (OR, 0.3; 95% CI, 0.1 to 0.6). Taking into account demographic and clinical covariates, allergists' care was related to worse subject-reported asthma-specific quality of life (P = 0.02), but not to statistically increased risk of hospitalization, decreased physical function, or an increased number of reported health-related restricted-activity days. We observed subject-reported specialist variation in management and health outcomes among adults with asthma not accounted for by differing disease severity or other clinical and demographical variables., Asthma among adults is common and costly, and appears to be rising in incidence and prevalence.[1-6] Of all ambulatory care visits in the United States, 1% have been estimated to [...]

Published
1997

111. Body composition and functional limitation in COPD

Author

Katz Patricia P, Lathon Phenius V, Yelin Edward H, Sidney Steve, Blanc Paul D, Eisner Mark D, Tolstykh Irina, Ackerson Lynn, and Iribarren Carlos

Subjects
Diseases of the respiratory system, RC705-779
Abstract

Abstract Background Low body mass index has been associated with increased mortality in severe COPD. The impact of body composition earlier in the disease remains unclear. We studied the impact of body composition on the risk of functional limitation in COPD. Methods We used bioelectrical impedance to estimate body composition in a cohort of 355 younger adults with COPD who had a broad spectrum of severity. Results Among women, a higher lean-to-fat ratio was associated with a lower risk of self-reported functional limitation after controlling for age, height, pulmonary function impairment, race, education, and smoking history (OR 0.45 per 0.50 increment in lean-to-fat ratio; 95% CI 0.28 to 0.74). Among men, a higher lean-to-fat ratio was associated with a greater distance walked in 6 minutes (mean difference 40 meters per 0.50 ratio increment; 95% CI 9 to 71 meters). In women, the lean-to-fat ratio was associated with an even greater distance walked (mean difference 162 meters per 0.50 increment; 95% CI 97 to 228 meters). In women, higher lean-to-fat ratio was also associated with better Short Physical Performance Battery Scores. In further analysis, the accumulation of greater fat mass, and not the loss of lean mass, was most strongly associated with functional limitation among both sexes. Conclusion Body composition is an important non-pulmonary impairment that modulates the risk of functional limitation in COPD, even after taking pulmonary function into account. Body composition abnormalities may represent an important area for screening and preventive intervention in COPD.

Published
2007
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113. Directly measured secondhand smoke exposure and COPD health outcomes

Author

Balmes John, Eisner Mark D, Yelin Edward H, Katz Patricia P, Hammond S Katherine, Benowitz Neal, and Blanc Paul D

Subjects
Diseases of the respiratory system, RC705-779
Abstract

Abstract Background Although personal cigarette smoking is the most important cause and modulator of chronic obstructive pulmonary disease (COPD), secondhand smoke (SHS) exposure could influence the course of the disease. Despite the importance of this question, the impact of SHS exposure on COPD health outcomes remains unknown. Methods We used data from two waves of a population-based multiwave U.S. cohort study of adults with COPD. 77 non-smoking respondents with a diagnosis of COPD completed direct SHS monitoring based on urine cotinine and a personal badge that measures nicotine. We evaluated the longitudinal impact of SHS exposure on validated measures of COPD severity, physical health status, quality of life (QOL), and dyspnea measured at one year follow-up. Results The highest level of SHS exposure, as measured by urine cotinine, was cross-sectionally associated with poorer COPD severity (mean score increment 4.7 pts; 95% CI 0.6 to 8.9) and dyspnea (1.0 pts; 95% CI 0.4 to 1.7) after controlling for covariates. In longitudinal analysis, the highest level of baseline cotinine was associated with worse COPD severity (4.7 points; 95% CI -0.1 to 9.4; p = 0.054), disease-specific QOL (2.9 pts; -0.16 to 5.9; p = 0.063), and dyspnea (0.9 pts; 95% CI 0.2 to 1.6 pts; p < 0.05), although the confidence intervals did not always exclude the no effect level. Conclusion Directly measured SHS exposure appears to adversely influence health outcomes in COPD, independent of personal smoking. Because SHS is a modifiable risk factor, clinicians should assess SHS exposure in their patients and counsel its avoidance. In public health terms, the effects of SHS exposure on this vulnerable subpopulation provide a further rationale for laws prohibiting public smoking.

Published
2006
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115. Lifetime environmental tobacco smoke exposure and the risk of chronic obstructive pulmonary disease

Author

Balmes John, Eisner Mark D, Katz Patricia P, Trupin Laura, Yelin Edward H, and Blanc Paul D

Subjects
Pulmonary Disease, Chronic Obstructive, Chronic Bronchitis, Pulmonary Emphysema, Tobacco smoke pollution, Industrial medicine. Industrial hygiene, RC963-969, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Exposure to environmental tobacco smoke (ETS), which contains potent respiratory irritants, may lead to chronic airway inflammation and obstruction. Although ETS exposure appears to cause asthma in children and adults, its role in causing COPD has received limited attention in epidemiologic studies. Methods Using data from a population-based sample of 2,113 U.S. adults aged 55 to 75 years, we examined the association between lifetime ETS exposure and the risk of developing COPD. Participants were recruited from all 48 contiguous U.S. states by random digit dialing. Lifetime ETS exposure was ascertained by structured telephone interview. We used a standard epidemiologic approach to define COPD based on a self-reported physician diagnosis of chronic bronchitis, emphysema, or COPD. Results Higher cumulative lifetime home and work exposure were associated with a greater risk of COPD. The highest quartile of lifetime home ETS exposure was associated with a greater risk of COPD, controlling for age, sex, race, personal smoking history, educational attainment, marital status, and occupational exposure to vapors, gas, dusts, or fumes during the longest held job (OR 1.55; 95% CI 1.09 to 2.21). The highest quartile of lifetime workplace ETS exposure was also related to a greater risk of COPD (OR 1.36; 95% CI 1.002 to 1.84). The population attributable fraction was 11% for the highest quartile of home ETS exposure and 7% for work exposure. Conclusion ETS exposure may be an important cause of COPD. Consequently, public policies aimed at preventing public smoking may reduce the burden of COPD-related death and disability, both by reducing direct smoking and ETS exposure.

Published
2005
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117. Patient goals in rheumatoid arthritis care: A systematic review and qualitative synthesis

Author

Hulen, Elizabeth, Ervin, Ayla, Schue, Allison, Evans-Young, Gina, Saha, Somnath, Yelin, Edward H., and Barton, Jennifer L.

Subjects
Arthritis, Rheumatoid, Humans, Goals, Article
Abstract

During the clinical encounter, rheumatoid arthritis (RA) patient goals for care often go unexplored. The aim of the present systematic review was to identify needs, goals and expectations of RA patients in order better to guide systematic elicitation of patient goals in clinical encounters.An academic librarian searched MEDLINE, PsychINFO and the Cochrane Library using a specialized algorithm developed to identify articles about patient goals for RA care. Investigators screened search results according to prespecified inclusion criteria and then reviewed included articles and synthesized the evidence qualitatively, utilizing an inductive approach.A total of 909 titles were retrieved in the literature search, of which 871 were excluded after a title/abstract screen. Of the remaining 38, 22 papers were included in the final review. Investigators identified four major themes in the literature: (a) the bodily experience of RA; (b) achieving normalcy and maintaining wellness; (c) social connectedness and support; and (d) interpersonal and healthcare system interactions.Patients' goals when receiving care for RA are multidimensional and span several facets of everyday life. Goals for RA care should be collaboratively developed between patients and providers, with particular attention to the patient's life context and priorities.

Published
2016

118. Labor force participation among persons with musculoskeletal conditions, 1970-1987: national estimates derived from a series of cross-sections

Author

Yelin, Edward H. and Katz, Patricia P.

Subjects
Employment -- Health aspects, Disabled persons -- Employment, Muscle diseases -- Health aspects, Health
Abstract

Musculoskeletal conditions such as rheumatoid arthritis have a significant and negative effect on labor force participation. In a study of many people with rheumatoid arthritis, about half were unable to work, and with time, close to 100 percent became unemployed. Other studies of the effect of musculoskeletal conditions on employment provide a wide range of the proportion unemployed. These illnesses are thought to incur a large cost associated with work loss. Musculoskeletal conditions are estimated to become more prevalent, both related to aging of the population as well as independently of this phenomenon, and work disability rates associated with these illnesses may also be rising. To better understand the effect of activity limitation on labor force limitation and the associated costs, data from a national study of 110,000 people during the years 1970 through 1987 were evaluated. Absolute levels of employment were of concern, as in 1987, 57 percent of working-age people with musculoskeletal disorders were employed, while 44 percent of people with activity limitations and 26 percent of people aged 55 to 64 with both a disorder and activity limitation were employed. Consistent with the increased participation of women in the work force, there was an increase of women with activity limitation who were working, especially women aged 18 to 44, but women aged 55 to 64 did not share in this gain. Part of the increase was attributed to the greater proportion of service industry jobs, which require less physical exertion, and an increase in computerization in the manufacturing sector. Labor force participation by men with activity limitation declined, and the decline was more severe with increasing age. Thus, more than half of activity-limited men aged 55 to 64 years were working 20 years ago, while only one third were working at the time of this study. The report suggests that enforcement of the Americans with Disabilities Act of 1990 should place emphasis on employment of people with musculoskeletal conditions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1991

120. Transitions in health status among community-dwelling elderly people with arthritis: a national, longitudinal study

Author

Yelin, Edward H. and Katz, Patricia P.

Subjects
Activities of daily living -- Demographic aspects, Arthritis -- Prognosis, Aging -- Health aspects, Health
Abstract

As many as half of the elderly US population are affected by arthritis. It is the most common cause of activity limitation in women over 65 and the second most common cause among elderly men. The proportion of people in this age group will increase significantly in the next 10 years. Thus, it is important to estimate the number of people affected by arthritis and the repercussions arthritis has on their function. These factors were investigated in a national study on non-institutionalized elderly people; changes in functional status over two years of the study were assessed. Out of approximately 15,000 people who were surveyed, 30 percent of the total group, 66 percent of those with arthritis, 55 percent of those with conditions other than arthritis, and 82 percent of those with arthritis and another condition reported a physical limitation. In spite of frequent physical limitations, almost 80 percent of the arthritic elderly independently completed activities of daily living (ADL) such as bathing, dressing, and eating. Approximately 75 percent of the same group also had no problems with instrumental activities of daily living (IADL) such as preparing meals, shopping, and doing housework. Among those who were limited in ADL, only 9 percent received or paid help for ADL, while 27 percent of those who were limited in IADL received or paid help for those activities. After a two-year follow-up, up to half of the arthritic people who were previously unlimited physically reported physical limitations, while a small percentage had entered a nursing home or died. Similar changes in status were found in subjects without arthritis, and in those with arthritis and another condition. Although some people improved in their ability to perform ADL and IADL, five times as many worsened during the two-year period. The study indicates that people with arthritis and another condition are much more likely to experience diminished functional capacity. Further evaluation of subjects with arthritis whose functional status improved may lead to improved treatment for those whose status decreased. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1990

121. A summary of the impact of musculoskeletal conditions in the United States

Author

Yelin, Edward H. and Felts, William R.

Subjects
Rheumatology -- Economic aspects, Medical care, Cost of -- Statistics, Muscle diseases -- Economic aspects, Health
Abstract

This article reviews the literature about the financial and social impact of musculoskeletal conditions (affecting bones and muscles), since their cost is now estimated to be 1 percent of the gross national product (GNP) each year. This substantial cost is due in part to the aging population. Yet it is possible that the data available understate the problem. The costs of disease are divided into two categories: direct costs for purchased health services, and indirect costs, incurred due to loss of productivity brought about by disability or death. In 1963, the direct cost of musculoskeletal conditions was about $2 billion per year or about 0.3 percent of the GNP; by 1980, it was up to 0.5 percent of the GNP at $13 billion. In 1963, 50 percent of the total cost of musculoskeletal conditions was attributed to indirect costs, such as lost wages. The proportion accounted for by indirect costs rose to 56 percent in 1972 and fell to 38 percent in 1980. People with musculoskeletal disease receive a disproportionately large amount of medical care, especially if they have co-existing conditions, which is common in older persons. People with musculoskeletal conditions represent 7 percent of the noninstitutionalized population, and account for 14 percent of physician visits and 19 percent of hospital stays. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1990

122. Is Health Care Use Equivalent Across Social Groups? A Diagnosis-Based Study.

Author

Yelin, Edward H.

Abstract

Analysis of medical and hospital services utilization revealed no consistent differences in number of physician visits by race, income, education, insurance coverage, or religion of users. Lack of insurance coverage and race were associated with fewer hospitalizations for certain diseases. Symptoms and diagnoses of disease were used to control for medical need. (Author/MJL)

Published
1983

126. Smoking Is the Most Significant Modifiable Lung Cancer Risk Factor in Systemic Lupus Erythematosus

Author

Bernatsky, Sasha, primary, Ramsey-Goldman, Rosalind, additional, Petri, Michelle, additional, Urowitz, Murray B., additional, Gladman, Dafna D., additional, Fortin, Paul R., additional, Yelin, Edward H., additional, Ginzler, Ellen, additional, Hanly, John G., additional, Peschken, Christine, additional, Gordon, Caroline, additional, Nived, Ola, additional, Aranow, Cynthia, additional, Bae, Sang-Cheol, additional, Isenberg, David, additional, Rahman, Anisur, additional, Hansen, James E., additional, Pierre, Yvan St., additional, and Clarke, Ann E., additional

Published
2018
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131. Efficiency Gains for Rheumatology Consultation Using a Novel Electronic Referral System in a Safety Net Health Setting

Author

Scheibe, Meghan M., Imboden, John B., Schmajuk, Gabriela, Margaretten, Mary, Graf, Jonathan D., Chen, Alice H., Yelin, Edward H., and Yazdany, Jinoos

Subjects
Male, Outcome and Process Assessment, Health Care, Rheumatology, Rheumatic Diseases, Humans, Female, Middle Aged, Referral and Consultation, Article, Medical Informatics
Abstract

Health information technology (HIT) holds promise in increasing access to rheumatologists by improving the quality and efficiency of referrals, but few studies have examined its use for this purpose. We evaluated the use and impact of a novel electronic referral (eReferral) system in rheumatology in a safety-net health system.We examined eReferrals over 4 years. Our primary outcome was use of preconsultation exchange, defined as back-and-forth communication between referring and specialty care providers, facilitating triage of referrals, requests for more information, or resolution of questions without a visit. We calculated the proportion of eReferrals that underwent preconsultation exchange, time to reviewer response, and number of visits scheduled. To increase generalizability, we selected a random sample of eReferrals to undergo additional blinded, adjudicated review to assess agreement on appropriateness for preconsultation exchange.Between 2008 and 2012, 2,383 eReferrals were reviewed and 2,105 were eligible for analysis. One-fourth of eReferrals were resolved without a clinic visit. The proportion of eReferrals undergoing preconsultation exchange increased over time (55% in 2008 versus 74% in 2011), and the volume of referrals also steadily increased over time. Reviewer response time averaged between 1 and 4 days. In the random sample of eReferrals that underwent adjudicated review, agreement between reviewers was high (κ = 0.72).HIT-enabled preconsultation exchange was used for a majority of eReferrals and facilitated communication between referring clinicians and rheumatologists. This redesigned system of care allowed for triage of a high number of referrals, with many referrals determined to be appropriate for preconsultation exchange.

Published
2015

132. Infection is the leading cause of hospital mortality in patients with dermatomyositis/polymyositis: data from a population-based study

Author

Murray, Sara G., Schmajuk, Gabriela, Trupin, Laura, Lawson, Erica, Cascino, Matthew, Barton, Jennifer, Margaretten, Mary, Katz, Patricia P., Yelin, Edward H., and Yazdany, Jinoos

Subjects
Aged, 80 and over, Male, Time Factors, Databases, Factual, Patient Discharge Summaries, Bacterial Infections, Middle Aged, Opportunistic Infections, Article, Dermatomyositis, United States, Polymyositis, Hospitalization, Logistic Models, Mycoses, Risk Factors, Cause of Death, Odds Ratio, Prevalence, Humans, Female, Hospital Mortality, Aged
Abstract

Dermatomyositis (DM) and polymyositis (PM) are debilitating inflammatory myopathies associated with significant mortality. We evaluated the relative contribution of infection to hospital mortality in a large population-based study of individuals with PM/DM.Data derive from the 2007 to 2011 Healthcare Cost and Utilization Project National Inpatient Samples and include all hospital discharges that met a validated administrative definition of PM/DM. The primary outcome was hospital mortality. Variables for infections and comorbidities were generated from discharge diagnoses using validated administrative definitions. Logistic regression was used to investigate the relationship between infection and mortality in individuals with PM/DM, adjusting for sociodemographics, utilization variables, and comorbidities. Relative risks (RRs) were calculated to compare the overall prevalence of specific infections and associated mortality in PM/DM hospitalizations with those seen in the general hospitalized population.A total of 15,407 hospitalizations with PM/DM met inclusion criteria for this study and inpatient mortality was 4.5% (700 deaths). In adjusted logistic regression analyses, infection (odds ratio [OR] 3.4, 95% confidence interval [95% CI] 2.9-4.0) was the strongest predictor of hospital mortality among individuals with PM/DM. Bacterial infection (OR 3.5, 95% CI 3.0-4.1), comprised primarily of pneumonia and bacteremia, and opportunistic fungal infections (OR 2.5, 95% CI 1.5-4.0) were independently associated with hospital mortality. The overall burden of infection in hospitalizations with PM/DM was significantly increased in comparison with the general hospitalized population (RR 1.5, 95% CI 1.4-1.6).Among hospitalized individuals with PM/DM, infection is the leading cause of mortality. Strategies to mitigate infection risk in both the clinic and hospital settings should be evaluated to improve disease outcomes.

Published
2015

133. Muscle strength, muscle mass, and physical disability in women with systemic lupus erythematosus

Author

Andrews, James S., Trupin, Laura, Schmajuk, Gabriela, Barton, Jennifer, Margaretten, Mary, Yazdany, Jinoos, Yelin, Edward H., and Katz, Patricia P.

Subjects
Adult, Clinical Sciences, Lupus, Autoimmune Disease, Article, Cohort Studies, Clinical Research, Lupus Erythematosus, Systemic, Humans, Psychology, Disabled Persons, Longitudinal Studies, Muscle Strength, Lupus Erythematosus, Systemic, Rehabilitation, Middle Aged, Health Surveys, Radiography, Cross-Sectional Studies, Physical Rehabilitation, Musculoskeletal, Body Composition, Public Health and Health Services, Female
Abstract

ObjectiveData describing relationships between muscle strength, muscle mass, and physical disability among individuals with systemic lupus erythematosus (SLE) are limited. The present study examines the relationship of muscle strength and muscle mass with physical disability among adult women with SLE.MethodsA total of 146 women from a longitudinal SLE cohort participated in the study. All measures were collected during an in-person research visit. Lower extremity muscle strength was assessed by peak knee torque of extension and flexion and by chair-stand time. Total lean body mass, appendicular lean mass, and fat mass (kg/m(2) ) were measured by whole-body dual x-ray absorptiometry. Self-reported physical disability was assessed using the Short Form 36 health survey (SF-36) physical functioning subscale, and the Valued Life Activities (VLA) disability scale. Spearman's rank correlation coefficients tested the correlations between muscle strength, muscle mass, and disability scores. Regression analyses modeled the effect of lower extremity muscle strength and mass on SF-36 and VLA disability scores controlling for age, SLE duration, SLE disease activity measured with the Systemic Lupus Activity Questionnaire, physical activity level, prednisone use, body composition, and depression.ResultsOn all measures, reduced lower extremity muscle strength was associated with poorer SF-36 and VLA disability scores. Trends persisted after adjustment for covariates. Muscle mass was moderately correlated with muscle strength, but did not contribute significantly to adjusted regression models.ConclusionLower extremity muscle strength, but not muscle mass, was strongly associated with physical disability scores. While further studies are needed, these findings suggest that improving muscle strength may reduce physical disability among women with SLE.

Published
2015

136. Muscle strength, muscle mass, and physical disability in women with systemic lupus erythematosus.

Author

Andrews, James S, Andrews, James S, Trupin, Laura, Schmajuk, Gabriela, Barton, Jennifer, Margaretten, Mary, Yazdany, Jinoos, Yelin, Edward H, Katz, Patricia P, Andrews, James S, Andrews, James S, Trupin, Laura, Schmajuk, Gabriela, Barton, Jennifer, Margaretten, Mary, Yazdany, Jinoos, Yelin, Edward H, and Katz, Patricia P

Abstract

ObjectiveData describing relationships between muscle strength, muscle mass, and physical disability among individuals with systemic lupus erythematosus (SLE) are limited. The present study examines the relationship of muscle strength and muscle mass with physical disability among adult women with SLE.MethodsA total of 146 women from a longitudinal SLE cohort participated in the study. All measures were collected during an in-person research visit. Lower extremity muscle strength was assessed by peak knee torque of extension and flexion and by chair-stand time. Total lean body mass, appendicular lean mass, and fat mass (kg/m(2) ) were measured by whole-body dual x-ray absorptiometry. Self-reported physical disability was assessed using the Short Form 36 health survey (SF-36) physical functioning subscale, and the Valued Life Activities (VLA) disability scale. Spearman's rank correlation coefficients tested the correlations between muscle strength, muscle mass, and disability scores. Regression analyses modeled the effect of lower extremity muscle strength and mass on SF-36 and VLA disability scores controlling for age, SLE duration, SLE disease activity measured with the Systemic Lupus Activity Questionnaire, physical activity level, prednisone use, body composition, and depression.ResultsOn all measures, reduced lower extremity muscle strength was associated with poorer SF-36 and VLA disability scores. Trends persisted after adjustment for covariates. Muscle mass was moderately correlated with muscle strength, but did not contribute significantly to adjusted regression models.ConclusionLower extremity muscle strength, but not muscle mass, was strongly associated with physical disability scores. While further studies are needed, these findings suggest that improving muscle strength may reduce physical disability among women with SLE.

Published
2015

137. Muscle Strength and Changes in Physical Function in Women With Systemic Lupus Erythematosus.

Author

Andrews, James S, Andrews, James S, Trupin, Laura, Schmajuk, Gabriela, Barton, Jennifer, Margaretten, Mary, Yazdany, Jinoos, Yelin, Edward H, Katz, Patricia P, Andrews, James S, Andrews, James S, Trupin, Laura, Schmajuk, Gabriela, Barton, Jennifer, Margaretten, Mary, Yazdany, Jinoos, Yelin, Edward H, and Katz, Patricia P

Abstract

ObjectiveCross-sectional studies have observed that muscle weakness is associated with worse physical function among women with systemic lupus erythematosus (SLE). The present study examines whether reduced upper and lower extremity muscle strength predict declines in function over time among adult women with SLE.MethodsOne hundred forty-six women from a longitudinal SLE cohort participated in the study. All measures were collected during in-person research visits approximately 2 years apart. Upper extremity muscle strength was assessed by grip strength. Lower extremity muscle strength was assessed by peak knee torque of extension and flexion. Physical function was assessed using the Short Physical Performance Battery (SPPB). Regression analyses modeled associations of baseline upper and lower extremity muscle strength with followup SPPB scores controlling for baseline SPPB, age, SLE duration, SLE disease activity (Systemic Lupus Activity Questionnaire), physical activity level, prednisone use, body composition, and depression. Secondary analyses tested whether associations of baseline muscle strength with followup in SPPB scores differed between intervals of varying baseline muscle strength.ResultsLower extremity muscle strength strongly predicted changes over 2 years in physical function even when controlling for covariates. The association of reduced lower extremity muscle strength with reduced physical function in the future was greatest among the weakest women.ConclusionReduced lower extremity muscle strength predicted clinically significant declines in physical function, especially among the weakest women. Future studies should test whether therapies that promote preservation of lower extremity muscle strength may prevent declines in function among women with SLE.

Published
2015

138. A population-based study of infection-related hospital mortality in patients with dermatomyositis/polymyositis.

Author

Murray, Sara G, Murray, Sara G, Schmajuk, Gabriela, Trupin, Laura, Lawson, Erica, Cascino, Matthew, Barton, Jennifer, Margaretten, Mary, Katz, Patricia P, Yelin, Edward H, Yazdany, Jinoos, Murray, Sara G, Murray, Sara G, Schmajuk, Gabriela, Trupin, Laura, Lawson, Erica, Cascino, Matthew, Barton, Jennifer, Margaretten, Mary, Katz, Patricia P, Yelin, Edward H, and Yazdany, Jinoos

Abstract

ObjectiveDermatomyositis (DM) and polymyositis (PM) are debilitating inflammatory myopathies associated with significant mortality. We evaluated the relative contribution of infection to hospital mortality in a large population-based study of individuals with PM/DM.MethodsData derive from the 2007 to 2011 Healthcare Cost and Utilization Project National Inpatient Samples and include all hospital discharges that met a validated administrative definition of PM/DM. The primary outcome was hospital mortality. Variables for infections and comorbidities were generated from discharge diagnoses using validated administrative definitions. Logistic regression was used to investigate the relationship between infection and mortality in individuals with PM/DM, adjusting for sociodemographics, utilization variables, and comorbidities. Relative risks (RRs) were calculated to compare the overall prevalence of specific infections and associated mortality in PM/DM hospitalizations with those seen in the general hospitalized population.ResultsA total of 15,407 hospitalizations with PM/DM met inclusion criteria for this study and inpatient mortality was 4.5% (700 deaths). In adjusted logistic regression analyses, infection (odds ratio [OR] 3.4, 95% confidence interval [95% CI] 2.9-4.0) was the strongest predictor of hospital mortality among individuals with PM/DM. Bacterial infection (OR 3.5, 95% CI 3.0-4.1), comprised primarily of pneumonia and bacteremia, and opportunistic fungal infections (OR 2.5, 95% CI 1.5-4.0) were independently associated with hospital mortality. The overall burden of infection in hospitalizations with PM/DM was significantly increased in comparison with the general hospitalized population (RR 1.5, 95% CI 1.4-1.6).ConclusionAmong hospitalized individuals with PM/DM, infection is the leading cause of mortality. Strategies to mitigate infection risk in both the clinic and hospital settings should be evaluated to improve disease outcomes.

Published
2015

139. Reasons for failure to receive pneumococcal and influenza vaccinations among immunosuppressed patients with systemic lupus erythematosus.

Author

Lawson, Erica F, Lawson, Erica F, Trupin, Laura, Yelin, Edward H, Yazdany, Jinoos, Lawson, Erica F, Lawson, Erica F, Trupin, Laura, Yelin, Edward H, and Yazdany, Jinoos

Abstract

ObjectiveTo better understand why immunosuppressed individuals with systemic lupus erythematosus (SLE) fail to receive influenza and pneumococcal vaccines.MethodsThese cross-sectional data were derived from the 2009 cycle of the Lupus Outcomes Study (LOS), an annual longitudinal telephone survey of individuals with confirmed SLE. Respondents were included in the analysis if they had taken immunosuppressive medications in the past year. We assessed any prior receipt of pneumococcal vaccine and influenza vaccine in the past year, and then elicited reasons for not receiving vaccination. We used bivariate statistics and multivariate logistic regression to assess frequency and predictors of reported reasons for not obtaining influenza or pneumococcal vaccines.ResultsAmong 508 respondents who received immunosuppressants, 485 reported whether they had received vaccines. Among the 175 respondents who did not receive an influenza vaccine, the most common reason was lack of doctor recommendation (55%), followed by efficacy or safety concerns (21%), and lack of time (19%). Reasons for not receiving pneumococcal vaccine (N = 159) were similar: lack of recommendation (87%), lack of time (7%), and efficacy or safety concerns (4%). Younger, less-educated, non-white patients with shorter disease duration, as well as those immunosuppressed with steroids alone, were at the greatest risk for not receiving indicated vaccine recommendations.ConclusionsThe most common reason why individuals with SLE did not receive pneumococcal and influenza vaccines was that physicians failed to recommend them. Data suggest that increasing vaccination rates in SLE will require improved process quality at the provider level, as well as addressing patient concerns and barriers.

Published
2015

140. Lower health literacy is associated with poorer health status and outcomes in chronic obstructive pulmonary disease

Author

Omachi, Theodore A, Sarkar, Urmimala, Yelin, Edward H, Blanc, Paul D, and Katz, Patricia P

Subjects
Male, Chronic Obstructive, Chronic Obstructive Pulmonary Disease, Clinical Sciences, utilization, health status, Severity of Illness Index, Pulmonary Disease, Hospital, Clinical Research, General & Internal Medicine, Behavioral and Social Science, Humans, health outcomes, Lung, Aged, Emergency Service, Middle Aged, Health Services, Prognosis, United States, Health Literacy, Hospitalization, Socioeconomic Factors, Quality of Life, Respiratory, Female
Abstract

BackgroundLimited health literacy is associated with poor outcomes in many chronic diseases, but little is known about health literacy in chronic obstructive pulmonary disease (COPD).ObjectiveTo examine the associations between health literacy and both outcomes and health status in COPD. PARTICIPANTS, DESIGN AND MAIN MEASURES: Structured interviews were administered to 277 subjects with self-report of physician-diagnosed COPD, recruited through US random-digit telephone dialing. Health literacy was measured with a validated three-item battery. Multivariable linear regression, controlling for sociodemographics including income and education, determined the cross-sectional associations between health literacy and COPD-related health status: COPD Severity Score, COPD Helplessness Index, and Airways Questionnaire-20R [measuring respiratory-specific health-related quality of life (HRQoL)]. Multivariable logistic regression estimated associations between health literacy and COPD-related hospitalizations and emergency department (ED) visits.Key resultsTaking socioeconomic status into account, poorer health literacy (lowest tertile compared to highest tertile) was associated with: worse COPD severity (+2.3 points; 95 % CI 0.3-4.4); greater COPD helplessness (+3.7 points; 95 % CI 1.6-5.8); and worse respiratory-specific HRQoL (+3.5 points; 95 % CI 1.8-4.9). Poorer health literacy, also controlling for the same covariates, was associated with higher likelihood of COPD-related hospitalizations (OR = 6.6; 95 % CI 1.3-33) and COPD-related ED visits (OR = 4.7; 95 % CI 1.5-15). Analyses for trend across health literacy tertiles were statistically significant (p

Published
2013

141. Socioeconomic Predictors of Incident Depression in Systemic Lupus Erythematosus.

Author

Mccormick, Natalie, Trupin, Laura, Yelin, Edward H., and Katz, Patricia P.

Subjects
DIAGNOSIS of mental depression, SYSTEMIC lupus erythematosus diagnosis, COMPARATIVE studies, MENTAL depression, INCOME, RESEARCH methodology, MEDICAL cooperation, MENTAL health, POVERTY, RESEARCH, RESEARCH funding, PSYCHOLOGICAL stress, SYSTEMIC lupus erythematosus, SOCIOECONOMIC factors, EVALUATION research, EDUCATIONAL attainment, DISEASE incidence, HEALTH & social status, PSYCHOLOGICAL factors, DIAGNOSIS, PSYCHOLOGY
Abstract

Objective: To assess different measures of socioeconomic status (SES) as predictors of incident depression among women with systemic lupus erythematosus (SLE).Methods: Data were derived from the 2010-2015 waves of the Lupus Outcomes Study, where individuals with confirmed SLE were interviewed annually by telephone. Depression was assessed using the Center for Epidemiologic Studies Depression Scale, using a validated lupus-specific cutoff (≥23) for major depressive disorder. Women interviewed in ≥2 consecutive waves, with scores <23 in the first wave (T1), were included. The level of financial strain was classified as high, moderate, or none based on responses to 3 questions. Generalized estimating equations were used to assess the impact of poverty status, income, education, and financial strain at T1 on the risk of incident depression the next year (T2), with adjustment for sociodemographic and disease status measures. Individuals could contribute more than one 2-year dyad to the analysis.Results: In total, 682 women contributed 2,097 observations, with 19% having high financial strain, 47% moderate strain, and 34% no strain. There were 166 women who had 184 episodes of incident depression (rate = 8.8/100 person-years). In bivariate analysis, poverty, lower income and education, disease activity, and high financial strain were associated with depression onset; race/ethnicity was not. Poverty, income, and education were not significant in multivariate analyses, but disease activity and high financial strain were (odds ratio 1.85 [95% confidence interval 1.06-3.23]).Conclusion: High financial strain was a significant predictor of new-onset depression in women with SLE, controlling for disease factors and other SES measures. Determining specific, modifiable sources of financial strain may help prevent the development of depression. [ABSTRACT FROM AUTHOR]

Published
2018
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142. The Brief Index of Lupus Damage (BILD): A patient-reported measure of damage in SLE

Author

Yazdany, Jinoos, Trupin, Laura, Gansky, Stuart A., Dall’era, Maria, Yelin, Edward H., Criswell, Lindsey A., and Katz, Patricia P.

Subjects
Adult, Aged, 80 and over, Male, Adolescent, Pilot Projects, Middle Aged, Article, Statistics, Nonparametric, Cohort Studies, Disability Evaluation, Young Adult, Surveys and Questionnaires, Health Status Indicators, Humans, Lupus Erythematosus, Systemic, Self-Examination, Female, Aged
Abstract

To develop and test the Brief Index of Lupus Damage (BILD), an interviewer-administered measure of damage in systemic lupus erythematosus (SLE), for use in epidemiologic studies in which administration of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) by trained physicians is not possible or feasible. In addition, we compared the BILD to another recently developed patient-reported measure, the Lupus Damage Index Questionnaire (LDIQ), which was designed as a written survey.A sample of 81 patients from 2 university-affiliated SLE clinics was used to test the criterion validity of the BILD and the LDIQ. A second sample, the Lupus Outcomes Study (n = 728), was used to ascertain the construct validity of the BILD.We found good agreement between most BILD items and corresponding SDI items, and moderately high overall Spearman's rank correlations for SDI with BILD (0.64) and with LDIQ (0.54). BILD scores were higher among older individuals, those with longer disease duration, and those with higher mean disease activity in the preceding 4 years. In addition, higher BILD scores were associated with poorer self-rated health and functional status, greater unemployment and work disability, and increased health care utilization.We developed and performed a preliminary validation study demonstrating content, criterion, and construct validity of a new practical patient-reported instrument of SLE disease damage. Although further studies are needed to examine reliability and to document psychometric properties in other populations, the BILD appears to represent a promising tool for studies of SLE outside the clinical setting.

Published
2011

143. ENVIRONMENTAL TOBACCO SMOKE EXPOSURE, RESPIRATORY SYMPTOMS, AND BRONCHODILATOR USE AMONG ADULTS WITH ASTHMA

Author

Eisner, Mark D., Katz, Patricia P., Yelin, Edward H., and Blanc, Paul D.

Subjects
Passive smoking -- Health aspects -- Complications and side effects, Asthma -- Complications and side effects -- Health aspects, Health, Complications and side effects, Health aspects
Abstract

Mark D Eisner, MD,MPH(*); Patricia P Katz, PhD; Edward H Yelin, PhD and Paul D Blanc, MD,MSPH. Medicine, University of California, San Francisco, CA. PURPOSE: Environmental tobacco smoke (ETS) may [...]

Published
2000

148. Quality of care in systemic lupus erythematosus: the association between process and outcome measures in the Lupus Outcomes Study.

Author

Yazdany, Jinoos, Yazdany, Jinoos, Trupin, Laura, Schmajuk, Gabriela, Katz, Patricia P, Yelin, Edward H, Yazdany, Jinoos, Yazdany, Jinoos, Trupin, Laura, Schmajuk, Gabriela, Katz, Patricia P, and Yelin, Edward H

Abstract

ObjectivesAlthough process measures to assess quality of care in systemic lupus erythematosus (SLE) are available, their relationship to long-term outcomes has not been studied. Using a prospective, longitudinal cohort study, we examined the associations between high-quality care and two important SLE outcomes, disease activity and damage.MethodsData were derived from the University of California, San Francisco Lupus Outcomes Study. Participants were followed from 2009 through 2013, responding to yearly surveys. Primary outcomes in this study were clinically meaningful increases in disease activity and damage, assessed by the Systemic Lupus Activity Questionnaire (SLAQ) and the Brief Index of Lupus Damage (BILD), respectively. Using multivariable regression, we examined the relationship between high performance on 13 validated quality measures (receipt of ≥85% of quality measures), and disease outcomes, adjusting for disease status, sociodemographic characteristics, healthcare services and follow-up time.ResultsThe 737 participants were eligible for a mean of five quality measures (SD 2, range 2-12). There were 155 and 162 participants who had clinically meaningful increases in SLAQ and BILD, respectively. In our models, we found no statistically significant relationship between performance on quality measures and changes in SLAQ. However, receiving higher-quality SLE care was significantly protective against increased disease damage (adjusted OR 0.4, 95% CI 0.4 to 0.7), even after adjusting for covariates.DiscussionIn this community-based cohort, we illustrate for the first time a strong link between processes of care, defined by SLE quality measures, and the subsequent accumulation of disease damage, an important outcome.

Published
2014

149. Educational and vocational outcomes of adults with childhood- and adult-onset systemic lupus erythematosus: nine years of followup.

Author

Lawson, Erica F, Lawson, Erica F, Hersh, Aimee O, Trupin, Laura, von Scheven, Emily, Okumura, Megumi J, Yazdany, Jinoos, Yelin, Edward H, Lawson, Erica F, Lawson, Erica F, Hersh, Aimee O, Trupin, Laura, von Scheven, Emily, Okumura, Megumi J, Yazdany, Jinoos, and Yelin, Edward H

Abstract

ObjectiveTo compare educational and vocational outcomes among adults with childhood-onset systemic lupus erythematosus (SLE) and adult-onset SLE.MethodsWe used data derived from the 2002–2010 cycles of the Lupus Outcomes Study, a longitudinal cohort of 1,204 adult subjects with SLE. Subjects ages 18–60 years living in the US (n = 929) were included in the analysis and were classified as childhood-onset SLE if age at diagnosis was <18 years (n = 115). Logistic regression was used to assess the unadjusted and adjusted effect of childhood-onset SLE, sex, race/ethnicity, baseline age, urban or rural location, and US region on the likelihood of completing a bachelor's degree. Generalized estimating equations were used to assess the effect of childhood-onset SLE, demographics, education, and disease-related factors on the odds of employment, accounting for multiple observations over the study period.ResultsSubjects with childhood-onset SLE were on average younger (mean ± SD 29 ± 10 years versus 44 ± 9 years), with longer disease duration (mean ± SD 15 ± 10 years versus 11 ± 8 years). Subjects with adult-onset SLE and childhood-onset SLE subjects were equally likely to complete a bachelor's degree. However, subjects with childhood-onset SLE were significantly less likely to be employed, independent of demographic and disease characteristics (odds ratio 0.62, 95% confidence interval 0.42–0.91).ConclusionWhile subjects with SLE are just as likely as those with adult-onset SLE to complete college education, childhood-onset SLE significantly increases the risk of not working in adulthood, even when controlling for disease and demographic factors. Exploring reasons for low rates of employment and providing vocational support may be important to maximize long-term functional outcomes in patients with childhood-onset SLE.

Published
2014

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